A Food Frequency Questionnaire for Hemodialysis Patients in Bangladesh (BDHD-FFQ): Development and Validation

Diet is a recognized risk factor and cornerstone for chronic kidney disease (CKD) management; however, a tool to assess dietary intake among Bangladeshi dialysis patients is scarce. This study aims to validate a prototype Bangladeshi Hemodialysis Food Frequency Questionnaire (BDHD-FFQ) against 3-day dietary recall (3DDR) and corresponding serum biomarkers. Nutrients of interest were energy, macronutrients, potassium, phosphate, iron, sodium and calcium. The BDHD-FFQ, comprising 132 food items, was developed from 606 24-h recalls and had undergone face and content validation. Comprehensive facets of relative validity were ascertained using six statistical tests (correlation coefficient, percent difference, paired t-test, cross-quartiles classification, weighted kappa, and Bland-Altman analysis). Overall, the BDHD-FFQ showed acceptable to good correlations (p 0.05). Cross-quartile classification indicated that <10% of patients were incorrectly classified. Weighted kappa statistics showed agreement with all but iron. Bland-Altman analysis showed positive mean differences were observed for all nutrients when compared to 3DDR, whilst energy, carbohydrates, fat, iron, sodium, and potassium had percentage data points within the limit of agreement (mean ± 1.96 SD), above 95%. In summary, the BDHD-FFQ demonstrated an acceptable relative validity for most of the nutrients as four out of the six statistical tests fulfilled the cut-off standard in assessing dietary intake of CKD patients in Bangladesh

Association of dietary intake and nutrition knowledge with diabetes self-management behavior among Bangladeshi type 2 diabetes mellitus adults: A multi-center cross-sectional study

Diabetes self-management behavior is important for patients to lessen disease-related complications, obtain optimum glycemic control and achieve a better quality of life. The study aimed to determine the relationship between dietary intake, nutrition knowledge, and self-management behaviors in Bangladeshi patients with type 2 diabetes mellitus (T2DM), with a focus on achieving optimal glycemic control, improving their quality of life. A cross-sectional study was conducted among T2DM patients from seven districts throughout Bangladesh. Data were collected using a validated semi-structured questionnaire for evaluating diabetes-related self-management behavior and existing nutrition knowledge. Dietary intakes were obtained using 24 h 3-days diet recall. Logistic regression analysis, Pearson's correlation and independent t-test were used to observe correlation and association among variables. A total of 411 patients with T2DM participated in the study, 59.4 % of patients achieved good dietary control, while 14.4 % were physically active, 49.4 % adhered well to medication, 44.0 % practiced effective self-monitoring, and 27.0 % possessed good diabetic nutrition knowledge. In fully adjusted multivariate logistic regression analysis, patients with a better glycemic control showed 14 times more control in their dietary intake [AOR: 14.21; 95 % CI: 5.62–35.94], and performing a good physical exercise 5 times more than the patients with high blood glucose level [AOR: 5.671; 95 % CI: 1.55–20.686]. Adherence toward medication prescription was also significantly higher among these patients. Glucose level was significantly higher among patients who had moderate [AOR: 3.367; 95 % CI: 1.29–8.73] and poor [AOR: 9.87; 95 % CI: 3.19–30.57] diabetes related nutritional knowledge. Patients with poor glycemic control consumed significantly more carbohydrates (251 ± 62 g vs 213 ± 47 g) and less dietary fiber (16.7 ± 4.5 g vs 20.5 ± 6.1 g) compared to the patients with optimum glycemic control. Our study findings suggest that, an improved level of nutrition knowledge may be beneficial to ensure optimum dietary intake, thus aid in an effective diabetes self-management behavior among Bangladeshi T2DM patients. Efforts should be made to help patient achieve optimum glycemic control, thus reduce their health-related complications and contribute to overall well-being

The modified 31-item questionnaire.

Hemodialysis (HD) is a treatment for ensuring the survival of end-stage kidney disease (ESKD) patients, and nutrition care is integral to their management. We sent questionnaires to evaluate the total dialysis service capacity and nutrition services across all dialysis facilities (DF) in Bangladesh, with responses from 149 out of 166 active DFs. Survey results revealed that 49.7% of DFs operated two shifts, and 42.3% operated three shifts daily, with 74.5% holding between one and ten dialysis machines. Sixty-three percent of DFs served between one and 25 patients per week, and 77% of patients received twice-weekly dialysis. The average cost for first-time dialysis was 2800 BDT per session (range: 2500–3000 BDT), but it was lower if reused dialyzers were used (2100 BDT, range: 1700–2800 BDT). Nutritionists were available in only 21% of the DFs. Parameters related to nutritional health screening (serum albumin, BMI, MIS-malnutrition inflammation assessment, and dietary intakes) were carried out in 37.6%, 23.5%, 2%, and 2% of the DFs, respectively, only if recommended by physicians. Nutrition education, if recommended, was provided in 68.5% of DFs, but only in 17.6% of them were these delivered by nutritionists. The recommendation for using renal-specific oral nutrition supplements (ONS) is not a familiar practice in Bangladeshi DFs and, therefore, was scarcely recommended. Dialysis capacity across Bangladesh is inadequate to meet current or projected needs and nutrition education and support across the DFs to benefit improving patients’ quality of life is also inadequate.</div

Sector wise distribution and center’s administration of DFs.

