SGA Score Research Articles

PREVALENCE OF NUTRITIONAL DEFICIENCIES IN CRITICALLY ILL PATIENTS ADMITTED TO INTENSIVE CARE UNIT

Objective: This study was conducted to assess the incidence of the excisting malnutrition in critically ill patients who are admitted to ICU. So that this can help in improving the nutrition therapy in these critically ill patients. And, to identify the comorbidities which as associated with severe malnutrition. Methods: All patients who are above 18 years admitted to ICU irrespective of sex, diagnosis and severity of disease are assessed for nutritional status with SGA score within 24 hours of admission. Results: In males severe malnourishment was noted in elderly age group with mean age of 64.33 ±17.32 compared to patients with < 60 years. In female patients moderately nourished patients were older with mean age of 61.37±12.69. there is no difference between male and female in well-nourished and severely malnourished group. But in moderately nourished group females are more than males(32.09% vs 24.92%). Diabetes mellitus seem to be the most common comorbidity noted. In diabetes mellitus 81.39% of patients were severely malnourished. Conclusion: it is shown that most of the patients admitted to ICU presents with pre excisting malnutrition. So nutrition therapy plays import role in management of these patients.

Inflammatory Markers in Patients with ESKD on Maintenance Hemodialysis, Hemodiafiltration (HDF), and Early Postkidney Transplant Patients and Their Relation to Quality of Life (SGA Score)

Inflammatory Markers in Patients with ESKD on Maintenance Hemodialysis, Hemodiafiltration (HDF), and Early Postkidney Transplant Patients and Their Relation to Quality of Life (SGA Score)

Screening and assessment of nutritional status and some related factors in patients who have laparoscopic surgery for colon cancer

Background: Preoperative malnutrition is a significant problem for cancer and colon cancer patients, so screening, monitoring, and supporting this condition becomes increasingly essential in the surgical field. In colorectal cancer, malnutrition is significantly associated with several consequences, including mortality and increasing the length of hospital stay after surgery. The NRS 2002 and SGA scores are practical malnutrition assessment tools widely used in clinical practice today. Materials and methods: A cross-sectional descriptive study was performed on 53 patients undergoing laparoscopic surgery due to colon cancer at Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital. The NRS-2002 tool was used for risk screening, and the SGA was used to assess the patient’s nutritional status. Information about the disease and related factors are referenced from medical records combined with asking the patient. Results: The average age was 61.5±14.5, of which 50.9% were male. ASA 1 accounted for the majority at 66.0%. Complications of surgical site infection accounted for 11.3%. Two patients with subcutaneous emphysema accounted for 3.8%, and one with urinary retention accounted for 1.9% were treated with conservative treatment. One patient had early postoperative small bowel obstruction due to abdominal drainage and was successfully treated medically, accounting for 1.9%. There were no major complications requiring reoperation and short-term mortality. The average hospital stay was 7.4 ± 2.1 days. According to the 2002 NRS score, there were 19 (35.8%) cases of nutritional at-risk; the SGA rating had 1.9% SGA-C and 15.1% SGA-B cases. There was a relationship between NRS-2002 and the patient’s blood albumin concentration. Conclusion: The prevalence of patients at nutritional risk and malnutrition is quite common. It is necessary to carry out routine screening and nutritional risk assessment to support colon cancer treatment. Key words: malnutrition, colorectal cancer, NRS 2002, SGA score.

Predictors of Skeletal Muscle Index for Patients Treated With Hemodialysis

ObjectiveThere is an increased risk of skeletal muscle mass (SMM) loss among patients with stage 5 chronic kidney disease (CKD) treated with maintenance hemodialysis (MHD). The reduced SMM considerably influences the development of protein-energy wasting (PEW). Patients who develop PEW have higher hospitalization and mortality rates than those without PEW. This study determined if key variables could predict SMM Index (SMM adjusted for height) in patients receiving MHD. MethodsWe conducted a secondary analysis of cross-sectional data obtained from the Rutgers Nutrition and Kidney Database (n=178). Data were utilized to calculate both SMM and SMM Index. Univariate and multiple linear regression models explored the relationship between SMM Index and the following variables: serum albumin (ALB), Kt/V, normalized protein catabolic rate (nPCR), serum creatinine (SCr), and urea reduction ratio (URR). ResultsMost participants were Black/African American (82.9%), male (59.1%), and obese (39%), with a mean age of 55.9 ± 11.9 years. The median SGA score was 5, indicating a lower risk of malnutrition. Participants had a mean SMM of 26.4kg and a median SMM Index of 8.9kg/m2. Univariate regression modeling found URR to be a significant predictor of SMM Index, with increases in the percentage of URR predicting lower SMM Index values. The adjusted regression modeling found similar results, with increases in URR percentage predicting declines in SMM Index. ConclusionThis study found that URR was a predictor of SMM Index in patients receiving MHD. Further research is required to explore these relationships and provide clinicians with a more extensive array of tools to recognize early signs of SMM loss to prevent the progression of PEW.

