title: Effect of intensive nutritional counseling and support on clinical outcomes of hemodialysis patients.
abstract: OBJECTIVE
  Protein-energy wasting is frequently found in patients on hemodialysis (HD). Anorexia and hypophagia contribute to malnutrition and increased morbidity and mortality, but the clinical impact of correcting hypophagia remains uncertain. We evaluated whether the correction of hypophagia influences morbidity and mortality in anorexic patients on HD.
  
  
  METHODS
  Thirty-four patients on HD were enrolled in a 2-y follow-up program including regular nutritional assessments. Patients not meeting the nutritional requirements during the follow-up received nutritional counseling, consisting of advice, individually tailored diets, and, for a failed dietary intervention, artificial nutrition. Biochemical, anthropometric, and body composition parameters, morbidity, and mortality were recorded in all patients at 12 and 24 mo.
  
  
  RESULTS
  At baseline, 14 patients (41%) were anorexic, and 20 patients (59%) were non-anorexic. Anorexic patients were hypophagic and presented with a decreased fat-free mass. After 12 and 24 mo, cholesterol, albumin, lymphocyte count, and body mass index did not differ between the groups, whereas fat-free mass (percentage) in supplemented anorexic patients significantly improved in no longer differing from non-anorexic patients (65.8 ± 4.4 versus 65.4 ± 8.9, respectively, P = NS; 65.8 ± 4.4 versus 66.7 ± 10.78, respectively, P = NS). Morbidity and mortality were not different between the two groups.
  
  
  CONCLUSIONS
  In patients on HD, nutritional counseling and nutritional support positively affect the nutritional status in hypophagic patients and make the risk of morbidity and mortality in anorexic patients comparable to those of non-anorexic patients.
authors.affiliation: Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Molfino
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Chiappini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Laviano
authors.forename: Thomas
authors.initials: T
authors.lastname: Ammann
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Bollea
authors.forename: Filippo
authors.initials: F
authors.lastname: Alegiani
authors.forename: Filippo
authors.initials: F
authors.lastname: Rossi Fanelli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Muscaritoli
mesh_terms: D000328:Adult; D000368:Aged; D000855:Anorexia / Q000178:diet therapy* / Q000453:epidemiology / Q000209:etiology / Q000378:metabolism; D001823:Body Composition; D001825:Body Fluid Compartments / Q000378:metabolism*; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D003376:Counseling; D002149:Energy Intake; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000178:diet therapy* / Q000628:therapy; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D009752:Nutritional Status; D015995:Prevalence; D011502:Protein-Energy Malnutrition / Q000178:diet therapy* / Q000209:etiology / Q000628:therapy; D006435:Renal Dialysis; D012709:Serum Albumin; D019282:Wasting Syndrome / Q000178:diet therapy* / Q000209:etiology / Q000628:therapy
chemical_list: D012709:Serum Albumin; D002784:Cholesterol