Ms .S .Amena Omer*, Mrs. H. Shyam, Ms. M. Kosi Reddy,
Clinical Dietitian
Apollo Hospitals, Hyderabad, India

Background: Anorexia is a common symptom among patients with prolonged illness. It leads to malnutrition of energy, proteins and other nutrients. Prolonged anorexia in cancer patients can lead to a complex syndrome called ‘’anorexia-cachexia syndrome’’. Anorexia/Cachexia adversely affects the patient’s body form, function, response to (chemotherapy or radiation) treatment, quality of life and survival. Hence, in order to provide effective health care, nutritional status of patients, their nutrient intake and appetite should be assessed periodically though out their treatment and intervened with nutritional, medical or psychological support.

Functional Assessment of Anorexia/Cachexia Therapy (FAACT) appetite scale is 12 questions based patient rated, symptom specific measure for appetite, and distress from anorexia of patients who complain of lack of appetite. The FAACT appetite scale assesses anorexia-related symptoms and differentiates their severity by assigning a score ranging from 0 (worst response) to 4 (best response). Therefore, it could be proposed that a score ≤24 may be sufficient to make a diagnosis of anorexia.

Aim: The aim of this study was to co-relate the FAACT score for anorexia with patient’s nutrient intake.

Methods: A study was carried out where the FAACT questionnaire was administered to 100 cancer in-patients receiving chemotherapy or radiation as treatment. Their 24 hour calorie and protein intake and anthropometric measures (BMI) were recorded in order to correlate it with the FAACT score.

Results: The FAACT scale assessed 57% of the sample to be anorexic with a score ≤24. Their BMI was in the range of 15-32kgs/m2 with an average of 24kgs/m2. They were also found to have a low protein intake with an average of 41 % of their RDA (1.2gms/IBW) and low calorie intake of an average of 65% of their RDA (30kcals/IBW).Thus, rightly co-relating the FAACT anorexia score to the low nutrient intake.
Similarly, those with a FAACT score of above 24 were found to have a protein intake of an average 97% of their RDA (1.2gms/IBW) and a calorie intake of an average 88% of their RDA (30kcals/IBW). Their BMI was found to be in the range of 15-34kgs/m2 and an average of 25kgs/m2. Thus making them more tolerant and receptive to cancer therapy with an increased rate of survival.

Conclusion: The FAACT scale helps in assessing anorexia /cachexia in cancer patients and co-related well with the high incidence of low calorie and low protein intake percentage to RDA. Thus categorizing them to be anorexic and nutrient deficient.

Award winning abstract submitted at the AICNU 2014 in Bangalore.

Authors

• Daphnee D K*
• Rajalakshmi P*
• Silvia Sargunam C*
• Balasubramaniam R**
• Dr. Bhuvaneshwari*

Department of *Dietetics, **Statistics, Apollo Hospitals, Greams Road, Chennai

Background

Malnutrition is common in chronic hemodialysis patients and is associated with poorer quality of life (QOL) when the degree of malnutrition becomes severe increasing the morbidity and mortality.

Aim

This study aims to assess and correlate the nutritional status of patients undergoing MHD with QOL.

Methods

A prospective-observational study conducted in our outpatient Hemodialysis unit with random sampling. A team of Clinical Dietitians collected the details of demographic, modified subjective global assessment (SGA), anthropometric, clinical measures and QOL using SF- 8 were gathered through interviews using a questionnaire specifically developed for this purpose. We included End Stage Renal disease patients who were on MHD atleast twice a week and who gave consent. Statistical analysis using Pearson correlation, Fisher’s exact test, Chi-Square test were used.

Results

A total of 60 patients (50% males), aged 53.5±15.7 years were included. SGA revealed 42(70%) as moderately malnourished. Based on total lymphocyte count 37(62%) were found to be mild to severely malnourished and using body mass index classification 37% males and 40% females were obese. There was a significant difference in the nutritional status between the sex using triceps skin fold thickness (TSF) (p=0.000), mid arm muscle circumference (MAMC) (p=0.002), mid arm muscle area (MAMA) (p=0.000). Depleted somatic protein and fat stores were found in males and females respectively. The SGA score had a negative correlation with MAC, MAMC, TSF, MAMA and a positive correlation was found between the somatic and visceral protein stores. The usual energy intake had a significant effect on the nutritional status (p=0.019). SGA correlated significantly with each variables of QOL (p<0.005). Emotional stability and social engagement was significantly higher in males (p<0.005).

Conclusion

Above mentioned multi-technique analysis can be used to identify patients who require more attention due to the risk of malnutrition. Regular monitoring/counselling by the qualified Clinical Dietitian will help in the improvement of nutritional status and better QOL.