Nutritional Assessment in Patients after Gastric Electrical Stimulation (GES).

Gastric electrical stimulation (GES) is used for patients with drug-refractory gastroparesis (Gp) symptoms. Approximately two-thirds of patients with Gp symptoms are either overweight or obese. We aimed to assess symptoms and nutritional status pre-GES and post-GES placement in a large sample of drug-refractory Gp patients. We conducted a chart review of 282 patients with drug-refractory Gp who received temporary followed by permanent GES at an academic medical center. Gastrointestinal symptoms were collected by a traditional standardized PRO (0-4, 0 being asymptomatic and 4 being worst symptoms), baseline nutritional status by BMI plus subjective global assessment (SGA score A, B, C, for mild, moderate, and severe nutritional deficits), ability to tolerate diet, enteral tube access, and parenteral therapy were assessed at baseline and after permanent GES placement. Comparing baseline with permanent, GES was found to significantly improve upper GI symptoms in all quartiles. Of the 282 patients with baseline body mass index (BMI) information, 112 (40%) patients were severely malnourished at baseline, of which 36 (32%) patients' nutritional status improved after GES. Among all patients, 76 (68%) patients' nutritional status remained unchanged. Many patients with high BMI were malnourished by SGA. We conclude that symptomatic patients of different BMIs showed improvement in their GI symptoms irrespective of baseline nutritional status. Severely malnourished patients were found to have an improvement in their nutritional status after GES therapy. We conclude that BMI, even if high, is not by itself a contraindication for GES therapy for symptomatic patients.

Analysis of Energy and Protein Intake with Nutritional Status of Chronic Kidney Failure Patients with Hemodialysis at Harapan and Doa Regional Hospital, Bengkulu City

Background:Chronic kidney disease is a global public health priority that continues to grow and is associated with high morbidity rates and is the third fastest growing cause of death in the world and the fifth leading cause of death. Malnutrition often occurs in end-stage renal disease patients undergoing hemodialysis (HD). Malnutrition is caused by catabolic events during the hemodialysis process. Objective: The aim of the study was to analyze energy intake, protein and nutritional status of chronic kidney failure patients on hemodialysis at Harapan and Doa Regional Hospital, Bengkulu City. Materials/Methods: Explanatory research type, with a cross sectional approach. The study population was all chronic kidney failure sufferers who underwent hemodialysis at Harapan and Doa Hospital, Bengkulu City in June-July 2023. Data were collected by interviews and anthropometric measurements, 3x24 hour recall forms and SGA forms and from patient medical records. Data processing was carried out using univariate tests. Result:This study shows that 98% of respondents' energy intake before hemodialysis had insufficient energy intake (< 80%) and 2% had sufficient energy intake (80), protein intake before hemodialysis 92% protein intake is less (< 80%) during hemodialysis and after hemodialysis 85% with less protein intake (< 80%), nutritional status of chronic kidney failure patients with hemodialysis good nutritional status (SGA score A), namely (54%) lack of protein intake, poor/moderate nutritional status (SGA B score), namely (43%), poor nutritional status (SGA C score), namely (3%). Conclusion:The conclusion of this study is that energy intake, protein and nutritional status in chronic kidney failure patients on hemodialysis are still lacking. Therefore, increasing intake needs to be done by paying attention to the patient's nutritional status

Nutritional integration in liver transplantation for 14 year old children in the 108 Military Central Hospital: A case report

