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Zhang H, Liu N, Dang H. Association of the Controlling Nutritional Status (CONUT) score with all-cause and cause-specific mortality in patients with diabetic kidney disease: evidence from the NHANES 2009-2018. BMJ Open 2024; 14:e079992. [PMID: 38653515 PMCID: PMC11043715 DOI: 10.1136/bmjopen-2023-079992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/16/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE To investigate the association between the Controlling Nutritional Status (CONUT) score and all-cause and cause-specific mortality in patients with diabetic kidney disease (DKD). DESIGN A retrospective cohort study. SETTING AND PARTICIPANTS Data on patients with DKD from the National Health and Nutrition Examination Survey 2009-2018. PRIMARY AND SECONDARY OUTCOME MEASURES All-cause mortality, cardiovascular disease (CVD)-related mortality, diabetes-related mortality and nephropathy-related mortality. RESULTS A total of 1714 patients were included, with 1119 (65.29%) in normal nutrition group (a score of 0-1), 553 (32.26%) in mild malnutrition group (a score of 2-4) and 42 (2.45%) in moderate and severe malnutrition group (a score of 5-12), according to the CONUT score. After controlling for age, race, marital status, smoking, hypertension, CVD, diabetic retinopathy, poverty income ratio, antidiabetics, diuretics, urinary albumin to creatinine ratio, uric acid, energy, protein, total fat, sodium and estimated glomerular filtration rate, a higher CONUT score was associated with a significantly greater risk of all-cause death (HR 1.30, 95% CI 1.15 to 1.46, p<0.001). In contrast to patients with a CONUT score of 0-1, those who scored 5-12 had significantly increased risks of all-cause death (HR 2.80, 95% CI 1.42 to 5.51, p=0.003), diabetes-related death (HR 1.78, 95% CI 1.02 to 3.11, p=0.041) and nephropathy-related death (HR 1.84, 95% CI 1.04 to 3.24, p=0.036). CONCLUSION Moderate and severe malnutrition was associated with greater risks of all-cause death, diabetes-related death and nephropathy-related death than normal nutritional status in DKD. Close monitoring of immuno-nutritional status in patients with DKD may help prognosis management and improvement.
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Affiliation(s)
- Huifeng Zhang
- Department of Nephrology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi, P.R.China
| | - Na Liu
- Department of Nephrology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi, P.R.China
| | - Huaixin Dang
- Drug Farm Inc Building D7, Jiashan 100032, Zhejiang, P.R.China
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Sun S, Wang Y, Pang S, Wu X. Combination of the glycated hemoglobin levels and prognostic nutritional index as a prognostic marker in patients with acute coronary syndrome and type 2 diabetes mellitus. Lipids Health Dis 2024; 23:12. [PMID: 38212760 PMCID: PMC10782571 DOI: 10.1186/s12944-023-01992-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/26/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Increased susceptibility to malnutrition and inadequate glycemic control are frequently observed in diabetic patients with coronary artery disease. The assessment of malnutrition is performed using the prognosis nutritional index (PNI). The inadequate glycemic control is measured using glycated hemoglobin (HbA1c). However, the combined effect of PNI and HbA1c on the prognosis in diabetic patients with coronary artery disease remains unknown. METHODS A study was conducted at Beijing Anzhen Hospital and included 2,005 patients diagnosed with type 2 diabetes mellitus (T2DM) accompanied by acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) from September 2021 to January 2022. Based on the median PNI and HbA1c, we categorized the patients into four groups including high (H)-PNI/low (L)-HbA1c, H-PNI/H-HbA1c, L-PNI/L-HbA1c, and L-PNI/H-HbA1c. Major adverse cardiac and cerebrovascular events (MACCE) were the primary outcome, including all-cause mortality, nonfatal myocardial infarction (MI), and nonfatal strokes. RESULTS Throughout a median follow-up of 16.3 months, 73 patients had MACCE, which comprised 36 cases of all-cause mortality. In comparison to the H-PNI, the L-PNI showed an obvious rise in MACCE and all-cause mortality (log-rank P = 0.048 and 0.021, respectively) among the H-HbA1c group. Compared to the other groups, the L-PNI/H-HbA1c group exhibited the greatest risk of MACCE (adjusted hazard ratio [aHR]: 2.50, 95% confidence interval [CI] 1.20-5.23, P = 0.014) and all-cause mortality (HR: 3.20, 95% CI 1.04-9.82, P = 0.042). With the addition of PNI, MACCE and all-cause mortality prediction models performed significantly better in patients with ACS and T2DM after PCI, particularly in those with H-HbA1c levels. CONCLUSIONS The combination of L-PNI and H-HbA1c is a prognostic marker for MACCE and all-cause mortality in patients diagnosed with ACS and T2DM who underwent PCI. The PNI can serve as an assessment tool of malnutrition in patients with ACS and T2DM accompanied by H-HbA1c who underwent PCI. Therefore, monitoring the long-term change of the PNI deserves attention in clinical practice.
