JMIR Publications

ABSTRACT

Background:

Food insecurity involves the lack of physical and economic access to sufficient, safe, and nutritious food that meets an individual's dietary needs. End-stage renal disease (ESRD) patients who are receiving haemodialysis treatment have particular dietary needs, but food insecurity may hinder them from adhering to the prescribed guidelines and preserve their nutritional status. However, no research has been conducted to elucidate food insecurity among patients undergoing haemodialysis in Malaysia.

Objective:

This study aims to assess the prevalence of food insecurity, the determinants, and its association with nutritional status, and explore the coping strategies employed among haemodialysis patients in Pahang, Malaysia.

Methods:

It is a cross-sectional study that will employ a mixed-methods approach and will be conducted on patients undergoing haemodialysis treatment at the Pahang Islamic Religious Council and Malay Customs (Majlis Ugama Islam dan Adat Resam Melayu Pahang, MUIP) dialysis centres. The inclusion criteria will include patients aged 18 years or older, who are generally healthy, and had been undergoing haemodialysis treatment regularly for at least three months. The food security status of the study participants will be determined using the Malay Food Insecurity Experience Scale (M-FIES). The nutritional status will include the anthropometric measurements (height, weight, body mass index (BMI), triceps skinfold (TSF) thickness, mid-upper arm circumference (MUAC), mid-arm muscle circumference (MAMC), and body fat percentage), biochemical parameters (serum urea, creatinine, albumin, phosphate, potassium, haemoglobin, and total iron binding capacity (TIBC)), clinical assessments (Malnutrition Inflammation Score (MIS) and protein energy wasting (PEW)), and dietary intake (adherence to total calorie, protein, sodium, potassium, and phosphorus intake and diet monotony index (DMI)). The determinants will be identified using logistic regression, while the association between food security status and nutritional status will be analysed using the chi-square or Fisher’s exact test and independent t-test. Semi-structured interviews will involve study participants who are categorised as mildly, moderately, or severely food insecure to explore the contributing factors of food insecurity and how they cope with it, based on their lived experience. It will be carried out until the data reaches saturation and will then be analysed thematically.

Results:

This study is being funded by the Ministry of Higher Education Malaysia through its Fundamental Research Grant Scheme (FRGS/1/2023/SS10/UIAM/02/1). Data have been collected involving 287 participants from four MUIP dialysis centres and are currently being analyzed.

Conclusions:

The implementation of this study protocol will provide new evidence to improve the understanding of food insecurity in this population. By elucidating its key contributing factors, coping strategies and potential connections with dietary intake in this population, it is expected to guide more informed policymaking and effective interventions.