Evaluation of the Appetite and Food Satisfaction Questionnaire (AFSQ); a simple dietary tool to screen for peritoneal dialysis patients with reduced diary intake

Background: Peritoneal dialysis (PD) patients are at risk of malnutrition due to dietary restrictions and gastro-intestinal effects of dialysis. Aims/Objectives: Evaluation of the Appetite and Food Satisfaction Questionnaire (AFSQ) which has been proposed as a simple, rapid screening tool to detect PD patients with reduced appetite and food intake. Methods: The AFSQ, a simple six-question tool combining pictorial images with a Likert scale of 0 to 3 was used to assess dietary protein intake in PD patients, who had contemporaneous body composition measured with bioimpedance, and assessments of dietary protein intake and dialysis adequacy. Results: AFSQs from 177 PD patients were reviewed, mean age 61.8 ± 15.2 years, 58.2% male, 46.9% diabetic, 36.2% white, median treatment 17 (14–30) months. The median AFSQ score was 5 (3–8), ranging from 0 to 17. Those with highest scores (≥7), had lower normalised dietary protein intake (nPNA) vs those with the lowest scores (0–3) (0.75 ± 0.17 vs 0.88 ± 0.26 g/kg/day), and lower 24-hour sodium removal (103 (48–111) vs 127 (81–168) mmol), P < 0.05. On multi-variable testing higher AFSQ cores were associated with lower nPNA and soft lean mass index (standardised β −0.19 and −0.18, P = 0.031 and 0.036, respectively). Conclusion: Multi-ethnic PD patients were readily able to complete the simple 6 question AFSQ. Patients with the highest food dissatisfaction scores had lower estimates of dietary protein intake, sodium removal and lean tissue mass. Thus, the AFSQ may have a role as a simple rapid screening tool to highlight PD patients who would benefit from formal dietitian review, particularly in resource limited settings.