Performance of subjective global assessment and malnutrition inflammation score for monitoring the nutritional status of older adults on hemodialysis

Abstract

Background & aims: Studies assessing the performance of 7-point subjective global assessment (7p-SGA) and malnutrition inflammation score (MIS) to assess longitudinal changes in nutritional status are lacking. Thus, we aimed to investigate whether longitudinal changes in 7p-SGA and MIS were associated with changes in objective parameters of nutritional status, as well as to evaluate the prognostic value of 7p-SGA and MIS on hospitalization events.

Methods: One hundred and four patients aged ≥60 years (70.2% male, age: 70.9 ± 6.9 years) on maintenance hemodialysis were studied. The 7p-SGA, MIS and objective parameters of nutritional status (anthropometrics, muscle strength, body cell mass and phase angle assessed by bioelectrical impedance analysis - BIA, albumin, creatinine and C-reactive protein) were assessed at baseline and 12 months after the enrollment. Follow-up for hospitalization events were carried out at 13.0 (interquartile range: 3.0; 21.0) months after the first year of enrollment.

Results: Analysis of repeated measures, stratified by gender, and adjusted for age and dialysis vintage, showed that for men, a 1-unit change in 7p-SGA was significantly associated (P < 0.05) with changes in all anthropometrics, muscle strength and BIA parameters. For women, changes in 7p-SGA were associated with most of the anthropometrics, muscle strength and BIA parameters. Similarly, for both genders, changes in MIS were associated with changes in most anthropometric, muscle strength, BIA measurements, albumin (only for men), and creatinine (only for women). In addition, when assessed by 7p-SGA, patients with a declining nutritional status had a higher relative risk (RR) of hospitalization events [RR: 2.08 (95 CI: 1.44-2.99; P < 0.001)] and length of hospital stay (days) [RR: 3.73 (95 CI: 3.29-4.22; P < 0.001)].

Conclusions: Longitudinal changes in 7p-SGA and MIS were associated with changes in most of the objective parameters tested during 12 months of follow-up. Furthermore, a declining 7p-SGA score predicted a greater number of hospitalization events and days of hospital stay.

Keywords: Elderly; Hemodialysis; Malnutrition inflammation score; Protein energy wasting; Subjective global assessment.