Evaluating dietary guidelines using diet quality (DQ) offers valuable insights into the healthfulness of a population's diet. We conducted a forensic analysis using DQ metrics to compare the Malaysian Dietary Guidelines (MDG-2020) with its former version (MDG-2010) in relation to cardiometabolic risk (CMR) for an adult Malaysian population. A DQ analysis of cross-sectional data from the Malaysia Lipid Study (MLS) cohort (n = 577, age: 20-65yrs) was performed using the healthy eating index-2015 (HEI-2015) framework in conformation with MDG-2020 (MHEI
Protein-energy wasting (PEW) is a devastating metabolic derangement that leads to increased morbidity and mortality in hemodialysis (HD) patients. This study aimed to determine the diagnostic test accuracy of bioelectrical impedance analysis derived-phase angle (PhA) in detecting PEW among HD patients. This was a multi-centre, cross-sectional study conducted amongst 152 multi-ethnic HD patients in Klang Valley, Malaysia. PEW was assessed using the International Society of Renal Nutrition and Metabolism criteria as the reference method. PhA was measured using a multi-frequency bioelectrical impedance spectroscopy at 50 kHz. Multiple and logistic regressions were used to determine factors associated with PhA and PEW diagnosis, respectively. A receiver operating characteristics curve analysis was used to establish the gender-specific PhA cut-offs to detect PEW. PEW existed in 21.1% of the HD patients. PhA was found as an independent predictor of PEW (adjOR = 0.308, p = 0.001), with acceptable to excellent discriminative performance (adjAUCmale = 0.809; adjAUCfemale = 0.719). Male patients had higher PhA cut-off compared to female patients (4.26° vs. 3.30°). We concluded that PhA is a valid and pragmatic biomarker to detect PEW in multi-ethnic Malaysian HD patients and a gender-specific cut-off is necessary, attributed to the gender differences in body composition.
Dietary non-adherence is highly prevalent among maintenance hemodialysis (HD) patients resulting in multitudes health complications and poor treatment outcomes. Given high penetration of smartphone, well-designed mobile health apps emerged as a potential tool to empower HD patients with dietary self-management skills. This need analysis study determined the perception and expectation of patients and dietitians on the features and the use of apps in dialysis care to foster development of evidence-based renal diet apps. This was a mixed-method study with concurrent triangulation design. The quantitative arm involved HD patients (n = 184) through face-to-face interview and dietitians (n = 120) via anonymous online survey. While the qualitative arm consisted of 10 in-depth interviews (HD patients) and 8 email interviews (dietitians). Descriptive and thematic analyses were used, and the results were compared. A total of 69.6% of HD patients owned a smartphone. More than half (53.9%) of the smartphone users had the experience of searching health information especially nutrition-related topics (91.3%). Majority of them (78.9%) perceived renal diet apps as very important and were willing to use (80.5%). They agreed that renal diet apps can help them in preventing nutrition complications (82.0%), planning menu (78.9%) and monitoring nutrient intakes (82.8%). In the context of practising dietitians, 60.8% aware of the existence of renal diet apps but only 38.3% of them would recommend existing renal diet apps to their patients due to lack of local content (42.5%) and unsure credibility (37.5%). Most of them (88.3%) perceived that local-based renal diet app is needed and agreed that it can enhance dietetics care in HD population (90.8%). Top features anticipated by both patients and dietitians included plan or order, tailored assistance, usability and tracker. Dietary self-management via mobile health apps seems to be feasible in the dialysis population given the high smartphone penetration, strong desire to use and positive perceptions from patients and dietitians. Features valued by patients and dietitians will be integrated into the design of the apps to promote acceptance and usage. This project is funded by the internal grant of Universiti Putra Malaysia (Inisiatif Putra Muda).
Dietary non-adherence is prevalent in hemodialysis (HD) patients. Limited health literacy is a recognized contributing factor to non-adherence in patients with chronic kidney disease. This study aimed to investigate health literacy in the context of dietary knowledge, health belief, self-management skill and dietary adherence in Malaysian HD patients.
