title: Effect of behavioral stage-based nutrition education on management of osteodystrophy among hemodialysis patients, Lebanon.
abstract: OBJECTIVE
  Assess the effect of intensive nutrition education by trained dedicated dietitians on osteodystrophy management among hemodialysis patients.
  
  
  METHODS
  Randomized controlled trial in 12 hospital-based hemodialysis units equally distributed over clusters 1 and 2. Cluster 1 patients were either assigned to usual care (n=96) or to individualized intensive staged-based nutrition education by a dedicated renal dietitian (n=88). Cluster 2 patients (n=210) received nutrition education from general hospital dietitians, educating their patients at their spare time from hospital duties. Main outcomes were: (1) dietary knowledge(%), (2) behavioral change, (3) serum phosphorus (mmol/L), each measured at T0 (baseline), T1 (post 6 month intervention) and T2 (post 6 month follow up).
  
  
  RESULTS
  Significant improvement was found only among patients receiving intensive education from a dedicated dietitian at T1; the change regressed at T2 without statistical significance: knowledge (T0: 40.3; T1: 64; T2: 63) and serum phosphorus (T0: 1.79; T1: 1.65; T2: 1.70); behavioral stages changed significantly throughout the study (T0: Preparation, T1: Action, T2: Preparation).
  
  
  CONCLUSIONS
  The intensive protocol showed to be the most effective.
  
  
  CONCLUSIONS
  Integrating dedicated dietitians and stage-based education in hemodialysis units may improve the nutritional management of patients in Lebanon and countries with similar health care systems.
authors.affiliation: Maastricht University, Maastricht, 6200 MD Maastricht, The Netherlands. Electronic address: mirey.karavetian@zu.ac.ae.
authors.forename: Mirey
authors.initials: M
authors.lastname: Karavetian
authors.affiliation: Maastricht University, Maastricht, 6200 MD Maastricht, The Netherlands. Electronic address: n.devries@maastrichtuniversity.nl.
authors.forename: Nanne
authors.initials: N
authors.lastname: de Vries
authors.affiliation: Lebanese National Kidney Registry, Beirut, Lebanon. Electronic address: hafezein@aol.com.
authors.forename: Hafez
authors.initials: H
authors.lastname: Elzein
authors.affiliation: Maastricht University, Maastricht, 6200 MD Maastricht, The Netherlands. Electronic address: r.rizk@maastrichtuniversity.edu.
authors.forename: Rana
authors.initials: R
authors.lastname: Rizk
authors.affiliation: Université Saint Joseph, Beirut, Lebanon. Electronic address: fida_b88@hotmail.com.
authors.forename: Fida
authors.initials: F
authors.lastname: Bechwaty
mesh_terms: D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000628:therapy*; D003376:Counseling; D004032:Diet; D019468:Disease Management; D005247:Feeding Behavior / Q000523:psychology*; D006266:Health Education; D006801:Humans; D007861:Lebanon; D064686:Nutritionists; D010758:Phosphorus / Q000097:blood; D006435:Renal Dialysis
chemical_list: D010758:Phosphorus
keywords: Behavioral change; Hemodialysis; Nutrition education; Osteodystrophy