马来西亚血液透析患者中臂肌围切断检测蛋白质能量浪费的临床应用

Q3 Nursing

Clinical Nutrition Open Science Pub Date : 2025-09-10 DOI:10.1016/j.nutos.2025.09.002

Qian-Qian Hoong , Jun-Hao Lim , Lee-Fang Teong , Nurul Iman Hafizah Adanan , Ban-Hock Khor , Sharmela Sahathevan , Pramod Khosla , Tilakavati Karupaiah , Zulfitri Azuan Mat Daud

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引用次数: 0

摘要

目的：蛋白质能量消耗（PEW）是血液透析（HD）患者中普遍存在的一种严重的营养不良形式。国际肾脏营养与代谢学会（ISRNM）为PEW制定了一个关键的诊断标准，即参考人群中臂肌围（MAMC）低于第50百分位（P50）减少10%以上。然而，缺乏针对特定人群的MAMC截断值使得诊断PEW具有挑战性。本研究旨在建立、验证和评估马来西亚HD患者诊断PEW的MAMC截止值。方法采用基于Frisancho参考的五重交叉验证方法，分训练、验证和测试三个阶段进行三期横断面研究。共有953名马来西亚HD患者被纳入分析。来自先前马来西亚HD研究的辅助数据被用于训练和验证阶段，约占数据集的85%。剩下的15%的数据集用于测试阶段，包括新收集的数据。数据收集包括面对面访谈、人体测量、生化结果、临床数据和饮食评估。使用ISRNM标准诊断PEW。根据ISRNM标准，描述性分析用于建立马来西亚HD MAMC在P50的皮尤诊断截止值。用受者工作特征曲线的曲线下面积（AUC）对这些新的截止点与弗里桑乔基准的有效性进行了评估和比较。结果马来西亚HD男性的P50 MAMC明显低于Frisancho参考值（24.29 cm vs 28.08 cm），而女性的P50 MAMC略高于Frisancho参考值（23.14 cm vs 22.17 cm）。新建立的马来西亚特异性的MAMC截断值表现出出色的辨别能力，在验证（AUCMalaysian = 0.904 vs AUCFrisancho = 0.812）和评估（AUCMalaysia = 0.871 vs AUCFrisancho = 0.749）方面都优于Frisancho截断值。结论这些MAMC截断值作为马来西亚首个hd特异性参考，为临床实践和未来研究增强了PEW诊断。

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Clinical utility of mid-arm muscle circumference cut-offs for detecting protein-energy wasting in Malaysian hemodialysis patients

Objective

Protein energy wasting (PEW) is a severe form of malnutrition prevalent among hemodialysis (HD) patients. A key diagnostic criterion outlined by the International Society of Renal Nutrition and Metabolism (ISRNM) for PEW is a reduction in mid-arm muscle circumference (MAMC) below the 50th percentile (P₅₀) of the reference population by more than 10%. However, the absence of population-specific MAMC cut-offs makes diagnosing PEW challenging. This study aimed to establish, validate and evaluate MAMC cut-offs for diagnosing PEW in Malaysian HD patients.

Methods

A three-phase cross-sectional study was conducted with training, validation and testing phases using a five-fold cross-validation approach against Frisancho reference. A total of 953 Malaysian HD patients were included in the analysis. Secondary data from previous Malaysian HD studies were utilized for both the training and validation phases, accounting for about 85% of the dataset. The remaining 15% of the dataset, used for the testing phase, comprised newly collected data. Data collection involved face-to-face interviews, anthropometric measurements, biochemical results, clinical data, and dietary assessments. PEW was diagnosed using the ISRNM criteria. Descriptive analysis was used to establish Malaysians HD MAMC cut-offs at P₅₀ for PEW diagnosis, as per ISRNM criteria. The area under the curve (AUC) of the receiver operating characteristics curve assessed and compared the validity of these new cut-offs against the Frisancho reference.

Results

The P₅₀ MAMC for Malaysian HD males was markedly lower than the Frisancho reference (24.29 cm vs 28.08 cm), whereas for females, it was slightly higher (23.14 cm vs 22.17 cm). The newly established Malaysian HD-specific MAMC cut-offs demonstrated excellent discrimination ability, outperforming Frisancho cut-offs for both validation (AUC_Malaysian = 0.904 vs AUC_Frisancho = 0.812) and evaluation (AUC_Malaysia = 0.871 vs AUC_Frisancho = 0.749).