title: Dialysis Malnutrition and Malnutrition Inflammation Scores: screening tools for prediction of dialysis-related protein-energy wasting in Malaysia.
abstract: OBJECTIVE
  Malnutrition is highly prevalent in Malaysian dialysis patients and there is a need for a valid screening tool for early identification and management. This cross-sectional study aims to examine the sensitivity of the Dialysis Malnutrition Score (DMS) and Malnutrition Inflammation Score (MIS) tools in predicting protein-energy wasting (PEW) among Malaysian dialysis patients.
  
  
  METHODS
  A total of 155 haemodialysis (HD) and 90 peritoneal dialysis (PD) patients were screened for risk of malnutrition using DMS and MIS and comparisons were made with established guidelines by International Society of Renal Nutrition and Metabolism (ISRNM) for PEW.
  
  
  RESULTS
  MIS cut-off score of >=5 indicated presence of malnutrition in all patients. A total of 59% of HD and 83% of PD patients had PEW by ISRNM criteria. Based on DMS, 73% of HD and 71% of PD patients exhibited moderate malnutrition, whilst using MIS, 88% and 90%, respectively were malnourished. DMS and MIS correlated significantly in HD (r2=0.552, p<0.001) and PD (r2=0.466, p<0.001) patients. DMS and MIS had higher sensitivity values in PD (81% and 82%, respectively) compared to HD (59% and 60%, respectively) patients.
  
  
  CONCLUSIONS
  The MIS cut-off scores for malnutrition classification were established (score >=5) for use amongst Malaysian dialysis patients. Both DMS and MIS are valid tools to be used for nutrition screening of dialysis patients especially those undergoing peritoneal dialysis. The DMS may be a more practical and simpler tool to be utilized in the Malaysian dialysis settings as it does not require laboratory markers.
authors.affiliation: Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia.
authors.forename: Gilcharan Singh
authors.initials: GS
authors.lastname: Harvinder
authors.affiliation: Department of Nutrition & Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia. Email: winnie_chee@imu.edu.my.
authors.forename: Winnie Chee Siew
authors.initials: WC
authors.lastname: Swee
authors.affiliation: Dietetics Program, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia.
authors.forename: Tilakavati
authors.initials: T
authors.lastname: Karupaiah
authors.affiliation: Dietetics Program, Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia.
authors.forename: Sharmela
authors.initials: S
authors.lastname: Sahathevan
authors.affiliation: Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Karuthan
authors.initials: K
authors.lastname: Chinna
authors.affiliation: Nephrology Department of Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
authors.forename: Ghazali
authors.initials: G
authors.lastname: Ahmad
authors.affiliation: Nephrology Department of Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
authors.forename: Sunita
authors.initials: S
authors.lastname: Bavanandan
authors.affiliation: Nephrology Department of Serdang Hospital, Kuala Lumpur, Malaysia.
authors.forename: Bak Leong
authors.initials: BL
authors.lastname: Goh
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D015992:Body Mass Index; D004032:Diet; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis* / Q000209:etiology; D007501:Iron / Q000378:metabolism; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects; D011502:Protein-Energy Malnutrition / Q000175:diagnosis* / Q000209:etiology; D012372:ROC Curve; D006435:Renal Dialysis / Q000009:adverse effects*; D015203:Reproducibility of Results; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D019282:Wasting Syndrome / Q000175:diagnosis*
chemical_list: D012709:Serum Albumin; D007501:Iron