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Basiri R, Spicer MT, Ledermann T, Arjmandi BH. Effects of Nutrition Intervention on Blood Glucose, Body Composition, and Phase Angle in Obese and Overweight Patients with Diabetic Foot Ulcers. Nutrients 2022; 14:nu14173564. [PMID: 36079822 PMCID: PMC9460794 DOI: 10.3390/nu14173564] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Nutrition can play an important role in the treatment of chronic wounds such as diabetic foot ulcers (DFUs); however, diet therapy is not currently part of the standard care for DFUs. There are numerous controversies about dietary recommendations, especially regarding calories and macronutrients, for overweight and obese patients with DFUs. This study examined the effects of nutrition education and supplementation on body composition in overweight and obese patients with DFUs. Twenty-nine patients with DFUs between the ages of 30 and 70 years were randomly assigned to either the treatment group (nutritional supplements, diet education, and standard care) or the control group (standard care). At baseline, the mean body mass index (BMI) was 33.5 kg/m2 for the treatment group and 34.1 kg/m2 for the control group. HbA1c decreased in both groups, with no significant difference between the groups. On average, patients in the treatment group lost less lean body mass and gained less fat than the control group ((3.8 kg vs. 4.9 kg) and (0.9 kg vs. 3.6 kg), respectively). While the interaction between group and time did not reach statistical significance for any of the study variables after adjustments for confounding variables, the observed changes are clinically relevant.
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Affiliation(s)
- Raedeh Basiri
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA
- Institute for Biohealth Innovation, George Mason University, Fairfax, VA 22030, USA
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL 32306, USA
- Center for Advancing Exercise and Nutrition Research on Aging, Florida State University, Tallahassee, FL 32306, USA
- Correspondence: (R.B.); (B.H.A.)
| | - Maria T. Spicer
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL 32306, USA
| | - Thomas Ledermann
- Department of Family and Child Sciences, Florida State University, Tallahassee, FL 32306, USA
| | - Bahram H. Arjmandi
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL 32306, USA
- Center for Advancing Exercise and Nutrition Research on Aging, Florida State University, Tallahassee, FL 32306, USA
- Correspondence: (R.B.); (B.H.A.)
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Zhang F, Ren Y, Wang H, Bai Y, Huang L. Daily Step Counts in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Observational Studies. Front Med (Lausanne) 2022; 9:842423. [PMID: 35252275 PMCID: PMC8891233 DOI: 10.3389/fmed.2022.842423] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/26/2022] [Indexed: 12/13/2022] Open
Abstract
BackgroundPhysical inactivity is an essential factor in the prognosis of patients with chronic kidney disease (CKD). Daily step count is a straightforward measure to assess physical activity levels. Understanding the step counts among different CKD stages is essential to change sedentary behavior.ObjectivesThis systematic review and meta-analysis aimed to investigate the daily step counts in patients with CKD at a different stage.DesignA systematic review and meta-analysis.Data SourcesThe literature search was performed in PubMed, Embase, and Web of Science from inception to November 3rd, 2021.Review MethodsObservational studies (cross-sectional, case-control, or cohort studies) reported specific values of step counts in CKD patients by the wearable device were included. A random-effects model was used to pool the data. Subgroup analysis explored differences in outcomes by stage of CKD. Heterogeneity between studies was assessed using the χ2 test of Cochrane's Q statistic. A contour-enhanced funnel plot was conducted to investigate publication bias. Univariate and multivariate meta-regression was conducted to examine possible sources of heterogeneity.ResultsTwenty-eight articles were identified and used for quantitative analysis. The result showed that the daily step count in patients with CKD was 4642.47 (95% CI: 4274.18–5010.76), and significantly lower than the healthy population. Subgroup analysis revealed that the step counts decreased before dialysis, dropped to a freezing point at the hemodialysis phase, and increased after kidney transplantation. Meta-regression analysis showed that daily step counts were relatively higher in the Americas or younger than 60 or kidney transplant recipients.ConclusionThe status of daily step counts in patients with CKD decreases with CKD severity and increases after kidney transplantation. Although studies have begun to focus on strategies to improve step counts in patients with CKD, future studies should focus more on step counts in pre-dialysis patients and changing their physically inactive lifestyle early to alleviate deteriorating renal function.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291551, identifier: CRD42021291551.
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Affiliation(s)
- Fan Zhang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yibo Ren
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Wang
- Department of Anorectal, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Bai
- Department of Cardiology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liuyan Huang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Liuyan Huang
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Xu X, Yang Z, Ma T, Li Z, Chen Y, Zheng Y, Dong J. Novel equation for estimating resting energy expenditure in patients with chronic kidney disease. Am J Clin Nutr 2021; 113:1647-1656. [PMID: 33693520 DOI: 10.1093/ajcn/nqaa431] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/16/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In chronic kidney disease (CKD), determining energy expenditure is the precondition for recommending energy intake in nutrition management. OBJECTIVES We aimed to develop and validate a resting energy expenditure (REE) equation for patients with CKD. METHODS This cross-sectional study enrolled 300 patients with CKD (stages 3-5) according to inclusion and exclusion criteria. Stepwise linear regression analysis was used to derive a new REE equation (eREE-CKD) according to actual REE (aREE) measured using indirect calorimetry in the development dataset. The eREE-CKD value was then validated with aREE in the validation dataset and compared with values from existing equations obtained in general populations, namely, the Harris-Benedict, Mifflin, WHO, and Schofield equations in terms of bias, precision, and accuracy. RESULTS The eREE-CKD equation: eREE-CKD (kcal) = (1 if male; 0 if female) × 106.0 - [1 if diabetes mellitus (DM); 0 if non-DM] × 51.6 - 4.7 × age (y) + 13.1 × weight (kg) + 645.5 (R2 = 0.779).The bias, precision, and accuracy (percentage of estimates that differed >20% from the measured REE) of the eREE-CKD equation were -0.4 (IQR: -29.8, 23.8) kcal, 98.4 (IQR: 79.5, 116.6) kcal, and 5.4%, respectively with indirect calorimetry as the reference method. Both bias and precision of the eREE-CKD were significantly better than the Harris-Benedict, WHO, and Schofield equations (P < 0.001) and similar to the Mifflin equation (P = 0.125 for bias and 0.268 for precision). Accuracy of the eREE-CKD was significantly better than the Harris-Benedict, WHO, Mifflin, and Schofield equations (P < 0.001). Bias, precision, and accuracy of the eREE-CKD equation were consistent when applied to subgroups categorized according to high-sensitivity C-reactive protein concentrations and CKD stages, respectively. CONCLUSIONS The eREE-CKD equation using age, sex, weight, and DM data could serve as a reliable tool for estimating REE in patients with CKD. This trial was registered at clinicaltrials.gov as NCT03377413.
