Nutritional Status Predicts Mortality in Diabetic Foot Ulcers Patients

NewsBot · Feb 7, 2017

Members do not see these Ads. Sign Up.
The Geriatric Nutritional Risk Index Independently Predicts Mortality in Diabetic Foot Ulcers Patients Undergoing Amputations.
Xie Y et al
J Diabetes Res. 2017;2017:5797194.

Objective. Patients with diabetic foot ulcers undergoing amputations have poor prognosis. Malnutrition usually occurs in this population and is associated with increased risk of mortality. The geriatric nutritional risk index (GNRI) is a widely used, simple, and well-established tool to assess nutritional risk. The purpose of this study was to assess the association between GNRI and all-cause mortality in diabetic foot ulcers patients undergoing minor or major amputations.
Methods. This was a retrospective cohort study including 271 adult patients. Patients were divided into two groups according to a GNRI cutoff value of 92, and characteristics and mortality were compared between the two groups. Cox proportional hazard analysis was performed to explore the association between GNRI and mortality.
Result. GNRI (p < 0.001), age (p < 0.001), and eGFR (p = 0.002) were independent predictors of mortality. Among a subgroup of 230 patients with minor amputation, increased age (p < 0.001), coronary artery disease (p = 0.030), and increased GNRI (p < 0.001) were major risk factors.
Conclusion. GNRI on admission might be a novel clinical predictor for the incidence of death in patients with diabetic foot ulcers who were undergoing amputations.
Click to expand...

Admin2 · Feb 8, 2017

Related Topics:
Vitamin D supplementation and diabetic foot ulcers
Amino Acid Supplementation in Diabetic Foot Wounds
Nutritional status deteriorates as the severity of diabetic foot ulcers increases
Mortality and diabetic foot related complications

NewsBot · May 27, 2017

Magnesium Supplementation and the Effects on Wound Healing and Metabolic Status in Patients with Diabetic Foot Ulcer: a Randomized, Double-Blind, Placebo-Controlled Trial
Razzaghi, R., Pidar, F., Momen-Heravi, M. et al.
Biol Trace Elem Res (2017). doi:10.1007/s12011-017-1056-5

Hypomagnesemia is associated with the development of neuropathy and abnormal platelet activity, both of which are risk factors for diabetic foot ulcer (DFU). This study was carried out to evaluate the effects of magnesium administration on wound healing and metabolic status in subjects with DFU. This randomized, double-blind, placebo-controlled trial was performed among 70 subjects with grade 3 DFU. Subjects were randomly divided into two groups (35 subjects each group) to receive either 250 mg magnesium oxide supplements or placebo daily for 12 weeks. Pre- and post-intervention wound depth and appearance were scored in accordance with the “Wagner-Meggitt’s” wound assessment tool. Fasting blood samples were taken at baseline and after the 12-week intervention to assess related markers. After the 12-week treatment, compared with the placebo, magnesium supplementation resulted in a significant increase in serum magnesium (+0.3 ± 0.3 vs. −0.1 ± 0.2 mg/dL, P < 0.001) and significant reductions in ulcer length (−1.8 ± 2.0 vs. −0.9 ± 1.1 cm, P = 0.01), width (−1.6 ± 2.0 vs. −0.8 ± 0.9 cm, P = 0.02), and depth (−0.8 ± 0.8 vs. −0.3 ± 0.5 cm, P = 0.003). In addition, significant reductions in fasting plasma glucose (−45.4 ± 82.6 vs. −10.6 ± 53.7 mg/dL, P = 0.04), serum insulin values (−2.4 ± 5.6 vs. +1.5 ± 9.6 μIU/mL, P = 0.04), and HbA1c (−0.7 ± 1.5 vs. −0.1 ± 0.4%, P = 0.03) and a significant rise in the quantitative insulin sensitivity check index (+0.01 ± 0.01 vs. −0.004 ± 0.02, P = 0.01) were seen following supplementation of magnesium compared with the placebo. Additionally, compared with the placebo, taking magnesium resulted in significant decrease in serum high-sensitivity C-reactive protein (hs-CRP) (−19.6 ± 32.5 vs. −4.8 ± 11.2 mg/L, P = 0.01) and significant increase in plasma total antioxidant capacity (TAC) concentrations (+6.4 ± 65.2 vs. −129.9 ± 208.3 mmol/L, P < 0.001). Overall, magnesium supplementation for 12 weeks among subjects with DFU had beneficial effects on parameters of ulcer size, glucose metabolism, serum hs-CRP, and plasma TAC levels. Clinical trial registration number: http://www.irct.ir: IRCT201612225623N96
Click to expand...