A 14 year old girl diagnosed with primary biliary cirrhosis, gastrointestinal bleeding, and esophageal varices underwent an assessment of her nutritional status using SGA, BAZ (Body Mass Index for age), and MUAC (Middle Upper Arm Circumference). Prior to transplantation, her SGA score was categorized as C, her BAZ was -1.63 standard deviations, and her MUAC measured 18.5cm. Patients receive specialized care tailored to the different stages of their condition following transplantation. In the early post-transplant period, nutritionists employ a combination of enteral and parenteral nutrition. By the end of the first week after surgery, the patient's total energy intake reached 1582.7 kcal, with a protein intake of 1.7g/kg, and her SGA score improved to B. Starting from Day 21, protein and energy intake increased to 2.4g/kg and 30kcal/kg/24h, respectively. Upon discharge, the patient exhibited enhanced nutritional status, with an SGA score of B, a BAZ of -1.56 standard deviations, and a MUAC measurement of 20.0cm. She also experienced a weight gain of 1.5kg within one month of leaving the hospital. Consequently, the implementation of a Nutritional Management Plan, structured around the distinct stages of liver transplantation, is of paramount importance, particularly for pediatric patients.

Nutritional Assessment Using Modified SGA Score and Its Correlation with Biochemical Profile Among Maintenance Hemodialysis Patients: A Cross Sectional Study at Multiple Hemodialysis Centers in Dhaka

Patients on maintenance hemodialysis are vulnerable to multitude of health-related issues, malnutrition being one ofthem. It is a key predictive factor for morbidity and mortality among patients on maintenance hemodialysis. Theprimary objective of the study was to assess the severity of malnutrition in patients undergoing maintenancehemodialysis, using modified subjective global assessment score and correlate it with biochemical parameters likeblood hemoglobin, serum creatinine, serum albumin, serum pre-albumin, serum triglyceride and serum totalcholesterol. Cross-sectional study from July 2016 to June 2017 was conducted at hemodialysis unit of SSMC & MH,BSMMU, BIRDEM hospital and NIKDU, Dhaka, among 80 maintenance hemodialysis patients. Adult patients overthe age of 18 years and on regular (>_2 sessions per week) hemodialysis for more than 3 months without any acuteinfection were enrolled. Nutritional status of the patients was evaluated using modified subjective global assessmentscore and compared with biochemical parameters for any correlation between them. Based on the modified SGAscores, of the 80 patients, 10% were well nourished and the rest were mildly malnourished, showing a high degree ofmalnutrition among respondents. There was strong positive correlation between modified subjective globalassessment score and age. Modified SGA score also showed statistically significant negative correlation with serumcreatinine, serum albumin and serum pre-albumin. Data obtained from this study confirm that modified subjectiveglobal assessment score can be used as a reliable index for identifying patients at risk for malnutrition and itcorrelates well with some of the biochemical profile. Bangabandhu Sheikh Mujib Med. Coll. J. 2022;1(1):14-19

Trend of pregnancy outcomes in type 1 diabetes compared to control women: a register-based analysis in 1996-2018.

In 1989, the St Vincent declaration aimed to approximate pregnancy outcomes of diabetes to that of healthy pregnancies. We aimed to compare frequency and trends of outcomes of pregnancies affected by type 1 diabetes and controls in 1996-2018. We used anonymized records of a mandatory nation-wide registry of all deliveries between gestational weeks 24 and 42 in Hungary. We included all singleton births (4,091 type 1 diabetes, 1,879,183 controls) between 1996 and 2018. We compared frequency and trends of pregnancy outcomes between type 1 diabetes and control pregnancies using hierarchical Poisson regression. The frequency of stillbirth, perinatal mortality, large for gestational age, caesarean section, admission to neonatal intensive care unit (NICU), and low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score was 2-4 times higher in type 1 diabetes compared to controls, while the risk of congenital malformations was increased by 51% and SGA was decreased by 42% (all p<0.05). These observations remained significant after adjustment for confounders except for low APGAR scores. We found decreasing rate ratios comparing cases and controls over time for caesarean sections, low APGAR scores (p<0.05), and for NICU admissions (p=0.052) in adjusted models. The difference between cases and controls became non-significant after 2009. No linear trends were observed for the other outcomes. Although we found that the rates of SGA, NICU care, and low APGAR score improved in pregnancies complicated by type 1 diabetes, the target of the St Vincent Declaration was only achieved for the occurrence of low APGAR scores.