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Affiliation(s)
- Shuaifeng Sun
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Yue Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Shuo Pang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Xiaofan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2nd Anzhen Road, Chaoyang District, Beijing, 100029, China.
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Go SI, Choi BH, Park MJ, Park S, Kang MH, Kim HG, Kang JH, Jeong EJ, Lee GW. Prognostic impact of pretreatment skeletal muscle index and CONUT score in diffuse large B-cell Lymphoma. BMC Cancer 2023; 23:1071. [PMID: 37932700 PMCID: PMC10629181 DOI: 10.1186/s12885-023-11590-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Although the prognostic value of the Controlling Nutritional Status (CONUT) score in diffuse large B-cell lymphoma (DLBCL) has been reported in several previous studies, its clinical relevance for the presence of sarcopenia has not been assessed. METHODS In this study, 305 DLBCL patients were reviewed. They were categorized into normal/mild (n = 219) and moderate/severe (n = 86) CONUT groups. Sarcopenia was assessed using the L3-skeletal muscle index measured by baseline computed tomography imaging. Based on CONUT score and sarcopenia, patients were grouped: A (normal/mild CONUT and no sarcopenia), B (either moderate/severe CONUT or sarcopenia, but not both), and C (both moderate/severe CONUT and sarcopenia). RESULTS The moderate/severe CONUT group showed higher rates of ≥ grade 3 febrile neutropenia, thrombocytopenia, non-hematologic toxicities, and early treatment discontinuation not related to disease progression, compared to the normal/mild CONUT group. The moderate/severe CONUT group had a lower complete response rate (58.1% vs. 80.8%) and shorter median overall survival (18.5 vs. 162.6 months) than the normal/mild group. Group C had the poorest prognosis with a median survival of 8.6 months, while groups A and B showed better outcomes (not reached and 60.1 months, respectively). Combining CONUT score and sarcopenia improved the predictive accuracy of the Cox regression model (C-index: 0.763), compared to the performance of using either CONUT score (C-index: 0.754) or sarcopenia alone (C-index: 0.755). CONCLUSIONS In conclusion, the moderate/severe CONUT group exhibited treatment intolerance, lower response, and poor prognosis. Additionally, combining CONUT score and sarcopenia enhanced predictive accuracy for survival outcomes compared to individual variables.
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Affiliation(s)
- Se-Il Go
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Bong-Hoi Choi
- Department of Nuclear Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Mi Jung Park
- Department of Radiology, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Sungwoo Park
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Gangnam-ro 79 Jinju, Jinju, 52727, Korea
| | - Myoung Hee Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Hoon-Gu Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Jung Hun Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Gangnam-ro 79 Jinju, Jinju, 52727, Korea
| | - Eun Jeong Jeong
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Gangnam-ro 79 Jinju, Jinju, 52727, Korea
| | - Gyeong-Won Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Gangnam-ro 79 Jinju, Jinju, 52727, Korea.
