Access Type

Open Access Thesis

Date of Award

January 2016

Degree Type


Degree Name



Nutrition and Food Science

First Advisor

Pramod Khosla


Both higher dietary phosphorus intake and a greater dietary phosphorus to protein ratio are associated with increased death risk in hemodialysis (HD) patients even after adjustments for serum phosphorus, type of phosphate binder used, and dietary protein, energy, and potassium intake. Furthermore, dietary phosphorus restriction to control serum phosphorus is often associated with a reduction in protein intake, which is associated with muscle wasting and poor survival. One highly prevalent complication of end stage renal disease is protein energy wasting (PEW), a state of decreased body protein and fat mass, which is strongly associated with increased morbidity and mortality in the HD population.

In a cross sectional study of 60 Malaysian HD patients, the extent to which diet composition associated with PEW parameters (serum chemistry, body mass, muscle mass, and dietary intakes), was analyzed.

It was found that favorable phosphorus to protein (P/pro) intake was inversely associated with PEW parameters of muscle mass and dietary protein intake. Both Chinese ethnicity and exercise habits appear to drive favorable P/pro intakes. A secondary outcome from this study included findings that, when compared to measurements of mid-arm muscle area, both bio impedance analysis and hand grip strength were both valuable markers for lean body mass.

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Nutrition Commons