COMPARISON OF NUTRITIONAL ASSESSMENT SCORES FOR NUTRITION INTERVENTIONS IN END STAGE RENAL DISEASE PATIENTS ON MAINTENANCE HAEMODIALYSIS AT A TERTIARY HEALTH CARE CENTRE

7 Feb 2025 12 a.m. 12 a.m.
WCN25-AB-3531, Poster Board= FRI-089

Introduction:

Introduction

Malnutrition is significantly prevalent in ESRD patients requiring haemodialysis and is associated with increased morbidity and mortality.

Tools for assessment of nutritional status

Subjective Global Assessment (SGA) of Nutrition: It is a nutrition assessment tool. SGA score consists of seven features: weight change, dietary intake, GI symptoms, functional capacity, co-morbidity, subcutaneous fat and signs of muscle wasting. Each component has a score from                    1 (normal) to 5 (very severe).

 Malnutrition Inflammation Score (MIS): It has a total of ten components. 70% indexes are common with SGA questionnaire and remaining 30% are serum albumin, total iron binding capacity, and body mass index. The sum of all components ranges from 0-30.

Global leadership Initiative for Malnutrition (GLIM): GLIM was an initiative of the 4 big clinical nutrition societies in the world (ESPEN, ASPEN, FELANPE and PENSA) to create a consensus on malnutrition definition. It has three phenotypic criteria (non-volitional weight loss, low BMI and reduced muscle mass) and two etiologic criteria (reduced food intake, and inflammation or disease burden). To diagnose malnutrition at least one phenotypic criterion and one etiologic criterion should be present.

Methods:

Study Design:

Aims & Objectives:

1. To use the SGA, GLIM and MIS malnutrition scores in assessing the status of malnutrition in ESRD patients receiving maintenance haemodialysis at our tertiary health care centre.

2. To find the changes in these scores after the nutritional intervention in these patients

3. To compare the efficacy of these three scores in nutritional assessment.

Eligibility criteria:

1.      Patients belonging to both sexes between 18 to 75 years,

2.      Patient diagnosed as end stage renal disease and are on maintenance haemodialysis twice or thrice a week.

Exclusion criteria: Those patients who were non-compliant, did not maintain the records or were unable to answer the questionnaire.

Total 55 patients were recruited in the study. Each patient was evaluated on the day of recruitment and then monthly till 6 months.

Methodology:

On the day of recruitment, history, clinical examination and anthropometric details were entered in the proforma and relevant laboratory studies were carried out and results were entered in the proforma. Each patient’s SGA, GLIM and MIS scores were calculated according to the standardized criteria mentioned above.      

With the help of a qualified dietician, nutritional interventions were done by suggesting dietary modifications and providing diet charts for these patients.

Results:

OBSERVATIONS & RESULTS

Table 1.1 Intra and inter group comparison of mean malnutrition score of MIS at different time intervals:

        Score

                            MIS

One-way    ANOVA

   

Initial

  3 months

6 months

P value

 

Mean± Standard Deviation

 

     

No malnutrition

37.0 ± 17.11

28.5 ± 09.33

23.0 ± 15.25

0.011 (S)

Moderately nourished

39.9± 10.09

32.7 ± 21.09

27.3± 09.52

0.020(S)

Severely malnourished

41.0 ± 09.40

36.0± 15.78

33.2 ± 19.16

0.001(HS)

P value

0.01(S)

0.04(S)

0.001(HS)

 

 

 

 

 

 

 

Table 1.2: Intra and inter group comparison of mean malnutrition score of SGA at different time intervals:

Score

                                  SGA

One-way

ANOVA

   

0 months (Baseline)

3months

6 months

P value

 

 

Mean± Standard Deviation

 

   

Well nourished

44.0 ± 27.11

41.5 ± 19.23

33.0 ± 05.15

0.001 (HS)

Mild to moderately

malnourished

47.07 ± 3.15

45.7± 10.04

34.8 ± 3.52

0.05(S)

Severely malnourished

59.0± 05.32

55.2 ± 05.46

52.0 ± 19.61

0.001(HS)

P value

0.01(S)

0.002(HS)

0.001(HS)

 

Table 1.3: Intra and inter group comparison of mean malnutrition score of GLIM at different time intervals:

Score

GLIM

One-way ANOVA

   

0months (Baseline)

3 months

6 months

P value

 

 

Mean± Standard Deviation

 

   

Mildly

malnourished

64.0 ± 22.12

61.5 ± 03.21

58.0 ± 13.11

0.51(HS)

Moderately malnourished

67.5 ± 18.13

62.3± 31.00

60.11 ± 11.71

0.17(NS)

Severely malnourished

68.0± 25.12

64.2 ± 15.36

62.0 ± 16.21

0.001 (S)

P value

0.01(S)

0.001(HS)

0.001(HS)

 

 

 

Table 1.4: Intra and inter group comparison of mean malnutrition score of BMI at different time intervals:

Score

BMI

One-way ANOVA

   

SGA

MIS

GLIM

P value

 

 

Mean± Standard Deviation

 

   

Initial

28.26 ± 1.21

28.61 ±2.12

29.32±2.11

0.021 (HS)

3 months

27.5± 1.61

29.16 ± 1.82

62.0 ± 16.21

0.32(NS)

6 months

32.21±0.21

27.21 ±0.82

30.6 ±1.31

0.001(HS)

P value

0.001(HS)

0.42(NS)

0.03(S)

 

 

Graph 1: Graph showing prevalence of malnutrition in study population according to the different tools at the end of study period

Conclusions:

Conclusions:

The study showed that SGA score was reliable, clinically efficient and was easy to use.

SGA and MIS had components to assess the muscle wasting of the patient which makes it better than using the GLIM scale.

Overall, it was noted that GLIM score did not perform better than 7p-SGA and MIS in diagnosing malnutrition.

Based on our findings it was seen that SGA scale was more useful and convenient for the diagnosis of malnutrition in CKD patients; followed by MIS and GLIM.

Hence it will be advised for clinicians to use SGA scale to aid in diagnosis and devise a treatment plan accordingly.

References:

Serón-Arbeloa C, Labarta-Monzón L, Puzo-Foncillas J, Mallor-Bonet T, Lafita-López A, Bueno-Vidales N, Montoro-Huguet M. Malnutrition screening and assessment. Nutrients. 2022 Jun 9;14(12):2392.

Avesani CM, Sabatino A, Guerra A, Rodrigues J, Carrero JJ, Rossi GM, Garibotto G, Stenvinkel P, Fiaccadori E, Lindholm B. A comparative analysis of nutritional assessment using global leadership initiative on malnutrition versus subjective global assessment and malnutrition inflammation score in maintenance hemodialysis patients. Journal of Renal Nutrition. 2022 Jul 1;32(4):476-82.

 

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.

 
PresenterNeelima Chafekar