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Background <p>Protein-energy wasting and frailty are highly prevalent among maintenance dialysis patients, particularly in low- and middle-income countries where nutrition care is often limited to brief, one-time counselling. We evaluated whether a home-based, supervised, personalised diet with structured follow-up could improve nutritional and functional outcomes compared with conventional dietary advice.</p> Methods <p>In this randomised controlled trial, 93 adults on maintenance dialysis were assigned to conventional diet (CD, <i>n</i> = 46) or supervised personalised diet (SPD, <i>n</i> = 47) for six months. Both groups received identical guideline-aligned dietary targets (25–35&#xa0;kcal/kg/day energy; 1.0–1.2&#xa0;g/kg/day protein) and portion-control tools. CD participants received one-time counselling; SPD participants received individualised meal planning based on 4-day dietary records analysed with DietCal™, fortnightly telephonic reinforcement and adjustments at 3 month intervals. The primary outcome was the Malnutrition–Inflammation Score (MIS); secondary outcomes included frailty (simplified Fried criteria) and dietary intake. Analyses followed the intention-to-treat principle using multiple imputation, with per-protocol sensitivity analyses.</p> Results <p>Baseline intake was markedly inadequate (23&#xa0;kcal/kg/day energy; 0.68&#xa0;g/kg/day protein), with 98% of participants malnourished (MIS ≥ 3), 52% severely malnourished, and 77% frail. At six months, MIS worsened in CD (8.9 to 10.6) but improved in SPD (8.6 to 6.4), yielding a significant between-group difference (<i>p</i> &lt; 0.001). Severe malnutrition prevalence was 76% in CD versus 13% in SPD (RR 0.17, 95% CI 0.08–0.36), and frailty prevalence was 91% in CD and 36% in SPD (RR 0.40, 95% CI 0.27–0.59). Energy and protein intake rose to 27.2&#xa0;kcal/kg/day and 0.97&#xa0;g/kg/day in SPD compared with 24.7&#xa0;kcal/kg/day energy and 0.84&#xa0;g/kg/day protein in CD respectively (both <i>p</i> &lt; 0.001). Per-protocol findings (<i>n</i> = 70) showed consistent results.</p> Conclusions <p>A home-based, supervised, personalised diet with structured remote follow-up significantly improved nutritional status, dietary intake, and frailty over six months in maintenance dialysis patients. This food-first, tele-counselling model demonstrates that systematic dietary assessment and personalised nutrition support can effectively address protein-energy wasting in dialysis populations. Future research should assess long-term sustainability, cost-effectiveness, and scalability through technology-enabled and task-sharing approaches adaptable to resource-limited settings.</p> Trial registration <p>CTRI/2021/07/034790.</p>

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Effect of a home-based supervised personalised diet on malnutrition and frailty in dialysis patients: a randomised controlled trial

  • 期刊论文

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  • 发表日期：

    2026年3月17日

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  • Preeti Chaudhary,
  • Lalit Pursnani ,
  • Himansu Sekhar Mahapatra,
  • Muthukumar Balakrishnan,
  • Angel Thomas,
  • Sheli Paul,
  • Vipul Gupta,
  • Sutanay Bhattacharyya,
  • Rajesh Tarachandani,
  • Anubhav Chakraborty

摘要

Background

Protein-energy wasting and frailty are highly prevalent among maintenance dialysis patients, particularly in low- and middle-income countries where nutrition care is often limited to brief, one-time counselling. We evaluated whether a home-based, supervised, personalised diet with structured follow-up could improve nutritional and functional outcomes compared with conventional dietary advice.

Methods

In this randomised controlled trial, 93 adults on maintenance dialysis were assigned to conventional diet (CD, n = 46) or supervised personalised diet (SPD, n = 47) for six months. Both groups received identical guideline-aligned dietary targets (25–35 kcal/kg/day energy; 1.0–1.2 g/kg/day protein) and portion-control tools. CD participants received one-time counselling; SPD participants received individualised meal planning based on 4-day dietary records analysed with DietCal™, fortnightly telephonic reinforcement and adjustments at 3 month intervals. The primary outcome was the Malnutrition–Inflammation Score (MIS); secondary outcomes included frailty (simplified Fried criteria) and dietary intake. Analyses followed the intention-to-treat principle using multiple imputation, with per-protocol sensitivity analyses.

Results

Baseline intake was markedly inadequate (23 kcal/kg/day energy; 0.68 g/kg/day protein), with 98% of participants malnourished (MIS ≥ 3), 52% severely malnourished, and 77% frail. At six months, MIS worsened in CD (8.9 to 10.6) but improved in SPD (8.6 to 6.4), yielding a significant between-group difference (p < 0.001). Severe malnutrition prevalence was 76% in CD versus 13% in SPD (RR 0.17, 95% CI 0.08–0.36), and frailty prevalence was 91% in CD and 36% in SPD (RR 0.40, 95% CI 0.27–0.59). Energy and protein intake rose to 27.2 kcal/kg/day and 0.97 g/kg/day in SPD compared with 24.7 kcal/kg/day energy and 0.84 g/kg/day protein in CD respectively (both p < 0.001). Per-protocol findings (n = 70) showed consistent results.

Conclusions

A home-based, supervised, personalised diet with structured remote follow-up significantly improved nutritional status, dietary intake, and frailty over six months in maintenance dialysis patients. This food-first, tele-counselling model demonstrates that systematic dietary assessment and personalised nutrition support can effectively address protein-energy wasting in dialysis populations. Future research should assess long-term sustainability, cost-effectiveness, and scalability through technology-enabled and task-sharing approaches adaptable to resource-limited settings.

Trial registration

CTRI/2021/07/034790.