Benchmarking diet quality to assess nutritional risk in hemodialysis patients: applying adequacy and moderation metrics of the hemodialysis-healthy eating index

• Main Authors: Sualeheen, Ayesha, Khor, Ban-Hock, Balasubramanian, Gaiyal Villy, Sahathevan, Sharmela, Chinna, Karuthan, Mat Daud, Zulfitri Azuan, Khosla, Pramod, Abdul Gafor, Abdul Halim, Karupaiah, Tilakavati, Cheak, Bee Boon, Ahmad, Ghazali, Leong, Goh Bak, Kun, Lim Soo, Visvanathan, Ravindran, Yahya, Rosnawati, Bavanandan, Sunita, Morad, Zaki
• Format: Article
• Published: Elsevier 2022
• Online Access: http://psasir.upm.edu.my/id/eprint/100522/; https://www.sciencedirect.com/science/article/abs/pii/S1051227622000176

Objectives: This study modified Healthy Eating Index (HEI) based on hemodialysis (HD)-specific nutritional guidelines and investigated associations between the diet quality (DQ) and nutritional risk in HD patients. Methods: The HD-HEI tool adapted the Malaysian Dietary Guidelines 2010 framework according to HD-specific nutrition guidelines. This HD-HEI was applied to 3-day dietary records of 382 HD patients. Relationships between HD-HEI scores and nutritional parameters were tested by partial correlations. Binary logistic regression models adjusted with confounders were used to determine adjusted odds ratio (adjOR) with 95% confidence interval (CI) for nutritional risk based on HD-HEI scores categorization. Results: The total HD-HEI score (51.3 ± 10.2) for this HD patient population was affected by ethnicity (Ptrend <.001) and sex (P =.003). No patient achieved “good” DQ (score: 81-100), while DQ of 54.5% patients were classified as “needs improvement” (score: 51-80) and remaining as “poor” (score: 0-51). Total HD-HEI scores were positively associated with dietary energy intake (DEI), dietary protein intake (DPI), dry weight, and handgrip strength, but inversely associated with Dietary Monotony Index (DMI) (all P <.05). Individually, scores for refined grain, total protein, and animal protein were positively associated with DEI (all P <.05), while total, animal, fish, and vegetable proteins indicated positive associations with DPI (all P <.05). Moderating metrics for convenience meals, saturated fats, sodium, and fluid negatively correlated toward DEI with similar trends for DPI excepting convenience meals and fluids. “Poor” DQ was associated with DMI ≥ 29.2 (adjOR 18.83, 95% CI 9.36-37.86, P <.001), Malnutrition Inflammation Score ≥ 5 (adjOR 1.78, 95% CI 1.01-3.15, P =.045), and protein energy wasting (adjOR 1.96, 95% CI 1.14-3.34, P =.031), but became nullified with covariate adjustments. “Poor” DQ was also associated with low lean tissue mass (<32.6 kg) in men (adjOR 2.38, 95% CI 1.01-5.58, P =.046) but not women. Conclusion: “Poor” DQ was associated with poor nutritional status in Malaysian HD patients, who should be targeted for nutritional counseling.