With the unprecedented growth of mobile technology, a plethora of dialysis diet apps have been developed to promote patient dietary self-management. Nevertheless, the utility of such apps remains questionable.This study aimed to evaluate the content, features, and quality of commercial dialysis diet apps for adult dialysis patients.This study consisted of a quantitative content analysis of commercial dialysis diet apps downloaded from Google Play and the Apple App Store available in the Asian marketplace, searched for using the following keywords in English: dialysis diet and diet for kidney disease. Free and paid apps available in English that provide nutrition information for adult dialysis patients were included. Apps that were not relevant to the dialysis diet, not meant for patient self-management, or redundant were excluded. Apps were evaluated for language medium (subscore=1), credibility (subscore=1), food database (subscore=1), valuable features (subscore=12), health-behavior theory constructs (subscore=60), and technical quality (subscore=25). The relationships among the variables of interest were determined by Pearson correlation. Stepwise multiple linear regression analysis was performed to identify the features that contribute to greater technical quality of dialysis diet apps. Statistical significance was defined as P<.05.A total of 22 out of 253 apps (8.7%) were eligible for evaluation. Based on a 100-point scale, the mean overall score of the apps was 31.30 (SD 14.28). Only 5% (1/22) of the apps offered relevant language options, and 46% (10/22) contained food databases. In addition, 54% (12/22) of the apps were not credible. The mean score for valuable features was 3.45 (SD 1.63) out of 12, in which general education (16/22, 73%), free download (15/22, 68%), and usability (13/22, 59%) were the three most popular features. However, the apps scored a mean of 13.41 (SD 11.56) out of 60 for health-behavior theory constructs. The overall app technical quality was considered poor, with a mean score of 2.70 (SD 0.41) out of 5. The scores of valuable features (r=.65, P=.001) and health-behavior theory constructs (r=.55, P=.009) were positively correlated with the overall technical quality of the commercial dialysis diet apps. Features such as free download (β=.43, P=.03) and usability (β=.41, P=.03) could significantly determine the functional quality of the apps. Health-behavior theory constructs such as self-monitoring could significantly predict both the subjective quality (β=.55, P=.008) and the engagement quality (β=.66, P=.001) of the apps, whereas the information quality domain could be determined by plan or orders (β=.48, P=.007) and knowledge (β=.45, P=.01).Although most of the available commercial dialysis diet apps are free and easy to use, they are subject to theory deficiency, limited language options, and a lack of food databases, credibility, tailored education, and overall technical quality.
BACKGROUND With the unprecedented growth of mobile technology, a plethora of dialysis diet apps have been developed to promote patient dietary self-management. Nevertheless, the utility of such apps remains questionable. OBJECTIVE This study aimed to evaluate the content, features, and quality of commercial dialysis diet apps for adult dialysis patients. METHODS This study consisted of a quantitative content analysis of commercial dialysis diet apps downloaded from Google Play and the Apple App Store available in the Asian marketplace, searched for using the following keywords in English: <i>dialysis diet</i> and <i>diet for kidney disease</i>. Free and paid apps available in English that provide nutrition information for adult dialysis patients were included. Apps that were not relevant to the dialysis diet, not meant for patient self-management, or redundant were excluded. Apps were evaluated for language medium (subscore=1), credibility (subscore=1), food database (subscore=1), valuable features (subscore=12), health-behavior theory constructs (subscore=60), and technical quality (subscore=25). The relationships among the variables of interest were determined by Pearson correlation. Stepwise multiple linear regression analysis was performed to identify the features that contribute to greater technical quality of dialysis diet apps. Statistical significance was defined as <i>P</i><.05. RESULTS A total of 22 out of 253 apps (8.7%) were eligible for evaluation. Based on a 100-point scale, the mean overall score of the apps was 31.30 (SD 14.28). Only 5% (1/22) of the apps offered relevant language options, and 46% (10/22) contained food databases. In addition, 54% (12/22) of the apps were not credible. The mean score for valuable features was 3.45 (SD 1.63) out of 12, in which general education (16/22, 73%), free download (15/22, 68%), and usability (13/22, 59%) were the three most popular features. However, the apps scored a mean of 13.41 (SD 11.56) out of 60 for health-behavior theory constructs. The overall app technical quality was considered poor, with a mean score of 2.70 (SD 0.41) out of 5. The scores of valuable features (<i>r</i>=.65, <i>P</i>=.001) and health-behavior theory constructs (<i>r</i>=.55, <i>P</i>=.009) were positively correlated with the overall technical quality of the commercial dialysis diet apps. Features such as free download (β=.43, <i>P</i>=.03) and usability (β=.41, <i>P</i>=.03) could significantly determine the functional quality of the apps. Health-behavior theory constructs such as self-monitoring could significantly predict both the subjective quality (β=.55, <i>P</i>=.008) and the engagement quality (β=.66, <i>P</i>=.001) of the apps, whereas the information quality domain could be determined by plan or orders (β=.48, <i>P</i>=.007) and knowledge (β=.45, <i>P</i>=.01). CONCLUSIONS Although most of the available commercial dialysis diet apps are free and easy to use, they are subject to theory deficiency, limited language options, and a lack of food databases, credibility, tailored education, and overall technical quality.
