title: Effects of dietary intake, appetite, and eating habits on dialysis and non-dialysis treatment days in hemodialysis patients: cross-sectional results from the HEMO study.
abstract: OBJECTIVE
  To evaluate differences between dietary energy intake (DEI), dietary protein intake (DPI), appetite, dietary patterns, and eating habits during dialysis treatment days (DD) and non-dialysis treatment days (NDD) in 1,901 adults receiving maintenance hemodialysis who were enrolled in the baseline phase of the National Institutes of Health-sponsored Hemodialysis (HEMO) study.
  
  
  METHODS
  A cross-sectional analysis of participants at baseline (before randomization).
  
  
  METHODS
  Fifteen clinical centers across the United States.
  
  
  METHODS
  DEI, DPI, and self-reported assessment of appetite, dietary patterns, and eating habits.
  
  
  RESULTS
  For the entire study cohort, total mean (+/- SD) DEI (1,566 +/- 636 kcal/day) and weight-adjusted DEI (23.2 +/- 9.5 kcal/kg/day) were significantly higher (P <.0001) on NDD than on DD (1,488 +/- 620 kcal/day and 22.2 +/- 9.6 kcal/kg/day), respectively. Similarly, DPI was significantly higher (P <.0001) on NDD (65.0 +/- 29.0 g/day and 0.96 +/- 0.43 g/kg/day) than on DD (60.2 +/- 26.5 g/day and 0.90 +/- 0.41 g/kg/day). On DD and NDD, the mean weight-adjusted DEI for the entire cohort was less than the HEMO study standard of care (SOC) of > or =28 kcal/kg/day, whereas on NDD, several subgroups reported dietary protein intakes that were closer to the study's SOC. These included men, patients under 50 years of age, nonblack participants, those without diabetes, those with a normal or mild Index of Co-Existing Disease score, and those on dialysis for more than 5 years. Protein and energy intakes declined with worsening self-reported appetites in both DD and NDD after adjusting for other subgroup effects.
  
  
  CONCLUSIONS
  Dietary energy and protein intakes of HEMO study participants were lower on DD than on NDD, and also lower than the SOC on both days, particularly with regard to energy intake. People receiving maintenance hemodialysis should be counseled to consume adequate amounts of energy and protein daily, especially on DD. Practitioners should monitor closely those patients who report poor appetite and should intervene appropriately.
authors.affiliation: Division of Nephrology and Hypertension, Beth Israel Medical Center, New York, NY, USA.
authors.forename: Jerrilynn D
authors.initials: JD
authors.lastname: Burrowes
authors.forename: Brett
authors.initials: B
authors.lastname: Larive
authors.forename: David B
authors.initials: DB
authors.lastname: Cockram
authors.forename: Johanna
authors.initials: J
authors.lastname: Dwyer
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: Sandra
authors.initials: S
authors.lastname: McLeroy
authors.forename: Diane
authors.initials: D
authors.lastname: Poole
authors.forename: Michael V
authors.initials: MV
authors.lastname: Rocco
mesh_terms: D000328:Adult; D000368:Aged; D001066:Appetite / Q000502:physiology*; D015992:Body Mass Index; D001835:Body Weight; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004044:Dietary Proteins / Q000008:administration & dosage; D004435:Eating / Q000502:physiology*; D002149:Energy Intake / Q000502:physiology; D005247:Feeding Behavior / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D013997:Time Factors
chemical_list: D004044:Dietary Proteins