Valoración de la ingesta en hemodiálisis mediante un cuestionario de consumo alimentario y apetito

espanolDentro del origen multifactorial de la malnutricion en hemodialisis periodica (HDP) la ingesta inadecuada es una causa importante, valorandose habitualmen- te mediante registro de consumo alimentario (RCA). Con el objetivo de detectar de forma sencilla y rapida un apobre ingesta, se desarrolla un Cuestionario de Consumo Alimentario y Apetito (CCAA) y se estima su capacidad para predecir un aporte proteico-calorico inadecuado, tomando como patron de referencia el RCA. Asi mismo se analiza la capacidad predictiva de insuficiente ingesta pro- teica que ofrece la tasa de catabolismo proteico (PCR) y se estudia si existen di- ferencias en los valores del RCA y del CCAA entre los dias de dialisis y los dias sin dialisis. Se incluyen en el estuio 44 pacientes en HDP en situacion clinica estable. Para la evaluacion de la ingesta se utilizo el metodo de RCA mixto (mediante pesada y entrevista) de dos dias (uno de dialisis y uno de no dialisis). Se determino el PCR y se desarrollo el CCAA, un cuestionario de 34 items acerca de la adecua- cion de la dieta y el nivel de apetito. Se realiza una baremacion del CCAA y se constrastan estos datos y los valores del PCR con el RCA mediante el analisis de curva ROC. La ingesta proteica media fue de 1,3 ± 0,3 g/kg/dia y la calorica de 29,2 ± 6 kcal/kg/dia segun RCA. El PCR medio fue de 1,14 ± 0,3. Al relacionar el CCAA con el RCA obtenemos un area bajo curva de 0,84 (IC 0,70-0,93) para la inges- ta proteica y de 0,73 (IC 0,57-0,85) para la calorica. El punto de corte en 18 ofre- ce unos valores de sensibilidad del 100% y especificidad del 44% para la de- teccion de pobre ingesta proteica ( EnglishProtein calorie malnutrition is a common complication in chronic hemodialysis patients (CHP). Although many factors could promote malnutrition, inadequate nu- trient intake seems to be one of the most important. An Appetite and Diet Assess- ment Questionaire (ADAQ) was developed, and we have performed a cross-sectio- nal study in 44 CHP to investigate its capacity to predict an inadequate intake. Dietary evaluation was based on a diet diary-assisted recalls (DDAR). On the other hand, the validity of PCR and the differences in the DDAR and ADAQ between the days of dialysis and the days without dialysis were studied. The predictive value of inadequate intake of the ADAQ and the PCR were analysed with the ROC curve. The protein intake was 1.3 ± 0.3 g/kg/day and the energy intake 29.2 ± 0.6 kcal/kg/day. The average PCR was 1.14 ± 0.3. The ROC curve to predict inadequa- te intake from the ADAQ shows an area under the curve of 0.84 for the protein in- take and 0.73 for the energy intake. A cut-off ponit of 18 gives a sensitivity of 100% and a specifity of 44% for the detection of poor protein intake ( The ROC curve to predict inadequate protein intake from the PCR obtains an area under the curve of 0.81. The cut-off 1.06 gives the best sensitivity (100%) and specifity (64%) for the detection of insufficient protein intake. We did not find any significant difference in the DDAR or in the ADAQ between the days of dialy- sis and the days without dialysis. Despite the subjective interpretation, the relationship between ADAQ and pro- tein-energy intakes analysed by DDAR was highly significant. The questionnaire is simple and can therefore be used as a screening rest to detect and correct al- terations in the diet which could otherwise lead to malnutrition. The determina- tion of PCR gives a good sensitivity and specifity for the detection of poor pro- tein intake, although the results are modified in anabolic or catabolic states which can clinically go undetected. We do not register differences in diet between the days of dialysis and the days without dialysis.