ArticleBMC nutrition2026
Effect of a home-based supervised personalised diet on malnutrition and frailty in dialysis patients: a randomised controlled trial.
Article in BMC nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundProtein-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.
methodsIn 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.
resultsBaseline 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.
conclusionsA 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.
trial registrationCTRI/2021/07/034790.
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