• Users Online: 114
  • Print this page
  • Email this page

Table of Contents
Year : 2018  |  Volume : 3  |  Issue : 1  |  Page : 9-10

Assessing nutritional status – Quick tools

1 PhD Scholar, Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Malaysia
2 Senior Lecturer, Dept. of Nutrition and Dietetics, Universiti Putra Malaysia, Malaysia
3 SRI Professor, School of BioSciences, Faculty of Health & Medical Sciences, Taylor's University Malaysia, Malaysia

Date of Web Publication16-May-2018

Correspondence Address:
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2395-1540.232540

Get Permissions

How to cite this article:
Sahathevan S, Hock KB, Mat Daud Z, Karupaiah T. Assessing nutritional status – Quick tools. J Renal Nutr Metab 2018;3:9-10

How to cite this URL:
Sahathevan S, Hock KB, Mat Daud Z, Karupaiah T. Assessing nutritional status – Quick tools. J Renal Nutr Metab [serial online] 2018 [cited 2019 Jun 25];3:9-10. Available from: http://www.jrnm.in/text.asp?2018/3/1/9/232540

Subjective Global Assessment (SGA) has been widely used to assess nutritional status in dialysis patients as its association with other nutritional markers has been reported by many studies[1],[2]. In addition, SGA was shown to have high predictive value towards mortality especially in dialysis population[1]. KDOQI has recommended SGA to be an appropriate nutritional assessment tool[3]. However, the semi-quantitative feature of the SGA limits its' reliability and precision as reported by Kalantar-Zadeh et al. (1999)[4]. On the other hand, SGA and its modifications such as Dialysis Malnutrition Score (DMS) and Malnutrition Inflammation Score (MIS) can be used as nutrition scoring system to assess presence of malnutrition[5]. DMS was a fully quantitative scoringbased tool, which used the components of the conventional SGA and was proposed to be a quicker and superior tool compared to SGA[4]. MIS was a better version of DMS which included 3 new elements that is body mass index, serum albumin and transferrin concentrations, making it more comprehensive and was proposed to address the main issue related to dialysis patients which is malnutrition-inflammation complex syndrome.[3]

  The Dialysis Malnutrition Score (DMS) Top

The DMS consisting of the 7 original SGA components (weight change, dietary intake, gastrointestinal symptoms, functional capacity, disease and physical examination of signs of muscle and fat wasting) provides a 5-point scale ranging from 1 (normal) to 5 (very severe malnutrition)[4],[6],[7]. Cumulative scores from total assessment range from 7 to 35 with rating varying from normal to moderate to severe malnutrition. Higher scores are indicative of increasing severity of malnutrition. The rating for DMS originated from the Dialysis Outcomes and Practice Patterns Study where patients were scored as normal, moderate (if any 3 areas or DMS component was rated as a moderate or severe level), or severe (at least 3 areas or DMS component was rated at severe level).[7]

  Malnutrition Inflammation Score (MIS) Top

MIS is based on the 7 components of SGA with the addition of body mass index, serum albumin and serum total iron binding capacity and each component is scored using a 4-point scale with 0 (normal) to 3 (very severe)[3]. The cumulative score ranges from 0 (normal) to 30 (severely malnourished). Similar to DMS, higher scores are indicative of increasing severity of malnutrition. The categorization for MIS was adapted from a Japanese HD patient population study[8] where patients were categorized as normal nutrition (score: 0-5), mild malnutrition (score: 6-10) and moderate-to-severe malnutrition (> 11).

  Geriatric Nutritional Risk Index (GNRI) Top

The GNRI has its origin in the NRI[9] which was initially developed to rate the severity of postoperative complications in surgical patients, by incorporating two objective measures namely serum albumin and weight loss. The NRI was later applied to identify risk of malnutrition in all hospitalized patients[10]. For its application in the geriatric CKD population, the GNRI was calculated based on serum albumin and body weight information, as per the into a formula: GNRI = [1.489 x albumin (g/dL)] + [41.7 x body weight/ideal body weight].[8],[11] Body weight or ideal body weight (IBW) is scored as 1 when the patient's body weight exceeded the IBW. IBW was calculated at BMI 22 kg/m2. The final GNRI score was categorized as <82 as severe malnutrition; score 82-92 as moderate malnutrition, score 92-98 as low risk malnutrition and >98 as no risk of malnutrition.

  Appetite and Dietary Assessment Tool (ADAT) Top

Poor appetite is causative of malnutrition and anorexia in end stage renal disease patients and is a risk factor for hospitalization and mortality[12],[13]. Indeed, many studies have explored appetite as a nutritional status indicator in the dialysis population[3],[14],[15]. Appetite assessment has also been suggested as potential marker for protein energy wasting by the International Society of Renal and Nutritional Metabolism guideline[5]. The discrepancy of high nutrient requirement and low nutrient intake indicates that there is a disruption in the appetite regulation systems[16]. In the PATCH study we are gauging HD patient's appetite using the first question from the original 44-item ADAT used in the Hemodialysis Study Group study[17]. This is a single, self-administered question with multiple-choice responses: During the past week (7 days), how would you rate your appetite? Patients are required to indicate their responses using a scale of 1 to 5: 1) very good, 2) good, 3) fair, 4) poor or 5) very poor. The question is administered to patients in bilingual versions of Malay and English languages.