Dietary non-adherence is pervasive in the hemodialysis (HD) population. Health literacy is a plausible predictor of dietary adherence in HD patients, but its putative mechanism is scarcely studied. Thus, this study aimed to establish the causal model linking nutrition literacy to dietary adherence in the HD population. This was a multi-centre, cross-sectional study, involving 218 randomly selected multi-ethnic HD patients from nine dialysis centres in Klang Valley, Malaysia. Dietary adherence and self-management skills were assessed using validated End-Stage Renal Disease Adherence Questionnaire and Perceived Kidney/Dialysis Self-Management Scale, respectively. Validated self-developed scales were used to gauge nutrition literacy, dietary knowledge and Health Belief Model constructs. Relationships between variables were examined by multiple linear regressions and partial least squares structural equation modeling. Limited nutrition literacy was evident in 46.3% of the HD patients, associated with older age, lower education level, and shorter dialysis vintage. Dietary adherence rate was at 34.9%. Nutrition literacy (β= 0.390, p < 0.001) was an independent predictor of dietary adherence, mediated by self-efficacy (SIE = 0.186, BC 95% CI 0.110-0.280) and self-management skills (SIE = 0.192, BC 95% CI 0.103-0.304). Thus, nutrition literacy-enhancing strategies targeting self-efficacy and self-management skills should be considered to enhance dietary adherence in the HD population.
Objective: Dialysate in peritoneal cavity is expected to affect multifrequency bioimpedance analysis measurement in peritoneal dialysis patients.Nevertheless, the extent of dialysate influence on multifrequency bioimpedance analysis measurement appears to be varied with the weight used in the calculation.Thus, this study aimed to evaluate the impact of dialysate on body composition when different weights were used in the multifrequency bioimpedance analysis measurement.Methods: This single-center study was conducted among 30 peritoneal dialysis patients in a tertiary referral hospital.Multifrequency bioimpedance analysis parameters were evaluated under 3 different conditions: (i) actual body weight without dialysate instilled (reference method); (ii) dialysate-included body weight with dialysate instilled (DIBW), and (iii) actual body weight with dialysate instilled (ABW).Differences, reproducibility, and agreements between the reference method with dialysate-included body weight and actual body weight methods were examined using repeated measure analysis of variance, intraclass correlation coefficients, and Bland-Altman analysis, respectively.Results: Pairwise comparisons showed significant differences (P <.05) between reference and DIBW in most multifrequency bioimpedance analysis parameters (10/14) except on intracellular water (P = .286),skeletal muscle mass (P = .518),skeletal muscle index (P = .079),and body cell mass (P = .357).Meanwhile, only extracellular water (P <.001), extracellular/ total body water (P <.001), and bone mineral content (P <.001) were significantly different for ABW when compared to the reference.Compared to DIBW, ABW showed lesser measurement bias, narrower 95% limit of agreement, and better reproducibility in most of the multifrequency bioimpedance analysis parameters with reference method. Conclusion:We concluded that dialysate-induced multifrequency bioimpedance analysis bias can be reasonably corrected using patient's actual body weight upon body composition assessment.
ObjectiveSarcopenia, characterized by the loss of muscle mass and function, is prevalent in peritoneal dialysis (PD) patients. Early diagnosis is crucial, but universal screening is often hindered by the complexity of diagnostic algorithms and limited clinical resources. Therefore, this study aims to investigate the ability of bioelectrical impedance analysis-derived phase angle (PhA), a convenient and cost-effective technique, in detecting sarcopenia among PD patients.MethodsA single-center cross-sectional study was conducted on 130 multi-ethnic PD patients in Malaysia. Sarcopenia was assessed using Asian Working Group for Sarcopenia (AWGS) 2019 diagnostic algorithm. PhA was measured by a multi-frequency bioelectrical impedance analysis device at 50kHz. Multivariable logistic regression was used to determine predictability of PhA on sarcopenia. Receiver operating characteristics analysis was used to evaluate the discriminative performance of PhA in detecting sarcopenia. Optimal gender-specific PhA cut-off values for sarcopenia detection were determined based on desired sensitivity and specificity.ResultsSarcopenia was identified in 25.4% of the PD patients. PhA emerged as an independent predictor of sarcopenia (adjOR= 0.147; 95%CI =0.042–0.516; P =0.003), exhibiting excellent discriminative power in identifying sarcopenia (adjAUCoverall= 0.818±0.041; bootstrapped 95%CI =0.734–0.899, P <0.001). The optimal PhA cut-off values for sarcopenia detection were ≤4.05° (92.9% sensitivity and 53.8% specificity) and ≤3.75° (78.9% sensitivity and 51.1% specificity) for male and female patients, respectively.ConclusionPhA serves as a pragmatic screening tool for identifying multi-ethnic Malaysian PD patients at risk of sarcopenia, facilitating early diagnosis and intervention to improve patient outcomes.
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