Association of depression with malnutrition in chronic hemodialysis patients

Koo, Ja-Ryong; Yoon, Jong-Woo; Kim, Seong-Gyun; Lee, Young-Ki; Oh, Kook-Hwan; Kim, Gheun-Ho; Kim, Hyung-Jik; Chae, Dong-Wan; Noh, Jung-Woo; Lee, Sang-Kyu; Son, Bong-Ki

doi:10.1016/S0272-6386(03)00201-4

« Previous Next »American Journal of Kidney Diseases
Volume 41, Issue 5 , Pages 1037-1042, May 2003

Association of depression with malnutrition in chronic hemodialysis patients☆

Ja-Ryong Koo, MD
- Address reprint requests to Ja-Ryong Koo, MD, Division of Nephrology, Department of Internal Medicine, Chunchon Sacred Heart Hospital, Hallym University, Kyo-Dong, Chunchon, Kangwon Do, South Korea 200-704
- Department of Internal Medicine, Division of Nephrology, College of Medicine, Hallym University, Chuchon, Kangwon Do, South Korea
Jong-Woo Yoon, MD
- Department of Internal Medicine, Division of Nephrology, College of Medicine, Hallym University, Chuchon, Kangwon Do, South Korea
Seong-Gyun Kim, MD
- Department of Internal Medicine, Division of Nephrology, College of Medicine, Hallym University, Chuchon, Kangwon Do, South Korea
Young-Ki Lee, MD
- Department of Internal Medicine, Division of Nephrology, College of Medicine, Hallym University, Chuchon, Kangwon Do, South Korea
Kook-Hwan Oh, MD
- Department of Internal Medicine, Division of Nephrology, College of Medicine, Hallym University, Chuchon, Kangwon Do, South Korea
Gheun-Ho Kim, MD
- Department of Internal Medicine, Division of Nephrology, College of Medicine, Hallym University, Chuchon, Kangwon Do, South Korea
Hyung-Jik Kim, MD
- Department of Internal Medicine, Division of Nephrology, College of Medicine, Hallym University, Chuchon, Kangwon Do, South Korea
Dong-Wan Chae, MD
- Department of Internal Medicine, Division of Nephrology, College of Medicine, Hallym University, Chuchon, Kangwon Do, South Korea
Jung-Woo Noh, MD
- Department of Internal Medicine, Division of Nephrology, College of Medicine, Hallym University, Chuchon, Kangwon Do, South Korea
Sang-Kyu Lee, MD
- Department of Psychiatry, College of Medicine, Hallym University, Chunchon, Kangwon Do, South Korea
Bong-Ki Son, MD
- Department of Psychiatry, College of Medicine, Hallym University, Chunchon, Kangwon Do, South Korea

Received 19 September 2002; received in revised form 16 January 2003; accepted 16 January 2003.

Abstract

Background:

Depression is the most common psychological complication and may increase mortality in chronic hemodialysis patients. Because depression could be associated with poor oral intake and activation of proinflammatory cytokines that could further increase mortality by malnutrition, we investigated the relation between depression and nutritional status in chronic hemodialysis patients.

Methods:

Sixty-two Korean patients completed the Beck Depression Inventory (BDI) questionnaire, and the diagnosis of depression was confirmed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depressive disorder. Nutritional status was evaluated using serum albumin level, normalized protein catabolic rate, subjective global assessment (SGA), and anthropometric measurement.

Results:

Mean BDI score was 22.7 ± 11.4, and 35 patients (56.5%) had a BDI score greater than 21, which is the suggested cutoff score for the diagnosis of depression for the Korean population. Of 40 patients who had a score higher than 18 on the BDI, 34 patients met DSM-IV criteria for major depressive disorder. BDI score correlated negatively with a variety of nutritional parameters: serum albumin level (r = −0.47; P < 0.001), normalized protein catabolic rate (r = −0.32; P < 0.05), SGA (r = −0.47; P < 0.01), triceps skinfold thickness (r = −0.40; P < 0.05), midarm muscle circumference (r = −0.57; P < 0.01), and body mass index (r = −0.28; P < 0.05). Multiple regression analysis also identified BDI score as an independent determinant for all kinds of nutritional parameters.

Conclusion:

In patients on chronic hemodialysis therapy, depression is related closely to nutritional status and could be an independent risk factor for malnutrition.

Keywords: Depression, nutrition, malnutrition, hemodialysis (HD)