  References Top

Locatelli, F., Fouque, D., Heimburger, O., Drüeke, T.B., Cannata-Andía, J.B., Hörl, W.H. &Ritz, E. 2002. Nutritional status in dialysis patients: A European consensus. Nephrology DialysisTransplant 17: 563-572.  Back to cited text no. 1
Dombros, N.V. 2001. Pathogenesis and management of malnutrition in chronic peritonealdialysis patients. Nephrology Dialysis Transplant 16(6): 111-113.  Back to cited text no. 2
Kalantar-Zadeh, K., Ikizler, T.A., Block, G., Avram, M.M. & Kopple, J.D. 2003. MalnutritionInflammation complex syndrome in dialysis patients: causes and consequences. AmericanJournal of Kidney Diseases 42(5): 864-881.  Back to cited text no. 3
Kalantar-Zadeh, K., Kleiner, M., Dunne, E., Lee, G.H. &Luft F.C. 1999. A modified subjective global assessment of nutrition for dialysis patients. Nephrology Dialysis Transplant 14: 1732-1738.  Back to cited text no. 4
Fouque, D., Kalantar-Zadeh, K., Kopple, J., Cano, N., Chauveau, P., Cuppari, L., Franch, H., Guarnieri, G., Ikizler, T.A., Kaysen, G., Lindholm, B., Massy, Z., Mitch, W., Pineda, E., Stenvinkel, P., Trevinho-Becerra, A. &Wanner, C. 2008. A proposed nomenclature anddiagnostic criteria for protein–energy wasting in acute and chronic kidney disease. KidneyInternational 73: 391–398.  Back to cited text no. 5
Pifer, T. B., Mccullough, K. P., Port, F. K., Goodkin, D. A., Maroni, B. J., Held, P. J., & Young, E. W. 2002. Mortality risk in hemodialysis patients and changes in nutritional indicators:DOPPS.Kidney International 62: 2238-2245.  Back to cited text no. 6
Steiber, A.L., Kalantar-Zadeh, K., Secker, D., McCarthy, M., Sehgal, A. & McCann, L. 2004. Subjectiveglobal assessment in chronic kidney disease: A review. Journal of Renal Nutrition 14(4): 191-200.  Back to cited text no. 7
Yamada, K., Furuya, R., Takita, T., Maruyama, Y., Yamaguchi, Y., Ohkawa, S. &Kumagai H.2008. Simplified nutritional screening tools for patients on maintenance hemodialysis. AmericanJournal of Clinical Nutrition 87: 106 –13.  Back to cited text no. 8
Buzby GP, Williford WO, Peterson OL, et al. A randomized clinical trial of total parenteral nutrition in malnourished surgical patients: the rationale and impact of previous clinical trials and pilot study on protocol design. Am J Clin Nutr 1988;47 (suppl):357– 365.  Back to cited text no. 9
Bouillanne O., Morineau G., Dupont C., et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 2005;82: 777– 783.  Back to cited text no. 10
Oliveira, et al. 2015. Correlation Between Nutritional Markers and Appetite Self-Assessments in Hemodialysis Patients. Journal of Renal Nutrition 23(3): 301-307.  Back to cited text no. 11
Heng, A.E. & Cano, N.J.M. 2009. Nutritional problems in adult patients with stage 5 chronickidneydisease on dialysis (both haemodialysis and peritoneal dialysis). NephrologyDialysisTransplant Plus 3:109-117.  Back to cited text no. 12
Kuhlmann, M.K., Kribben, A., Wittwer, M. &Hörl, W.H. 2007. OPTA-malnutrition in chronicrenal failure.Nephrology Dialysis Transplant 22(3): 13-19.  Back to cited text no. 13
Burrowes, J.D., Larive, B., Chertow, G.M., Cockram, D.B., Dwyer, J.T., Greene, T., Kusek, J.W., Leung, J. &Rocco, M.V. 2005. Self-reported appetite, hospitalization and death inhaemodialysis patients: Findingsfrom the Hemodialysis (HEMO) Study. Nephrology DialysisTransplant 20: 2765–2774.  Back to cited text no. 14
Carrero JJ, Qureshi AR, Axelsson J, et al. (2007). Comparison of nutritional and inflammatorymarkers in dialysis patients with reduced appetite. American Journal of Clinical Nutrition 85: 695–701.  Back to cited text no. 15
Wright, M., Woodrow, G., O'Brien, et al. 2003. Disturbed appetite patterns and nutrient intake inperitoneal dialysis patients. PeritonealDialysisInternational 23: 550-556.  Back to cited text no. 16
Burrowes, J. D., Powers, S. N., Cockram, D. B., et al. 1996. Use of an Appetite and DietAssessment Tool in the pilot phase of a hemodialysisclinical trial: Mortality and morbidity inhemodialysis study. Journal of Renal Nutrition 6(4): 229-232.  Back to cited text no. 17


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
The Dialysis Mal...
Malnutrition Inf...
Geriatric Nutrit...
Appetite and Die...

 Article Access Statistics
    PDF Downloaded76    
    Comments [Add]    

Recommend this journal