#4971 IMPACT OF RAMADAN FASTING ON NUTRITION, INFLAMMATION AND DIALYSIS ADEQUACY AMONG HEMODIALYSIS PATIENTS

Abstract Background and Aims There is a paucity of data concerning safety of fasting in Ramadan in End stage kidney disease patients (ESKD) on haemodialysis (HD). The aim of the present study was to assess the possible effect of fasting on nutritional status (clinical, biochemical variables), inflammatory status and adequacy of haemodialysis. This observational study was carried out during 2022 when fasting duration was around 14 hours. Method Sixty-five patients suffered from ESKD who received regular HD for more than six months in dialysis unit, urology and nephrology center Mansoura university were included in this prospective observational study. Patients were categorized into three groups. 21 patients fasted all days of Ramadan,25 patients fasted days other than session days and 19 patients never. We did not oblige our patient to fast. nutritional status was assessed clinically by Anthropometric measurements including body weight, BMI, triceps skin fold thickness (TSF) and estimation of protein catabolic rate (PCR) were measured, and laboratory by serum Albumin, cholesterol and fasting blood glucose. Neutrophils to lymphocytes ratio (NLR), Soluble receptor of advanced glycation end product(SRAGE) and human B-cell lymphoma/leukemia2 (BCL2) was measured as inflammatory markers, also dialysis adequacy was determined with urea reduction ratio (URR) and KT/V. Assessment of all patients were carried out before and after Ramadan month and was repeated 3 months after Ramadan in all patients. Results In 30 days fasting group: there was significant reductions (all P &amp;lt; .02), serum albumin, triceps skin fold thickness, Subjective global assessment score (SGA) for nutritional assessment also in inflammatory markers as neutrophils to lymphocytes ratio (NLR) and human Bcell lymphoma/leukemia2 (BCL2). But these were not accompanied by any significant change (all P &amp;gt;0.05) in body mass index, serum cholesterol, fasting blood sugar (FBS), urea reduction ratio (URR), intradialytic weight gains (IDWG), Kt/V and human soluble receptor for advanced glycation end products (sRAGEs). In the group Who was reported fasting in days other than HD session days: fasting led to significant reductions (all P &amp;lt; .02) only in serum albumin and triceps skin fold thickness. There were no significant changes in BMI, URR, Cholesterol, FBS, KT/V, IDWG, SGA score, NLR, sRAGEs and BCL2. In patients Who never fast at all: there was significant reduction (all P&amp;lt;0.02) in triceps skin fold thickness, significant change in SGA score and also in sRAGEs and BCL2. Conclusion There was no harmful effect for Muslim patients receiving regular HD who want to fast Ramadan in days other than HD session days. In the current study the fasting group has the benefit of both being fasting and non-significant changes in mostly all nutritional assessment points, inflammatory markers and the adequacy of HD.

#6287 EFFECT OF REMOTE ISCHEMIC PRECONDITIONING ON NUTRITIONAL STATUS, COGNITIVE FUNCTION, AND BONE IN HEMODIALYSIS PATIENTS: A RANDOMIZED CONTROLLED TRIAL

