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

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.

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.

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.

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.

CTRI/2021/07/034790.