Association of nutritional markers with physical and mental health status in prevalent hemodialysis patients from the HEMO study.
OBJECTIVE
To determine associations of potentially modifiable nutritional factors with physical and mental health status after adjusting for sociodemographic and comorbid conditions.


METHODS
Cross-sectional multivariable analysis.


METHODS
Fifteen dialysis centers across the United States participating in the Reduction of Morbidity and Mortality Among Hemodialysis Patients (HEMO) study.


METHODS
Enrollment of 1,545 prevalent hemodialysis subjects in the HEMO study. INDEPENDENT (PREDICTOR) VARIABLES: The following nutritional markers were assessed in this analysis: serum albumin, energy intake, protein catabolic rate, serum creatinine, midarm muscle circumference, calf circumference, and smoking status. Smoking status, although not a nutritional factor per se, was also included because it is a modifiable lifestyle factor.


METHODS
Physical and mental health status were assessed using the medical staff-assessed Karnofsky Index and the patient self-assessed Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36).


RESULTS
After adjusting for sociodemographic factors and comorbid conditions, serum albumin, serum creatinine, and calf circumference were independently associated with Karnofsky Index scores. Similarly, serum creatinine and calf circumference were also independently associated with the Physical Component Summary (PCS) score of the SF-36. Of the nutritional variables selected, no variables were significantly associated with the Mental Component Summary (MCS) score of the SF-36.


CONCLUSIONS
Markers of poor nutrition were associated with decreased physical functioning scores, independent of case mix. Measures that improve nutrition may therefore have wide-reaching effects to improve not only morbidity and mortality but also health-related quality of life for patients with end-stage renal disease.
Allen
Kristina L
KL
Dialysis Program, University of Utah, Salt Lake City, UT, USA.
Miskulin
Dana
D
Yan
Guofen
G
Dwyer
Johanna T
JT
Frydrych
Anne
A
Leung
June
J
Poole
Diane
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D015415:Biomarkers / Q000032:analysis*; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D002149:Energy Intake; D005260:Female; D006304:Health Status; D006801:Humans; D017567:Karnofsky Performance Status; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000523:psychology* / Q000628:therapy; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009752:Nutritional Status / Q000502:physiology; D011506:Proteins / Q000378:metabolism; D011788:Quality of Life; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis; D012907:Smoking
D015415:Biomarkers; D011506:Proteins; D012709:Serum Albumin; D003404:Creatinine