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Lo Buglio A, Scioscia G, Bellanti F, Tondo P, Soccio P, Natale MP, Lacedonia D, Vendemiale G. Controlling Nutritional Status Score as a Predictor for Chronic Obstructive Pulmonary Disease Exacerbation Risk in Elderly Patients. Metabolites 2023; 13:1123. [PMID: 37999219 PMCID: PMC10673254 DOI: 10.3390/metabo13111123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
The Controlling Nutritional Status (CONUT) score is a simple screening tool able to assess poor nutritional status as well as to predict clinical adverse outcomes in different clinical settings. No data are available in older patients with chronic obstructive pulmonary disease (COPD). This study aimed to investigate the CONUT score as a predictor of frequent exacerbations. We retrospectively enrolled 222 patients aged 65 years or older, classified in two groups according to the number of exacerbations (or hospitalizations because AECOPD) during the previous year. The two groups were further divided according to low (<5) or high (≥5) CONUT scores. A total of 67.2% of frequent exacerbators had a high CONUT score. These patients exhibited a significantly higher CAT score, lower FEV1 percentage value, and higher prevalence of severe GOLD stages compared to those with low CONUT. Multivariate analysis showed that a CONUT score ≥ 5 was the best independent predictor (OR 20.740, p < 0.001) of the occurrence of ≥2 exacerbations (or 1 hospitalization) during the previous year. The CONUT score seemed to have a high prognostic value for frequent exacerbations for COPD in older patients. The predictive role of different CONUT score cut-off values needs to be validated in larger COPD populations in future multi-center, prospective clinical studies.
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Affiliation(s)
- Aurelio Lo Buglio
- Department of Medical and Surgical Sciences, Institute of Internal Medicine, University of Foggia, Policlinico of Foggia, 71122 Foggia, Italy; (F.B.); (G.V.)
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, Institute of Respiratoy Diseases, University of Foggia, Policlinico of Foggia, 71122 Foggia, Italy; (G.S.); (P.T.); (P.S.); (M.P.N.); (D.L.)
| | - Francesco Bellanti
- Department of Medical and Surgical Sciences, Institute of Internal Medicine, University of Foggia, Policlinico of Foggia, 71122 Foggia, Italy; (F.B.); (G.V.)
| | - Pasquale Tondo
- Department of Medical and Surgical Sciences, Institute of Respiratoy Diseases, University of Foggia, Policlinico of Foggia, 71122 Foggia, Italy; (G.S.); (P.T.); (P.S.); (M.P.N.); (D.L.)
| | - Piera Soccio
- Department of Medical and Surgical Sciences, Institute of Respiratoy Diseases, University of Foggia, Policlinico of Foggia, 71122 Foggia, Italy; (G.S.); (P.T.); (P.S.); (M.P.N.); (D.L.)
| | - Matteo Pio Natale
- Department of Medical and Surgical Sciences, Institute of Respiratoy Diseases, University of Foggia, Policlinico of Foggia, 71122 Foggia, Italy; (G.S.); (P.T.); (P.S.); (M.P.N.); (D.L.)
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, Institute of Respiratoy Diseases, University of Foggia, Policlinico of Foggia, 71122 Foggia, Italy; (G.S.); (P.T.); (P.S.); (M.P.N.); (D.L.)
| | - Gianluigi Vendemiale
- Department of Medical and Surgical Sciences, Institute of Internal Medicine, University of Foggia, Policlinico of Foggia, 71122 Foggia, Italy; (F.B.); (G.V.)