Abstract Background and Aims Remote ischemic preconditioning (RIPC) is a process in which a brief period of ischemia is induced in one part of the body to protect another part from damage due to subsequent periods of more severe ischemia. Hemodialysis sessions are considered an ischemic process because it involves reducing blood flow to certain parts of the body, which can lead to tissue damage .Malnutrition, deterioration of cognitive function, bone disorders, cardiovascular disease, and hemodynamic instability can result from ischemia induced by hemodialysis sessions. These adverse effects increase mortality in HD patients. RIPC has been studied as a potential therapeutic strategy to reduce the risk of cardiovascular events in hemodialysis patients; however, the effect of RIPC on cognitive function, nutritional status, and bone disorder among hemodialysis patients has not been enough studied. Aim: to assess the effect of remote ischemic preconditioning on nutritional status, bone disorders, and cognitive function in hemodialysis patients at the urology and nephrology center, Mansoura University. Method Fifty patients who received regular hemodialysis for more than one year in our dialysis unit were included. The patients were randomized (single-blind) into two groups a control group (20 patients) and an intervention group (30 patients). Before each HD session, sphygmomanometer cuffs was placed around the non-vascular access arm. Three cycles of ischemia for five minutes were performed followed by reperfusion for five minutes. Ischemia was induced by inflating the sphygmomanometer cuffs to 200 mmHg. This maneuver was done before each HD session for 12 weeks. The Montreal Cognitive Assessment (MOCA) was used to assess cognitive function. The nutritional state was assessed by anthropometric measurement (body weight, BMI), laboratory (serum albumin and serum cholesterol), and Subjective Global Assessment Form (SGA). Serum calcium (s.Ca) and serum phosphorus (s.po), serum alkaline phosphate (s. ALP) and intact parathyroid hormone (iPTH) were used as indices for bone profile. Results The intervention group include 30 patient with mean age (36+/-10), 19 male (63.3%) and 11 females (36.7%). The control group include 20 patient with mean age (46+/-9), 12 male (60%) and eight female (40%). None of these patients’ demographic data (age, sex, original kidney disease, and duration of dialysis) were significantly different between the study groups (P&amp;gt;0.05). MOCA test score at baseline was (24.5 +/-2.6) at intervention group and (24.4+/-3.2) at control group, and after 12 weeks intervention was (24.8 +/-2.2) at intervention group and (24.4+/-2.8) at control group. there were no statistical significance regarding cognitive function between the two group over time (p = 0.4). NO significant Statistical changes in anthropometric measurements (Body weight (p = 0.3) and BMI (P = 0.6) were found between the two groups. Additionally, no significant changes (serum albumin and cholesterol) were detected. SGA score at baseline was at intervention group (1.2+/-0.4) and control group (1.1 +/- 0.3), and after 12 week was at the intervention group (1.4 +/-0.5) and control group (1.6 +/-0.5). SGA showed no statistical significance between the two groups over time (p = 0.2). No significant statistical changes regarding bone profile (s.ca (p = 0.5), s.PO (p = 0.2), s.ALP (p = 0.7) and iPTH (p = 0.5)). Conclusion Although some studies showed a beneficial effect of RIBC on reduction of cardiovascular risk, our study found no significant effect on cognitive function, nutritional status, and bone disorders among hemodialysis patients.

Development and assessment of a nutrition literacy scale for patients with end-stage kidney disease undergoing dialysis and its correlation with quality of life

Objectives To construct a valid and reliable Nutritional Literacy Scale for patients with end-stage kidney disease (ESKD) receiving dialysis and evaluate associations between nutrition literacy and quality of life. Methods A total of 208 ESKD patients receiving dialysis were selected for this study. Nutrition literacy evaluation items were drafted based on dietary guidelines for chronic kidney disease (CKD), Literature reviews and expert consultation. Scale reliability and validity were then assessed. Factors influencing nutrition literacy and the associations among nutrition literacy, nutritional status, and quality of life were evaluated. Results The scale consists of 28 items with a scale-level content validity index of 0.91 and item-level content validity indices ranging from 0.83 to 1.00. Factor analysis identified 4 common factors (dimensions) named nutrition knowledge, cognitive attitude, behavioral practice, and information acquisition ability that collectively explained 56.31% of literacy score variation. The overall Cronbach’s α coefficient of the scale was 0.83, the dimensional Cronbach’s α coefficients ranged from 0.79 to 0.87, and the retest reliability was r = 0.73 (p < 0.05). Age, education level, residence (urban vs. Rural), occupational status and dialysis modalities were significant factors influencing nutrition literacy. Nutrition literacy score was negatively correlated with SGA score and positively correlated with serum albumin and prealbumin concen- trations, and with SF-36 quality of life score (all p < 0.05). Conclusions This new Nutrition Literacy Scale demonstrates high reliability and validity for Chinese ESKD patients undergoing dialysis. The nutrition literacy is influenced by age, education level, residence, occupational status and dialysis modalities, associated not only with nutritional status but also with quality of life.