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Affiliation(s)
- Xiao Xu
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhikai Yang
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Tiantian Ma
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Ziqian Li
- Clinical Nutrition Department, Peking University First Hospital, Beijing, China
| | - Yuan Chen
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingdong Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
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Hassan NK, Gillani SW, Kaoje AA, Fari FM, Elashmouny HM, Sulayman NM, Mohammadi NA. A Clinical Review on Nutritional Requirements and Assessment for Type 2 Diabetes Mellitus with Chronic Renal Disease. Curr Diabetes Rev 2020; 16:922-930. [PMID: 32072916 DOI: 10.2174/1573399816666200211120402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/26/2020] [Accepted: 01/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND A significant correlation exists between type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD), where up to 40% of diabetic patients suffer from CKD as a direct result of diabetic complications. The management of diabetes in CKD patients can be challenging due to their need for disease-specific diets, as well as increased risks of complications due to malnutrition, which is why their dietary needs and nutritional requirements require attention to detail, and have to be assessed and tailored according to the patient's needs. OBJECTIVES This systematic review aimed to assess nutritional requirements for type 2 diabetes mellitus patients with chronic renal failure. METHODS In this review, 85 articles were screened, and 22 articles were then analyzed and selected as per the study criteria. PRISMA guidelines were used to select and screen the articles. Data search included a PubMed search using MeSH terms, and a literature review through the Cochrane library and the British Medical Journal. RESULTS The study highlighted the important nutrients and minerals needed to be maintained within a specified range in accordance with the patient's needs and conditions. In addition, dietary restrictions must be set to prevent disease progression and deterioration. Dietary intake in hemodialysis patients must be carefully calculated based on their needs, with tight monitoring of their blood glucose. Protein intake in hemodialysis patients should be determined based on risk-to-benefit ratios. CONCLUSION Dietary requirements should be individualized based on the patient's disease severity and progression. Assessment of the patient's previous and current diet, as well as matching it with their dietary requirements and preferences is crucial.
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Affiliation(s)
| | - Syed Wasif Gillani
- Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
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Ma CM, Wang N, Su QW, Yan Y, Yin FZ. Age, Pulse, Urea and Albumin (APUA) Model: A Tool for Predicting in-Hospital Mortality of Community-Acquired Pneumonia Adapted for Patients with Type 2 Diabetes. Diabetes Metab Syndr Obes 2020; 13:3617-3626. [PMID: 33116713 PMCID: PMC7553637 DOI: 10.2147/dmso.s268679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to develop a tool for predicting in-hospital mortality of community-acquired pneumonia (CAP) in patients with type 2 diabetes (T2DM). METHODS A retrospective study was conducted on 531 CAP patients with T2DM at The First Hospital of Qinhuangdao. The primary outcome was in-hospital mortality. Variables to develop the nomogram were selected using multiple logistic regression analysis. Discrimination was evaluated using receiver operating characteristic (ROC) curve. Calibration was evaluated using the Hosmer-Lemeshow test and calibration plot. RESULTS Multiple logistic regression analysis showed that age, pulse, urea and albumin (APUA) were independent risk predictors. Based on these results, we developed a nomogram (APUA model) for predicting in-hospital mortality of CAP in T2DM patients. In the training set, the area under the curve (AUC) of the APUA model was 0.814 (95% CI: 0.770-0.853), which was higher than the AUCs of albumin alone, CURB-65 and Pneumonia Severity Index (PSI) class (p<0.05). The Hosmer-Lemeshow test (χ 2=5.298, p=0.808) and calibration plot (p=0.802) showed excellent agreement between the predicted possibility and the actual observation in the APUA model. The results of the validation set were similar to those of the training set. CONCLUSION The APUA model is a simple and accurate tool for predicting in-hospital mortality of CAP, adapted for patients with T2DM. The predictive performance of the APUA model was better than CURB-65 and PSI class.
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Affiliation(s)
- Chun-Ming Ma
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, People’s Republic of China
| | - Ning Wang
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
| | - Quan-Wei Su
- Department of Internal Medicine, Chengde Medical College, Chengde, Hebei, People’s Republic of China
| | - Ying Yan
- Department of Internal Medicine, Chengde Medical College, Chengde, Hebei, People’s Republic of China
| | - Fu-Zai Yin
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei, People’s Republic of China
- Correspondence: Fu-Zai Yin Email
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