NewsBot · Jul 20, 2018

Protein requirement and its intake in subjects
with diabetic foot ulcers at a tertiary care hospital
Nida Sajid et al
Pak J Med Sci. 2018;34(4):

Objective: To assess the protein intake and requirement among subject with type 2 diabetes having foot
ulcers.
Methods: This study was conducted at Baqai Institute of Diabetology & Endocrinology (BIDE), a tertiary care
diabetes centre of Karachi, Pakistan among people with type 2 diabetic foot ulcer attending foot clinic from
January 2012 to March 2015. The baseline characteristics, dietary intake and laboratory investigations of
the study participants were obtained through electronic hospital database “Health Management System”
(HMS) based on the 24 hours dietary recall interview. Total grams of protein were calculated from each
food group consumed by the subject. Protein intake of the subjects was recorded in mean grams and
the protein requirement was calculated according to their body weight. The comparison of intake and
requirement of protein choices was done through comparing the mean of both variables. SPSS version 13
was used for analysing the results.
Results: A total of 542 subjects were included in the study, 365 (67.2%) were males and 178 (32.8%) were
females. Mena age of the subject was 54.61±10.51 (yrs) with the duration of diabetes and mean body
mass index were 14.22±7.98 (yrs) and 26.65±5.38 (kg/m2
), respectively. The dietary records showed the
protein intake of subjects with diabetic foot ulcer is not appropriate when compared to daily requirement.
Mean grams of protein intake is 76.87gms in males and 56.84gms in females. On the other-hand protein
requirement is much higher than the intake, which is 219.5gms in males and 130.2gms in females.
Conclusion: Dietary counselling should be a part of the treatment among subjects with diabetic foot ulcer
to identify their nutritional needs and suggesting them better option to fulfil their protein requirement
essential for wound healing process.
Click to expand...

NewsBot · Sep 9, 2018

Protein requirement and its intake in subjects with diabetic foot ulcers at a tertiary care hospital.
Sajid N et al
Pak J Med Sci. 2018 Jul-Aug;34(4):886-890.

OBJECTIVE:
To assess the protein intake and requirement among subject with type 2 diabetes having foot ulcers.

METHODS:
This study was conducted at Baqai Institute of Diabetology & Endocrinology (BIDE), a tertiary care diabetes centre of Karachi, Pakistan among people with type 2 diabetic foot ulcer attending foot clinic from January 2012 to March 2015. The baseline characteristics, dietary intake and laboratory investigations of the study participants were obtained through electronic hospital database "Health Management System" (HMS) based on the 24 hours dietary recall interview. Total grams of protein were calculated from each food group consumed by the subject. Protein intake of the subjects was recorded in mean grams and the protein requirement was calculated according to their body weight. The comparison of intake and requirement of protein choices was done through comparing the mean of both variables. SPSS version 13 was used for analysing the results.