Nutritional Status and Health Related Quality of Life Of Chronic Kidney Disease Patients

Background: Chronic kidney disease is a steadily growing health problem. Malnutrition is common in this irreversible state of kidney failure. The CKD along with malnutrition adversely affect the HRQOL of the patients. This study was conducted to assess the association between nutritional status and HRQOL of CKD patients. Methods: This cross-sectional study was conducted among 220 CKD patients at Gonoshasthaya Dialysis Centre in Dhaka of Bangladesh during the period from July 2019 to June 2020. Data were collected purposively by using a semi-structured questionnaire with face to face interview, physical examinations and review of medical records. Results: In this study, majority of the patients were male (67.7%) and mean (±SD) age was 47.59±12.51 years. The patients were higher in proportion (60.0%) in stage 5. Mean (±SD) duration of CKD was 3.8 (±1.83) years. Based on SGA score, majority of the patients (81.8%) were mild to moderately malnourished while 5.5% were severely malnourished. Overall mean (±SD) score of HRQOL was 47.07 (±14.89). The score was higher (53.84±13.60) in KDCS followed by MCS (45.99±21.06) and PCS (41.35±14.92). Mean (±SD) score of HRQOL was 33.27±9.80, 45.67±14.26 and 61.96±9.16 in severely malnourished, mild to moderately malnourished and well-nourished patients respectively (F = 24.191, p &lt; .001). Correlation between mean score of HRQOL and SGA score was positively significant (r= .709, p&lt;.001). Age, income, family member, duration of CKD, hemoglobin, serum albumin and SGA score together accounted for 65.6% variability of HRQOL score (R2 = 0.656, adjusted R2 = 0.645, (F= 57.829, p &lt;.001) with the SGA score recording a higher beta value (beta = 0.474, p &lt;.001). Conclusion: The study found, most of the patients were malnourished with a low level of HRQOL score. Correlation between the mean score of HRQOL and SGA score was significant and strongly positive. JOPSOM 2021; 40(2): 44-51

Association of Serum Prealbumin With Nutritional Status of End-Stage Renal Disease Patients Under Maintenance Hemodialysis

Background: End-stage renal disease (ESRD) patients undergoing maintenance hemodialysis often suffer from malnutrition. The primary objective of the study was to measure the level of serum prealbumin, assess the correlation of serum prealbumin with modified subjective global assessment score and determine a cut-off value for prealbumin that can estimate the nutritional status of the study population with highest accuracy, among ESRD patients under maintenance hemodialysis. Methods: A one year long cross-sectional study from July 2016 to June 2017 was conducted at hemodialysis unit of SSMC &amp; MH, BSMMU, BIRDEM hospital and NIKDU, Dhaka, among 80 maintenance hemodialysis patients. Adult patients over the age of 18 years and on regular (≥2 sessions per week) hemodialysis for more than 3 months without any acute infection were enrolled. Nutritional status of the patients was evaluated using modified subjective global assessment score. Serum prealbumin level was compared with both anthropometric and biochemical parameters, as well as with modified SGA score. Using modified SGA score as gold standard, receiver operating characteristic curve was used to estimate best fitting cut-off value for serum prealbumin for nutritional assessment among ESRD patients under maintenance hemodialysis. Results: Mean age of study population was 52.3 years and 66.3% respondents were male. Most prominent primary renal diseases were diabetic nephropathy (48.8%). According to modified SGA score, 10% of the study population had normal nutritional status and 90% had mild to moderate malnutrition. Mean serum prealbumin was 27.8 mg/dl. Serum prealbumin showed significant negative correlation with age, modified SGA score and triglyceride; significant positive correlation was shown with BMI, serum creatinine and serum albumin. Using receiver operating characteristic curve, 32.6 mg/dl was found to be the best fitting cut-off value for nutritional assessment with 73.6% sensitivity, 62.5% specificity and 72.5% accuracy. Conclusion: Data obtained from this study strongly indicates that serum prealbumin can be used as a marker for nutritional assessment among ESRD patients undergoing maintenance hemodialysis. JOPSOM 2021; 40(2):9-15

Assessment of malnutrition in patient with liver cirrhosis and its association with dietary intake

Introduction: Cirrhosis is incurable, irreversible chronic liver disease and impose a health and economic burden. Malnutrition is related to the progression of liver dysfunction and it is associated with many complications. The current study aims to perform a nutritional assessment for patients with liver cirrhosis using SGA, and study the relationship between protein energy malnutrition and severity of liver cirrhosis using Child-Pugh score. Patients and methods: Cross-sectional study was conducted in Baghdad medical city for 4 months on 50 liver cirrhotic patients. Patients were interviewed, recall diet history, current nutritional requirement, SGA and Child-Pugh score were calculated for each patient, p value ≤ 0.05 were considered significant Results: The average age was 54.7±14.7 years. Majority were men, married, of primary or less education, living in urban settings. NAFLD (34%) and alcohol (32%) were the leading causes. Twenty-nine (58%) had sever disease and 16 (32%) were malnourished. The study showed a significant association between severity of disease and patients’ state of nutrition.

