Disturbed appetite patterns and nutrient intake in peritoneal dialysis patients.
OBJECTIVE
Malnutrition is common among peritoneal dialysis (PD) patients. Reduced nutrient intake contributes to this. It has long been assumed that this reflects disturbed appetite. We set out to define the appetite profiles of a group of PD patients using a novel technique.


METHODS
Prospective, cross-sectional comparison of PD patients versus controls.


METHODS
Teaching hospital dialysis unit.


METHODS
39 PD patients and 42 healthy controls.


METHODS
Visual analog ratings were recorded at hourly intervals to generate daily profiles for hunger and fullness. Summary statistics were generated to compare the groups. Food intake was measured using 3-day dietary records.


METHODS
Hunger and fullness profiles. Derived hunger and fullness scores.


RESULTS
Controls demonstrated peaks of hunger before mealtimes, with fullness scores peaking after meals. The PD profiles had much reduced premeal hunger peaks. A postmeal reduction in hunger was evident, but the rest of the trace was flat. The PD fullness profile was also flatter than in the controls. Mean scores were similar despite the marked discrepancy in the profiles. The PD group had lower peak hunger and less diurnal variability in their hunger scores. They also demonstrated much less change in fullness rating around mealtimes, while the mean and peak fullness scores were little different. The reported nutrient intake was significantly lower for PD.


CONCLUSIONS
The data suggest that PD patients normalize their mean appetite perception at a lower level of nutrient intake than controls, suggesting that patient-reported appetite may be misleading in clinical practice. There is a loss of the usual daily variation for the PD group, which may contribute to their reduced food intake. The technique described here could be used to assess the impact of interventions upon the abnormal PD appetite profile.
Wright
Mark
M
Renal Unit, Leeds General Infirmary, Leeds, United Kingdom. Mark.wright@leedsth.nhs.uk
Woodrow
Graham
G
O'Brien
Siobahn
S
King
Neil
N
Dye
Louise
L
Blundell
John
J
Brownjohn
Aleck
A
Turney
John
J
D000328:Adult; D000368:Aged; D001066:Appetite; D003430:Cross-Sectional Studies; D002149:Energy Intake; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010530:Peritoneal Dialysis / Q000009:adverse effects; D011446:Prospective Studies