Is energy intake underreported in hemodialysis patients?

A cross-sectional study, with 344 patients stable adults, of ten hemodialysis centers in Goiânia-GO. Energy intake was assessed by six 24-hour dietary recalls and basal metabolic rate (BMR) was estimated using the Harris Benedict equation. It was considered as underreporting when the ratio between the average energy intake and basal metabolic rate was lower than1.27. For analysis of factors associated with underreporting, the Poisson regression with robust variance estimation was applied.

Results:

The prevalence of underreporting was 65.7%, being more significant in individuals who are overweight and in the non dialysis days. The result of the multivariate analysis identified four factors independently associated with the underreporting: being a female (PR = 1.27, CI = 1.10 to 1.46), body mass index ≥ 25 kg/m² (PR = 1.29, CI = 1.12 to 1.48), three meals or lower/day (PR = 1.31, CI = 1.14 to 1.51) and hemodialysis length lower than 5 years (PR = 1.19CI = 1.01 to 1.40).

Conclusion:

The population showed a high prevalence of underreporting of energy intake. Being a female, presenting overweight, lower number of meals/day and lower length time on hemodialysis were factors associated with underreporting.

Keywords:
energy intake; kidney failure, chronic; renal dialysis; self report

Characteristics (n = 344)	n (%) or mean ±SD
Age (years)	49.33 ± 13.76^* * Mean ± standard deviation;
Gender
Males	204 (59.30)
Sedentary lifestyle	274 (79.65)
CKD etiology^ Chronic kidney disease;
Hypertensive nephrosclerosis	130 (37.70)
Glomerulonephritis	67 (19.50)
Diabetic nephropathy	54 (15.70)
Undetermined	26 (7.60)
Others	67 (19.50)
Comorbidities
Arterial hypertension	228 (66.28)
Diabetes	12 (3.49)
Arterial hypertension + Diabetes	40 (11.63)
Non-existent	51 (14.83)
Others	13 (3.77)
Time on hemodialysis
< 5 years	216 (62.79)
≥ 5 years	128 (37.21)
Body Mass Index
< 18.5 kg/m²	30 (8.72)
18.5 - 24.99 kg/m²	203 (59.01)
≥ 25 kg/m²	111 (32.27)
Daily intake
Energy (kcal)	1490.3 (1269.5-1840.1)^* ***** Median (percentile 25-75),
Energy/kg of ideal weight or adjusted (kcal)	25.4 ± 7.4
Carbohydrate (%)	54.52 ± 4.66
Protein (%)	15.47 ± 2.27
Protein/kg ideal or adjusted weight (g)	0.97 ± 0.27
Lipids (%)	30.00 ± 3.60
Basal Metabolism Rate	1368.0 (1242.7-1534.1)^* ***** Median (percentile 25-75),
EI/BMR^# # Ratio between energy intake and basal metabolism rate.	1.13 ± 0.27

Variable	BMI < 25kg/m² (n = 233)	BMI ≥ 25kg/m² (n = 111)
Variable	Mean ± dp^* * Standard deviation; or n(%)	Mean ± dp^* ** Teste t independente ou Qui-quadrado de Pearson; or n (%)
Underreporting	139 (59.7)	87 (78.4)	0.001
EI^* ***** EI: Energy Intake in kcal/day;	1577.4 ± 420.4	1616.4 ± 549.7	0.468
EI/kg ^# # EI/kg: energy intake by kilogram of ideal or adjusted weight;	27.4 ± 7.0	21.2 ± 6.6	< 0.001
BMR^¶ ¶ BMR: Basal Metabolic Rate in kcal/day;	1338.6 ± 174.1	1531.6 ± 234.5	< 0.001
EI/BMR^§ § EI/BMR: energy intake and basal metabolic rate ratio.	1.17 ± 0.26	1.05 ± 0.28	< 0.001

Variables (n = 344)	Days on dialysis	Days off dialysis	p ^* * Paired t-Test, Wilcoxon or Descartes rule of signs;
Underreporting^ EI/BMR < 1.27; (n,%)	211 (61.3)	256 (74.4)	< 0.001
Kcal/day	1576.5(1309.2-1893.8)^* ***** median;	1439.3(1185.4-17.89.1)^* ***** median;	< 0.001
Carbohydrate (%)	54.8 ± 5.4	54.2 ± 5.7	0.067
Protein (%)	15.42 ± 2.3	15.4 ± 2.6	0.082
Lipids (%)	29.7 ± 4.1	30.2 ± 4.7	0.490
	Under-reporters (n = 226)	Valid reporters (n = 118)	p ^# # Independent t-test.
Kcal/day	1364.3 ± 283.7	2022.4 ± 283.7	< 0.001
Carbohydrate (%)	54.3 ± 4.9	55.0 ± 4.2	0.139
Protein (%)	15.9 ± 2.4	14.7 ± 1.8	< 0.001
Lipids (%)	29.9 ± 3.5	30.2 ± 3.7	0.403

Variáveis (n = 344)	Prevalence (n/%)	Gross PR^* * Prevalence ratios; (IC^ Confidence interval; 95%)	p ^# # Simple Poisson regression.
Gender
Males	121 (59.31)	1	0.002
Females	105 (75.00)	1.26 (1.08-1.46)	0.002
Age
< 60 years	164 (63.57)	1	0.125
≥ 60 years	62 (72.09)	1.13 (0.96-1.33)	0.125
Escolaridade
≤ 8 years	160 (70.18)	1.23 (1.03-1.47)	0.022
> 8 years	66 (56.90)	1	0.022
Family income
≤ 2 minimum wages	110 (67.90)	1.06 (0.91-1.24)	0.416
> 2 minimum wages	116 (63.74)	1	0.416
Occupation
Working	45 (56.25)	1	0.065
Not working	181 (68.56)	1.21 (0.98-1.50)	0.065
Marital status
With a spouse	136 (67.00)	1.04 (0.89-1.22)	0.547
Without a spouse	90 (63.83)	1	0.547
Diabetes
No	187 (64.26)	1	0.147
Yes	39 (73.58)	0.87 (0.72-1.04)	0.147
Time in hemodialysis
≤ 5 years	151 (69.91)	1.19 (1.01-1.41)	0.042
> 5 years	75 (58.59)	1	0.042
BMI^* ***** Body mass index;
< 25 kg/m²	139 (59.66)	1	0.000
≥ 25 kg/m²	87 (78.38)	1.31 (1.13-1.51)	0.000
Meals/day
≤ 3	98 (76.56)	1.29 (1.11-1.49)	0.001
> 3	128 (59.26)	1	0.001

Variables (n = 344)	RP^* * Prevalence ratio; (IC^ Confidence interval; 95%)	p ^* ***** Poisson regression with a robust variance estimate.
Gender
Males	1	0.001
Females	1.27 (1.10-1.46)	0.001
Body Mass Index
< 25 kg/m²	1	0.000
≥ 25 kg/m²	1.29 (1.12-1.48)	0.000
Meals/day
≤ 3	1.31 (1.14-1.51)	0.000
> 3	1	0.000
Time in hemodialysis
≤ 5 years	1.19 (1.01-1.40)	0.030
> 5 years	1	0.030

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[1] Inaiana Marques Filizola Vaz. Hospital das Clinicas da Universidade Federal de Goiás. 1ª avenida, s/nº, St Leste Universitário, Goiânia,GO, Brasil. CEP: 74605-08. E-mail: inaianaufg@gmail.com