The association between MNA and PG-SGA malnutrition assessment and the quality of life among hemodialysis patients

BackgroundThe simple nutritional assessment tools by Mini Nutritional Assessment (MNA) and Patient Generated Subjective Global Assessment (PG – SGA) was proposed to affect the Quality of Life (QOL) in hemodialysis patients. However, currently, no evidence assessed the potency of MNA and PG - SGA for predicting the QOL in hemodialysis patients. ObjectiveTo assess the potential implication of MNA and PG-SGA nutritional tools and the QOL among hemodialysis patients. MethodsA cross - sectional study was performed in Universitas Muhammadiyah Malang Hospital, Malang, Indonesia. A validated Kidney Disease Quality of Life – 36™ (KDQOL – 36™) instrument was used to assess the QOL. The nutritional status was assessed using MNA and PG - SGA checklist. The association between nutritional status and QOL was determined by using multiple logistic regression. ResultsA total of 96 hemodialysis patients was enrolled in our study. Of them, good QOL was observed in 75 patients (78.12%). We found that hemodialysis patients with higher MNA score and lower PG - SGA score was associated with good QOL. We also found that normal MNA nutritional status was associated with good QOL. Moreover, we also found that the score of MNA ≥23.75 and PG - SGA score ≤3,5 were associated with good QOL. ConclusionMNA and PG-SGA nutritional assessment tools are the important indicator in predicting the QOL in hemodialysis patients.

Maternal and Fetal Outcome among Women having Pre Eclampsia with Hyperuricemia

Objective: To find out the frequency of some common maternal and fetal outcomes among women having pre eclampsia with hyperuricemia. Study design: Cross sectional study. Place and duration of study: Department of Obstetrics and Gynaecology, Hayatabad Medical Complex, Peshawar from April 2019 to Oct 2019. Patients and methods: A total of 161 women with singleton pregnancy irrespective of gravity and party, in age group ranging from 20-35 years having pre eclampsia with hyperuricemia were included in consective manner. All patients signed informed written consent for study and its outcome. Detailed history taking and examination were performed and standard lab investigations were sent. All patients were followed up till 40th day of delivery for maternal (caesarean section, eclampsia and maternal death) and fetal outcome [intrauterine fetal death, (small for gestational age) SGA and APGAR score]. Data was analyzed using SPSS version 20. Results: Maternal complications in patients of pre eclampsia with hyperuricemia were eclampsia 15.5%, caesarean section 18% and death 19.3%. Fetal complications included SGA 11.8%, intrauterine death 16.8% and APGAR score at 5 minutes 24.2%. The mean age and standard deviation of sample were 28.4 + 4.8 years, mean gravidity (2.7±1.1), mean parity (2.4±0.9) and mean BMI (24.37±2.4 kg/m2). Conclusion: Hyperuricemia in pre-eclampsia is a poor prognostic factor with increased maternal and fetal deaths, worsening of pre eclampsia to eclampsia and low APGAR scores of fetus. Key words: Pre eclampsia, hyperuricemia, maternal death, caesarean section, small for gestational age, APGAR score

Comparison of Body Mass Index with Modified Subjective Global Assessment for Detection of Malnutrition Among Patients Under Maintenance Hemodialysis: A Multi-Center Cross-Sectional Study