RESULTS:
A total of 542 subjects were included in the study, 365 (67.2%) were males and 178 (32.8%) were females. Mena age of the subject was 54.61±10.51 (yrs) with the duration of diabetes and mean body mass index were 14.22±7.98 (yrs) and 26.65±5.38 (kg/m2), respectively. The dietary records showed the protein intake of subjects with diabetic foot ulcer is not appropriate when compared to daily requirement. Mean grams of protein intake is 76.87gms in males and 56.84gms in females. On the other-hand protein requirement is much higher than the intake, which is 219.5gms in males and 130.2gms in females.

CONCLUSION:
Dietary counselling should be a part of the treatment among subjects with diabetic foot ulcer to identify their nutritional needs and suggesting them better option to fulfil their protein requirement essential for wound healing process.
Click to expand...

NewsBot · Nov 28, 2018

An Assessment of the Nutritional Status of Men and Women with, or at risk
of, a Diabetic Foot Ulcer (DFU).
Thesis

Aim: The study aimed to establish the nutritional status of adults with, or at risk of,
a DFU, of any grade, and to determine if there were differences in nutritional
status between men and women.
Method: A quantitative, non-experimental observational study design was
employed. Participants were recruited from a vascular foot protection clinic
through convenience sampling;ethical approval was sought and obtained. The
following assessments were completed; Subjective Global Assessment (SGA),
Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST)
and Mini-Nutritional Assessment short and long form (MNA-SF and MNA-LF).
Results / Discussion: Fifteen participants were recruited, 10 with DFU Wagner
grade 1-3 and five without DFU. Using SGA, the majority of participants were
assessed as mild/moderately malnourished (66.7%; n=10), and the remaining
(33.3%; n=5) were well-nourished. Further analysis showed that 80% (n=4) of
those assessed as being well-nourished did not have a DFU, while of those
mild/moderately malnourished, 90% (n=9) had a DFU present. There was a lack of
congruence between the other assessment tools. For example, of those assessed
as being mild/moderately malnourished, 50% (n=5) had a pre-obese BMI. Of those
without a DFU, 100% (n=5) had received recent dietetic input. Of those with a
current DFU, 100% (n=10) had not had recent dietetic input.
Conclusion: The results of this research suggest that current malnutrition
assessment tools may not all be suitable for the identification of malnutrition in
DFU patients. Further, the role of the dietitian in the management of patient with
DFU may be underestimated.
Click to expand...

NewsBot · Sep 26, 2019

Broad-Ranging Nutritional Deficiencies Predict Amputation in Diabetic Foot Ulcers.
Brookes JDL et al
Int J Low Extrem Wounds. 2019 Sep 24

Diabetic foot ulcers present across the spectrum of nonhealing wounds, be it acute or many months duration. There is developing literature highlighting that despite this group having high caloric intake, they often lack the micronutrients essential for wound healing. This study reports a retrospective cohort of patients' micro- and macro-nutritional state and its relationship to amputation. A retrospective cohort was observed over a 2-month period at one of Australia's largest tertiary referral centers for diabetic foot infection and vascular surgery. Patient information, duration of ulcer, various biochemical markers of nutrition and infection, and whether the patient required amputation were collected from scanned medical records. A cohort of 48 patients with a broad-spectrum of biochemical markers was established. Average hemoglobin A1c (HbA1c) was 8.6%. A total of 58.7% had vitamin C deficiency, including 30.4% with severe deficiency, average 22.6 Ł} 5.8 μmol/L; 61.5% had hypoalbuminemia, average albumin 28.7 Ł} 2.5 g/L. Average vitamin B12 was 294.6 Ł} 69.6 pmol/L; 57.9% had low vitamin D, average 46.3 Ł} 8.3 nmol/L. Basic screening scores for caloric intake failed to suggest this biochemical depletion. There was a 52.1% amputation rate; biochemical depletion was associated with risk of amputation with vitamin C (P < .01), albumin (P = .03), and hemoglobin (P = .01), markedly lower in patients managed with amputation than those managed conservatively. There was no relation between duration of ulceration and nutrient depletion. Patients with diabetic foot ulceration rely on multidisciplinary care to optimize their wound healing. An important but often overlooked aspect of this is nutritional state, with micronutrients being very important for the healing of complex wounds. General nutritional screening often fails to identify patients at risk of micronutrient deficiency. There is a high prevalence of vitamin deficiency in patients with diabetic foot ulcers. This presents an excellent avenue for future research to assess if aggressive nutrient replacement can improve outcomes in this cohort of patients.
Click to expand...

