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Comparison between direct and indirect methods to diagnose malnutrition and cardiometabolic risk in haemodialisys patients

Balbino, K. P., Epifânio, A. P. S., Ribeiro, S. M. R., da Silva, L. D. M., Gouvea, M. G., Hermsdorff, H. H. M.
Journal of human nutrition and dietetics 2017 v.30 no.5 pp. 646-654
adipose tissue, bioelectrical impedance, body fat, cross-sectional studies, hemodialysis, males, malnutrition, nutritional status, obesity, patients, risk factors, waist circumference
BACKGROUND: The present study aimed to evaluate the nutritional status of patients undergoing haemodialysis (HD) by comparing nutritional risk scores with biochemical, anthropometric and body composition variables. METHODS: Eighty‐five individuals [65.9% male, mean (SD) age 62 (14) years] participated in a cross‐sectional study. Global Objective Assessment (GOA) and Modified Global Subjective Assessment (mGSA) scores, as well as biochemical, anthropometric and body composition data, were collected using standardised procedures. RESULTS: The prevalence of malnutrition ranged from 20.0% (% body fat by electrical bioimpedance) to 95.3% (by GOA), depending on the indicator or score used. According to the waist circumference, 61.2% of the individuals presented abdominal obesity and visceral adipose tissue was excessive in 20% of them. Malnutrition diagnosis by GOA showed the relationship between the anthropometric and body composition indicators, as assessed by the extent that the ratings of risk nutritional/mild malnutrition and mainly moderate malnutrition were accompanied by a significant decrease in nutritional status and body composition variables. However, with respect to categories of mGSA, no statistically significant differences were observed for nutritional status and body composition variables. In the receiver operator characteristic curve analyses, mGSA and GOA were good indicators for diagnosing malnutrition because both achieved an AUC > 0.5. CONCLUSIONS: mGSA and GOA were more sensitive with respect to identifying individuals at nutritional risk compared to the isolated anthropometric indicators, thus indicating their utility in diagnostic malnutrition. However, individuals at high nutritional risk also presented cardiometabolic risk, as diagnosed mainly by central fat indicators, suggesting the application of both malnutrition and cardiometabolic risk markers in HD patients.