Background: Patients under maintenance hemodialysis are at increased risk of malnutrition, causing from multitude of factors. Present study aims to assess the prevalence of malnutrition among maintenance hemodialysis patients using both modified subjective global assessment score and body mass index, compare them and assess the sensitivity and specificity of body mass index for detecting malnutrition, along with determining a new cutoff value for BMI that better represent the maintenance hemodialysis patient’s nutritional status. Methods: This was a cross-sectional study conducted in the hemodialysis unit of Bangabandhu Sheikh Mujib Medical University, Sir Salimullah Medical College Mitford Hospital, BIRDEM General Hospital and National Institute of Kidney Diseases &amp; Urology; among 80 adult CKD patients who were on regular (≥2 sessions per week) maintenance hemodialysis for more than 3 months without any acute infection, during the period of July 2016 to June 2017. Nutritional assessment was done for each patient using modified SGA score along with BMI. Sensitivity analysis of WHO recommended cutoff value for BMI was done among the study population using modified SGA score as gold standard test for detection of malnutrition among the respondents. ROC curve was used to estimate the best fitting cutoff value of BMI that showed highest sensitivity, specificity and accuracy for detracting malnutrition among maintenance hemodialysis patients. Results: The study participants were predominantly male (66.3%) and from age group 45 to 59 years (36.3%). Modified SGA score detected 90.0% of the study population as malnourished. WHO recommended 18.5 kg/m2 cutoff value was also used to detect malnutrition among study population and 13.8% were found to be malnourished, with a sensitivity and specificity of 12.5% and 75.0% respectively. Accuracy was found to be 18.8%. Using ROC curve, 23.1 kg/m2 was found to be the best fitting cutoff value of BMI for the study population to detect malnutrition. With a sensitivity of 47.2%, specificity of 37.5% and accuracy of 46.3%. Conclusion: BMI showed low sensitivity for detecting malnutrition among patients under maintenance hemodialysis, compared to modified SGA score and should be avoided as a screening tool, but 23.1 kg/m2 cutoff value for BMI showed potential to be used as an easy to use and quick tool for detecting malnutrition among such patients. Further study with larger sample size could shed more light on this. JOPSOM 2021; 40(1): 14-21

Can Overnutrition Lead to Wasting?—The Paradox of Diabetes Mellitus in End-Stage Renal Disease Treated with Maintenance Hemodialysis

Background: The population of end-stage renal disease (ESRD) patients with diabetes mellitus (DM) may be at increased risk of protein energy wasting (PEW). The aim of the study was to investigate the impact of DM on selected indicators of PEW in the ESRD population that was undergoing maintenance hemodialysis (MHD). Methods: A total of 515 MHD patients were divided into two subgroups with and without DM. The evaluation of diet composition, Charlson Comorbidity Index (CCI), SGA, and laboratory and BIS analyses were performed. All-cause and cardiovascular mortality was recorded. Results: DM patients had lower albumin (3.93 (3.61–4.20) vs. 4.10 (3.80–4.30) g/dL, p < 0.01), total cholesterol (158 (133–196) vs. 180 (148–206) mg/dL, p < 0.01), and creatinine (6.34 (5.08–7.33) vs. 7.12 (5.70–8.51) mg/dL, p < 0.05). SGA score (12.0 (10.0–15.0) vs. 11.0 (9.0–13.0) points, p < 0.001), BMI (27.9 (24.4–31.8) vs. 25.6 (22.9–28.8) kg/m2, p < 0.001), fat tissue index (15.0 (11.4–19.6) vs. 12.8 (9.6–16.0) %, p < 0.001), and overhydration (2.1 (1.2–4.1) vs. 1.8 (0.7, 2.7) L, p < 0.001) were higher in the DM group. Increased morbidity, reflected in the CCI and mortality—both all-cause and cardiovascular—were observed in DM patients. Conclusions: Hemodialysis recipients with DM experience overnutrition with a paradoxically higher predisposition to PEW, expressed by a higher SGA score and lower serum markers of nutrition. This population is also more comorbid and is at higher risk of death, including from cardiovascular causes.

High-Protein Dietary Supplementation and Nutritional Status Improvement of Malnourished Patients in Hospital Care

Hospital malnutrition is common in Indonesia and other developing countries. In Asia, the prevalence of hospital malnutrition ranges between 27-39%. The causes of malnutrition in hospital care include insufficient food intake and increased catabolic processes due to underlying causes such as metabolic disease, infection, and malignancy. Several studies have demonstrated that malnutrition increases the morbidity and mortality of hospitalized patients, prolongs hospital stay, and delays recovery. Therefore, healthcare providers must recognize malnutrition early by conducting nutritional screening and assessment to prevent worsening of malnutrition and administer the optimal nutritional therapy to patients. Apart from giving a standard diet, high-protein food supplementation in liquid form remains a suitable alternative for patients, especially since it is easily digestible. A high protein diet is associated with a better mortality rate, better weight gain, and improved SGA score in patients.