EFFECT OF STRUCTURED NUTRITIONAL EDUCATION ON SUBJECTIVE GLOBAL ASSESSMENT SCORES IN HAEMODIALYSIS PATIENTS: A SINGLE CENTRE –PROSPECTIVE OBSERVATIONAL STUDY.

Introduction:

Background: Nutritional assessment using Subjective Global Assessment (SGA) scores is a validated measure for patients on dialysis. These scores indicate the nutritional status of these patients, with higher scores correlating with better quality of life and well-being.

Aim: To study the effect of structured nutritional education on SGA scores in dialysis patients. Secondary aim is to find possible influencers affecting the severity of malnutrition

Methods:

Of the 106 incident dialysis patients, 88 were included in this study. Inclusion criteria were patients older than 30 years and a minimum of 3 months on haemodialysis.

SGA scores at the time of enrolment in March 2023 were obtained using the standard SGA questionnaire. Scores were categorized as normal (<7), mild (7-14), moderate (15-28), and severe (>28), for the purpose of this study. Of the 88 patients, 64 were in the mild group and 24 in the moderate group; no patients were in the normal or severe categories.

For both groups, age, sex, duration on dialysis, number of dialysis sessions per week, and comorbidities (diabetes, hypertension, coronary artery disease and COPD) were recorded. Independent t-tests compared averages for age and duration of dialysis, while Chi-square tests compared percentages for other parameters.

Structured nutritional education was provided by a qualified nutritionist, and patients were followed for 9 months. Education included audio-visual education every 30 days, with availability for interim clarifications. The program emphasized managing phosphate and potassium levels and strategies to increase protein intake.

At the end of the 9-month period, SGA scores were recalculated and compared between the two groups.

Results:

Older age and higher prevalence of comorbid conditions like diabetes and COPD were the influencers significantly associated with worse nutritional status.

Gender distribution, duration of dialysis, dialysis frequency, and other comorbidities did not significantly influence SGA score categorization.

Changes in SGA scores after 9 months were considered

As same if score was ± 1 from initial score.

As improved if score ≥ 2 from initial score

And as deteriorated if score ≤ 2 from initial score and classified into two groups: a) stayed within the group, b) shifted to the moderate group

Following 9 months of structured nutritional education:

Mild Group:

52% maintained SGA scores

22% improved, mean score change of 2.35 (range 2-4)

15.63% deteriorated within mild range, mean change of 2.5 (range 2-5)

10.37% shifted to moderate range, mean change of 5.7 (range 3-7), but only 2 points above the midrange in each case

Moderate Group:

16.67% maintained scores

83.3% improved, mean score change of 9.15 (range 5-16), all shifting to mild range

Patients deteriorating or lacking improvement had frequent admissions due to intercurrent illnesses.

Conclusions:

The elderly, and patients with type 2 diabetes mellitus and COPD and those with > 2 comorbidities significantly affected SGA score categorization. SGA scores improve with structured nutritional education but intercurrent illnesses prevent improvement and may worsen SGA scores.

I have no potential conflict of interest to disclose.

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