NewsBot · Apr 18, 2023

The association between micronutrient levels and diabetic foot ulcer: A systematic review with meta-analysis
Shilia Jacob Kurian et al
Front Endocrinol (Lausanne). 2023 Mar 29

Background: Diabetic foot ulcers (DFU) are a major complication of diabetes mellitus (DM). Nutrient deficiencies are among the major risk factors in DFU development and healing. In this context, we aimed to investigate the possible association between micronutrient status and risk of DFU.

Methods: A systematic review (Prospero registration: CRD42021259817) of articles, published in PubMed, Web of Science, Scopus, CINAHL Complete, and Embase, that measured the status of micronutrients in DFU patients was performed.

Results: Thirty-seven studies were considered, of which thirty were included for meta-analysis. These studies reported levels of 11 micronutrients: vitamins B9, B12, C, D, E, calcium, magnesium, iron, selenium, copper, and zinc. DFU, compared to healthy controls (HC) had significantly lower vitamin D (MD: -10.82 14 ng/ml, 95% CI: -20.47, -1.16), magnesium (MD: -0.45 mg/dL, 95% CI: -0.78, -0.12) and selenium (MD: -0.33 µmol/L, 95% CI: -0.34, -0.32) levels. DFU, compared to DM patients without DFU, had significantly lower vitamin D (MD: -5.41 ng/ml, 95% CI: -8.06, -2.76), and magnesium (MD: -0.20 mg/dL, 95% CI: -0.25, -0.15) levels. The overall analysis showed lower levels of vitamin D [15.55ng/ml (95% CI:13.44, 17.65)], vitamin C [4.99µmol/L (95% CI:3.16, 6.83)], magnesium [1.53mg/dL (95% CI:1.28, 1.78)] and selenium [0.54µmol/L (95% CI:0.45, 0.64)].

Conclusion: This review provides evidence that micronutrient levels significantly differ in DFU patients, suggesting an association between micronutrient status and risk of DFU. Therefore, routine monitoring and supplementations are warranted in DFU patients. We suggest that personalized nutrition therapy may be considered in the DFU management guidelines.
Click to expand...

NewsBot · May 14, 2023

The short-term prognosis of diabetic foot ulceration is independent of nutritional status at admission
Florine Feron et al
J Wound Care. 2023 May 2;32(5):312-317.

Diabetic foot ulcers are one of the complications of diabetes. Malnutrition is one of the risk factors for wounds but, on the other hand, diabetic foot ulceration may promote malnutrition. In this single-centre retrospective study we evaluated the frequency of malnutrition at first admission and the severity of foot ulceration. We demonstrated that malnutrition at admission correlated with duration of hospitalisation and with death rate rather than with the risk of amputation. Our data challenged the concept that protein-energy deficiency may worsen the prognosis of diabetic foot ulcers. Nevertheless, it is still important to screen nutritional status at baseline and during the follow-up in order to start specific nutritional support therapy as soon as possible in order to reduce morbidity/mortality related to malnutrition.
Click to expand...

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Nutritional status deteriorates as the severity of diabetic foot ulcers increases

Controlling Nutritional (CONUT) score and ulcer healing

Nutritional management of Diabetic Neuropathy

Nutritional supplements and wound healing

People living with diabetes are unaware of their foot risk status

Race and Insurance Status Association With Receiving Orthopedic Surgeon-Prescribed Foot Orthoses

Effect of Footwear and Foot Orthotics on Venous Status

Share This Page