Currently submitted to: JMIR Formative Research
Date Submitted: Jul 31, 2026
Open Peer Review Period: Aug 11, 2026 - Oct 6, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The Prevalence of Food Insecurity, Its Determinants, and Association with Nutritional Status Among Haemodialysis Patients in Pahang, Malaysia: A Cross-Sectional Study
ABSTRACT
Background:
Food insecurity, defined as the lack of physical and economic access to adequate, safe, and nutritious food, may compromise dietary adherence among patients with end-stage renal disease (ESRD) undergoing haemodialysis. Given their stringent dietary requirements, food insecurity may adversely affect nutritional management and health outcomes. However, research on food insecurity among haemodialysis patients in Malaysia remains limited.
Objective:
This study aimed to determine the prevalence and determinants of food insecurity and its association with nutritional status in this population.
Methods:
This cross-sectional study was conducted among 287 adults (≥ 18 years old) receiving maintenance haemodialysis for at least three months at four dialysis centres operated by the Pahang Islamic Religious Council and Malay Customs (Majlis Ugama Islam dan Adat Resam Melayu Pahang, MUIP). Food security status was measured using the Malay version of the Food Insecurity Experience Scale (M-FIES). Its determinants were assessed using validated, interviewer-administered questionnaires. Nutritional status was characterised by anthropometric measurements (post-dialysis), biochemical parameters obtained from the patients’ medical record, clinical indicators including the Malnutrition Inflammation Score (MIS) and protein energy wasting (PEW), and three-day dietary intake assessed via 24-hour dietary recalls. Data were analysed using linear and logistic regression.
Results:
About one-third of participants were food insecure, with 16.4% mildly, 9.4% moderately, and 5.6% severely food insecure. Younger age (aOR=9.816, 95% CI=3.189-30.211, p<0.001), lower educational attainment (aOR=7.968, 95% CI=1.619-39.213, p=0.011), inability to afford food (aOR=12.364, 95% CI=1.040-146.930, p=0.046), and inconsistent adherence to dietary recommendations (aOR=2.659, 95% CI=1.170-6.042, p=0.020) were independently associated with food insecurity. However, no significant association was observed between food security status and nutritional status indicators.
Conclusions:
Food insecurity affects approximately one in every three haemodialysis patients attending the selected dialysis centres in Pahang and is driven by socioeconomic and behavioural factors. Although not directly associated with current nutritional status, its substantial prevalence underscores the need for routine screening and integrated nutrition–social support strategies within dialysis care to mitigate long-term risks and support sustainable dietary adherence.
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