Sector wise distribution and center’s administration of DFs.</p

Nutrition screening and provision of nutrition education in different DFs based on sector and nutritionist accessibility.

Nutrition screening and provision of nutrition education in different DFs based on sector and nutritionist accessibility.</p

Inclusivity in global research.

Hemodialysis (HD) is a treatment for ensuring the survival of end-stage kidney disease (ESKD) patients, and nutrition care is integral to their management. We sent questionnaires to evaluate the total dialysis service capacity and nutrition services across all dialysis facilities (DF) in Bangladesh, with responses from 149 out of 166 active DFs. Survey results revealed that 49.7% of DFs operated two shifts, and 42.3% operated three shifts daily, with 74.5% holding between one and ten dialysis machines. Sixty-three percent of DFs served between one and 25 patients per week, and 77% of patients received twice-weekly dialysis. The average cost for first-time dialysis was 2800 BDT per session (range: 2500–3000 BDT), but it was lower if reused dialyzers were used (2100 BDT, range: 1700–2800 BDT). Nutritionists were available in only 21% of the DFs. Parameters related to nutritional health screening (serum albumin, BMI, MIS-malnutrition inflammation assessment, and dietary intakes) were carried out in 37.6%, 23.5%, 2%, and 2% of the DFs, respectively, only if recommended by physicians. Nutrition education, if recommended, was provided in 68.5% of DFs, but only in 17.6% of them were these delivered by nutritionists. The recommendation for using renal-specific oral nutrition supplements (ONS) is not a familiar practice in Bangladeshi DFs and, therefore, was scarcely recommended. Dialysis capacity across Bangladesh is inadequate to meet current or projected needs and nutrition education and support across the DFs to benefit improving patients’ quality of life is also inadequate.</div

Nutritionist accessibility in different DFs.

Hemodialysis (HD) is a treatment for ensuring the survival of end-stage kidney disease (ESKD) patients, and nutrition care is integral to their management. We sent questionnaires to evaluate the total dialysis service capacity and nutrition services across all dialysis facilities (DF) in Bangladesh, with responses from 149 out of 166 active DFs. Survey results revealed that 49.7% of DFs operated two shifts, and 42.3% operated three shifts daily, with 74.5% holding between one and ten dialysis machines. Sixty-three percent of DFs served between one and 25 patients per week, and 77% of patients received twice-weekly dialysis. The average cost for first-time dialysis was 2800 BDT per session (range: 2500–3000 BDT), but it was lower if reused dialyzers were used (2100 BDT, range: 1700–2800 BDT). Nutritionists were available in only 21% of the DFs. Parameters related to nutritional health screening (serum albumin, BMI, MIS-malnutrition inflammation assessment, and dietary intakes) were carried out in 37.6%, 23.5%, 2%, and 2% of the DFs, respectively, only if recommended by physicians. Nutrition education, if recommended, was provided in 68.5% of DFs, but only in 17.6% of them were these delivered by nutritionists. The recommendation for using renal-specific oral nutrition supplements (ONS) is not a familiar practice in Bangladeshi DFs and, therefore, was scarcely recommended. Dialysis capacity across Bangladesh is inadequate to meet current or projected needs and nutrition education and support across the DFs to benefit improving patients’ quality of life is also inadequate.</div

Distribution of DFs across Bangladesh based on geographic divisions.

This is the S1 Table legend: aBangladesh is divided into 8 administrative divisions which are further divided into 64 districts. Data for the individual districts can be found in S2 Table. bTotal number of centers. cNumber of centers that are Private, NGO or Government operated. An additional 21 centers were not active during the data collection period (14 in Dhaka, 4 in Chittagong, 2 in Rajashahi and 1 in Mymensingh). dThe sum of the population of each division as reported in the 2011 decennial national census. The 2021 national census has been delayed due to Covid-19. Current total population of Bangladesh as of Feb 2022 is ~ 167 million. (DOCX)</p

DFs providing nutrition education.

Hemodialysis (HD) is a treatment for ensuring the survival of end-stage kidney disease (ESKD) patients, and nutrition care is integral to their management. We sent questionnaires to evaluate the total dialysis service capacity and nutrition services across all dialysis facilities (DF) in Bangladesh, with responses from 149 out of 166 active DFs. Survey results revealed that 49.7% of DFs operated two shifts, and 42.3% operated three shifts daily, with 74.5% holding between one and ten dialysis machines. Sixty-three percent of DFs served between one and 25 patients per week, and 77% of patients received twice-weekly dialysis. The average cost for first-time dialysis was 2800 BDT per session (range: 2500–3000 BDT), but it was lower if reused dialyzers were used (2100 BDT, range: 1700–2800 BDT). Nutritionists were available in only 21% of the DFs. Parameters related to nutritional health screening (serum albumin, BMI, MIS-malnutrition inflammation assessment, and dietary intakes) were carried out in 37.6%, 23.5%, 2%, and 2% of the DFs, respectively, only if recommended by physicians. Nutrition education, if recommended, was provided in 68.5% of DFs, but only in 17.6% of them were these delivered by nutritionists. The recommendation for using renal-specific oral nutrition supplements (ONS) is not a familiar practice in Bangladeshi DFs and, therefore, was scarcely recommended. Dialysis capacity across Bangladesh is inadequate to meet current or projected needs and nutrition education and support across the DFs to benefit improving patients’ quality of life is also inadequate.</div