Association of depression with malnutrition in chronic hemodialysis patients.
BACKGROUND
Depression is the most common psychological complication and may increase mortality in chronic hemodialysis patients. Because depression could be associated with poor oral intake and activation of proinflammatory cytokines that could further increase mortality by malnutrition, we investigated the relation between depression and nutritional status in chronic hemodialysis patients.


METHODS
Sixty-two Korean patients completed the Beck Depression Inventory (BDI) questionnaire, and the diagnosis of depression was confirmed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depressive disorder. Nutritional status was evaluated using serum albumin level, normalized protein catabolic rate, subjective global assessment (SGA), and anthropometric measurement.


RESULTS
Mean BDI score was 22.7 +/- 11.4, and 35 patients (56.5%) had a BDI score greater than 21, which is the suggested cutoff score for the diagnosis of depression for the Korean population. Of 40 patients who had a score higher than 18 on the BDI, 34 patients met DSM-IV criteria for major depressive disorder. BDI score correlated negatively with a variety of nutritional parameters: serum albumin level (r = -0.47; P < 0.001), normalized protein catabolic rate (r = -0.32; P < 0.05), SGA (r = -0.47; P < 0.01), triceps skinfold thickness (r = -0.40; P < 0.05), midarm muscle circumference (r = -0.57; P < 0.01), and body mass index (r = -0.28; P < 0.05). Multiple regression analysis also identified BDI score as an independent determinant for all kinds of nutritional parameters.


CONCLUSIONS
In patients on chronic hemodialysis therapy, depression is related closely to nutritional status and could be an independent risk factor for malnutrition.
Department of Internal Medicine, Division of Nephrology, College of Medicine, Hallym University, Chuchon, Kangwon Do, South Korea. jrkoo@hallym.ac.kr
Ja-Ryong
JR
Koo
Jong-Woo
JW
Yoon
Seong-Gyun
SG
Kim
Young-Ki
YK
Lee
Kook-Hwan
KH
Oh
Gheun-Ho
GH
Kim
Hyung-Jik
HJ
Kim
Dong-Wan
DW
Chae
Jung-Woo
JW
Noh
Sang-Kyu
SK
Lee
Bong-Ki
BK
Son
D000328:Adult; D003866:Depressive Disorder / Q000150:complications*; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy; D008297:Male; D044342:Malnutrition / Q000523:psychology*; D009752:Nutritional Status; D006435:Renal Dialysis; D012307:Risk Factors