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Is malnutrition a determining factor of health-related quality of life in hemodialysis patients? A cross-sectional design examining relationships with a comprehensive assessment of nutritional status

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Abstract

Purpose

To identify relationships between health-related quality of life (HRQOL) and nutritional status in hemodialysis (HD) patients.

Method

Secondary data from a cross-sectional survey was utilized. HRQOL was assessed for 379 HD patients using the generic Short Form 36 (SF-36) and disease-specific Kidney-Disease Quality of Life-36 (KDQOL-36). Malnutrition was indicated by malnutrition inflammation score (MIS) ≥ 5, and presence of protein-energy wasting (PEW). The individual nutritional parameters included the domains of physical status, serum biomarkers, and dietary intake. Multivariate associations were assessed using the general linear model.

Results

MIS ≥ 5 was negatively associated with SF-36 scores of physical functioning (MIS < 5 = 73.4 ± 8.0 SE vs MIS ≥ 5 = 64.6 ± 7.7 SE, P < 0.001), role-limitation-physical (MIS < 5 = 65.3 ± 14.3 SE vs MIS ≥ 5 = 52.9 ± 14.0 SE, P = 0.006), general health (MIS < 5 = 53.7 ± 7.5 SE vs MIS ≥ 5 = 47.0 ± 7.1 SE, P = 0.003), and PCS-36 (MIS < 5 = 40.5 ± 3.3 SE vs MIS ≥ 5 = 35.9 ± 3.1 SE, P < 0.001); and KDQOL-36 score of symptoms/problems (MIS < 5 = 78.9 ± 5.6 SE vs MIS ≥ 5 = 74.8 ± 5.4 SE, P = 0.022), but not with PEW by any tool. Of individual nutritional parameters, underweight (68.1 ± 5.4 SE, P = 0.031), normal weight (63.8 ± 2.8 SE, P = 0.023), and overweight (64.3 ± 2.9 SE, P = 0.003) patients had significantly higher physical functioning scores compared to obese patients (44.8 ± 5.5 SE). Serum albumin levels were positively associated with physical functioning (P = 0.041) score. HGS was also positively associated with physical functioning (P = 0.036), and vitality (P = 0.041) scores. Greater dietary phosphorus intakes were significantly associated with lower scores for role limitation-physical (P = 0.008), bodily pain (P = 0.043), and PCS-36 (P = 0.024).

Conclusion

Malnutrition diagnosis by MIS, but not PEW, indicated associations with HRQOL in HD patients. Individual nutritional parameters that related to higher HRQOL were BMI < 30 kg/m2, better dietary phosphorus control, greater muscle strength and higher visceral protein pool.

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Acknowledgements

Members of PaTCH (Malaysia) Investigators are Dr. Bee Boon Cheak (Hospital Selayang, Malaysia), Dr. Lim Soo Kun (Universiti Malaya, Malaysia), Dr. Ravindran Visvanathan (Hospital Kuala Lumpur, Malaysia), Dr. Rosnawati Yahya (Hospital Kuala Lumpur, Malaysia), and Dr. Sunita Bavanandan (Hospital Kuala Lumpur, Malaysia)

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Authors and Affiliations

  1. School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Selangor, Malaysia

    Hi-Ming Ng & Karuthan Chinna

  2. Department of Dietetics & Nutrition Services, Sunway Medical Centre, Petaling Jaya, Selangor, Malaysia

    Hi-Ming Ng

  3. Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia

    Ban-Hock Khor

  4. Department of Allied Health Sciences, Faculty of Science, Universiti Tunku Abdul Rahman, Kampar Campus, Kampar, Perak, Malaysia

    Sharmela Sahathevan

  5. Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

    Ayesha Sualeheen

  6. Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia

    Abdul Halim Abdul Gafor

  7. Department of Nephrology, Serdang Hospital, Kajang, Selangor, Malaysia

    Bak-Leong Goh

  8. Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia

    Ghazali Ahmad

  9. National Kidney Foundation of Malaysia, Petaling Jaya, Selangor, Malaysia

    Zaki Morad

  10. Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia

    Zulfitri Azuan Mat Daud

  11. Department of Nutrition and Food Science, Wayne State University, Detroit, MI, USA

    Pramod Khosla

  12. School of BioSciences, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Selangor, Malaysia

    Tilakavati Karupaiah

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  1. Hi-Ming Ng
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the PaTCH Study (Malaysia) Investigators

  • Bee Boon Cheak
  • , Lim Soo Kun
  • , Ravindran Visvanathan
  • , Rosnawati Yahya
  •  & Sunita Bavanandan

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Ng, HM., Khor, BH., Sahathevan, S. et al. Is malnutrition a determining factor of health-related quality of life in hemodialysis patients? A cross-sectional design examining relationships with a comprehensive assessment of nutritional status. Qual Life Res 31, 1441–1459 (2022). https://doi.org/10.1007/s11136-021-03018-6

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