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Sun S, Tao S, Xi X, Jiang T, Zhu Q, Zhou Y, Li H. Analysis of the predictive value of the Geriatric Nutritional Risk Index for osteoporosis in elderly patients with T2DM: a single-center retrospective study. J Orthop Surg Res 2023; 18:760. [PMID: 37805606 PMCID: PMC10560427 DOI: 10.1186/s13018-023-04237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Malnutrition is recognized as a risk factor for osteoporosis and T2DM. Previous studies have demonstrated the relationship between nutritional assessment tools and BMD. However, few studies have compared the effects of three nutritional risk assessment tools (GNRI, CONUT, and PNI). This study aimed to investigate the correlation between three nutritional assessment tools and BMD and to compare their validity in predicting osteoporosis in type 2 diabetes mellitus in the elderly. METHODS This retrospective study collected clinical data from 525 elderly patients with type 2 diabetes mellitus and categorized the patients into osteoporotic and non-osteoporotic groups. The correlation between the three nutritional assessment tools and BMD was analyzed using Spearman partial correlation. Binary logistics regression was used to analyze the relationship between GNRI and osteoporosis. ROC curves were used to compare the validity of GNRI, PNI, and CONUT in predicting osteoporosis. RESULTS Spearman's partial correlation showed a positive correlation between femoral neck BMD and lumbar spine BMD, but no correlation was observed between total hip BMD and GNRI. Logistic regression analyses showed no association between PNI, CONUT scores, and the development of osteoporosis. After adjusting for age, sex, smoking, alcohol consumption, BMI, ALB, Cr, UA, FBG, TG, and HDL, the correlation between GNRI and osteoporosis remained. ROC curve analysis showed that GNRI in combination with age and albumin had better predictive ability for osteoporosis than PNI and CONUT. CONCLUSION GNRI was an independent protective factor against osteoporosis in elderly patients with T2DM, and the predictive ability of GNRI for osteoporosis in elderly patients with T2DM was better than that of PNI and CONUT scores.
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Affiliation(s)
- Silu Sun
- School of Nursing, Chengdu Medical College, Tianhui Road, Chengdu, 610083, China
| | - Simin Tao
- School of Nursing, Chengdu Medical College, Tianhui Road, Chengdu, 610083, China
| | - Xiaoyan Xi
- Department of Orthopedics, The First Affiliated Hospital of Chengdu Medical College, 278 Baoguang Avenue, Middle Section, Chengdu, 610599, China
| | - Tao Jiang
- Department of Orthopedics, The First Affiliated Hospital of Chengdu Medical College, 278 Baoguang Avenue, Middle Section, Chengdu, 610599, China
| | - Qian Zhu
- School of Nursing, Chengdu Medical College, Tianhui Road, Chengdu, 610083, China
| | - Yan Zhou
- School of Nursing, Chengdu Medical College, Tianhui Road, Chengdu, 610083, China
| | - Hui Li
- School of Nursing, Chengdu Medical College, Tianhui Road, Chengdu, 610083, China.
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Mechanick JI, Christofides EA, Marchetti AE, Hoddy KK, Joachim J, Hegazi R, Hamdy O. The syndromic triad of COVID-19, type 2 diabetes, and malnutrition. Front Nutr 2023; 10:1122203. [PMID: 36895277 PMCID: PMC9988958 DOI: 10.3389/fnut.2023.1122203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic challenges our collective understanding of transmission, prevention, complications, and clinical management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Risk factors for severe infection, morbidity, and mortality are associated with age, environment, socioeconomic status, comorbidities, and interventional timing. Clinical investigations report an intriguing association of COVID-19 with diabetes mellitus and malnutrition but incompletely describe the triphasic relationship, its mechanistic pathways, and potential therapeutic approaches to address each malady and their underlying metabolic disorders. This narrative review highlights common chronic disease states that interact epidemiologically and mechanistically with the COVID-19 to create a syndromic phenotype-the COVID-Related Cardiometabolic Syndrome-linking cardiometabolic-based chronic disease drivers with pre-, acute, and chronic/post-COVID-19 disease stages. Since the association of nutritional disorders with COVID-19 and cardiometabolic risk factors is well established, a syndromic triad of COVID-19, type 2 diabetes, and malnutrition is hypothesized that can direct, inform, and optimize care. In this review, each of the three edges of this network is uniquely summarized, nutritional therapies discussed, and a structure for early preventive care proposed. Concerted efforts to identify malnutrition in patients with COVID-19 and elevated metabolic risks are needed and can be followed by improved dietary management while simultaneously addressing dysglycemia-based chronic disease and malnutrition-based chronic disease.
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Affiliation(s)
- Jeffrey I Mechanick
- The Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, New York, NY, United States.,Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Albert E Marchetti
- Medical Education and Research Alliance (Med-ERA, Inc.), New York, NY, United States.,Rutgers New Jersey Medical School, Newark, NJ, United States
| | | | - Jim Joachim
- Internal Medicine and Medical Nutrition, San Diego, CA, United States
| | | | - Osama Hamdy
- Joslin Diabetes Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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