Prolonged hospitalization and 1-year mortality are associated with sarcopenia and malnutrition in older patients with type 2 diabetes: A prospective cohort study

AIM

To assess the relationship of the presence of sarcopenia and malnutrition with unfavorable clinical outcomes: prolonged length of hospital stay (LOS), readmission, and one-year mortality in older patients with type 2 diabetes (T2D).

METHODS

Were included 319 patients with ≥ 60 years of age with T2D hospitalized at a university hospital in Southern Brazil. Sarcopenia was diagnosed according to handgrip strength (HGS), calf circumference (CC), and the timed up and go (TUG) walking test, and malnutrition according to the subjective global assessment (SGA) and the mini nutritional assessment long form (MNA-LF). Multivariate analyses, adjusted for confounders, were performed to assess the association of sarcopenia and malnutrition with clinical outcomes. One-year survival was compared using Kaplan-Meier analysis.

RESULTS

The association between sarcopenia and malnutrition increased by 2.42 times (95 %CI 1.35-4.36) the probability of LOS ≥ 14 days and by 2.01 times (95 %CI 1.09-3.72) the risk of one-year mortality. Older patients with malnutrition and sarcopenia have a higher risk of one-year mortality (log-rank p < 0.05) compared with well-nourished patients without sarcopenia.

CONCLUSION

In older patients with type 2 diabetes, those with sarcopenia, and malnutrition have higher odds of prolonged hospitalization and risk of mortality within one year after hospital discharge.

LOSS et al.Nutrition as a risk for mortality and functionality in critically ill older adultsNutrition as a risk for mortality and functionality in critically ill older adults

BACKGROUND & AIMS

There is no specific recommendation for nutrition therapy for critically ill older adults. However, targeting caloric and protein balance and avoiding fasting could improve outcomes in this high-risk nutritional population. This study aimed to evaluate the associations between nutrition and mortality/functionality in critically ill older patients.

METHODS

Single-center retrospective observational study of critically ill patients aged 65 years or older. We extracted data from the dietician evaluations about calories, proteins, and the type of diet (fasting, oral, enteral, parenteral) prescribed in the first week of intensive care unit admission. Primary outcomes were intrahospital mortality and independence and functional capacity evaluated after hospital discharge.

RESULTS

Out of the 2,043 patients screened, 533 were included in the study. Most patients were men (52.1%), with a median age of 73 (68-78) years. Overall, the intrahospital mortality rate was 53.8%. SAPS-3, albumin, C-reactive protein, and surgical patients were independently associated with fasting in a multivariate analysis. The multivariate regression analyses showed that SAPS-3, albumin, and fasting were independently associated with mortality. Each fasting day increases the risk of mortality by 16.7%. Also, independence and functional capacity were not related to nutritional prescription.

CONCLUSION

Older adults (65 years or older) constitute a fragile population in which nutritional breaks were associated with increased hospital mortality. Furthermore, a prospective clinical trial is necessary to establish the best strategy to feed this population. This article is protected by copyright. All rights reserved.

Predictive equations for evaluation for resting energy expenditure in Brazilian patients with type 2 diabetes: what can we use?

BACKGROUND

Evaluation of the resting energy expenditure (REE) is essential to ensure an appropriate dietary prescription for patients with type 2 diabetes. The aim of this record was to evaluate the accuracy of predictive equations for REE estimation in patients with type 2 diabetes, considering indirect calorimetry (IC) as the reference method.

METHODS

A cross-sectional study was performed in outpatients with type 2 diabetes. Clinical, body composition by electrical bioimpedance and laboratory variables were evaluated. The REE was measured by IC (QUARK RMR, Cosmed, Rome, Italy) and estimated by eleven predictive equations. Data were analyzed using Bland-Altman plots, paired t-tests, and Pearson's correlation coefficients.

RESULTS

Sixty-two patients were evaluated [50% female; mean age 63.1 ± 5.2 years; diabetes duration of 11 (1-36) years, and mean A1C of 7.6 ± 1.2%]. There was a wide variation in the accuracy of REE values predicted by equations when compared to IC REE measurement. In all patients, Ikeda and Mifflin St-Jeor equations were that most underestimated REE. And, the equations that overestimated the REE were proposed by Dietary Reference Intakes and Huang. The most accurate equations were FAO/WHO/UNO in women (- 1.8% difference) and Oxford in men (- 1.3% difference).

CONCLUSION

In patients with type 2 diabetes, in the absence of IC, FAO/WHO/UNO and Oxford equations provide the best REE prediction in comparison to measured REE for women and men, respectively.

Basal metabolic rate in Brazilian patients with type 2 diabetes: comparison between measured and estimated values

OBJECTIVES

The aims of this study are to investigate which of the seven selected predictive equation for estimating basal metabolic rate (BMR) is the best alternative to indirect calorimetry (IC) and to evaluate the dietary energy intake in patients with type 2 diabetes.

SUBJECTS AND METHODS

Twenty-one patients with type 2 diabetes participated in this diagnostic test study. Clinical and laboratorial variables were evaluated as well as body composition by absorptiometry dual X-ray emission (DXA) and BMR measured by IC and estimated by prediction equations. Dietary intake was evaluated by a quantitative food frequency questionnaire. Data were analyzed using Bland-Altman plots, paired t-tests, and Pearson's correlation coefficients.

RESULTS

Patients were 62 (48-70) years old, have had diabetes for 8 (2-36) yeas, and 52.4% were females. The mean body composition comprised a fat-free mass of 49.8 ± 9.4 kg and a fat mass of 28.3 ± 7.2 kg. The energy intake was 2134.3 ± 730.2 kcal/day and the BMR by IC was 1745 ± 315 kcal/day. There was a wide variation in the accuracy of BMR values predicted by equations when compared to IC BMR measurement. Harris-Benedict, Oxford, FAO/WHO/UNO equations produced the smallest differences to IC, with a general bias of < 8%. The FAO/WHO/UNO equation provided the best BMR prediction in comparison to measured BMR.

CONCLUSION

In patients with type 2 diabetes, the equation of the FAO/WHO/UNO was the one closest to the BMR values as measured by IC.

Association of plasma vitamin D status with lifestyle patterns and ambulatory blood pressure monitoring parameters in patients with type 2 diabetes and hypertension

AIMS

To evaluate nutritional and metabolic parameters associated with vitamin D status and blood pressure (BP) in type 2 diabetes and hypertensive patients.

METHODS

BP evaluated by office and 24-h ambulatory BP monitoring (ABPM). Physical activity was evaluated by daily step count, body composition by DXA, and diet by a food frequency questionnaire.

RESULTS

116 patients were evaluated and median 25-hydroxyvitamin D level was 21 (16-27) ng/ml; 43% deficient (<20 ng/ml). Vitamin D deficiency was associated with higher systolic ABPM (136 ± 10 vs. 130 ± 13 mmHg; P = 0.01) and daytime ABPM (138 ± 11 vs. 133 ± 13 mmHg; P = 0.02), lower step counts (4400 [2700-6600] vs. 6400 [4700-8100] steps/day), lower urinary calcium (47 [32-141] vs. 89 [68-152] mEq), and higher fat mass (31 ± 8 vs. 27 ± 6.5 kg). Milk intake (37 vs. 64%; P = 0.009) and fish (31 vs. 69%; P < 0.001) were lower in deficients. On multivariate analysis, adjusted for fat mass and colder seasons, <5000 steps/day (OR = 3.30; 95%CI 1.34-8.12), no milk/fish intake (OR = 6.56; 95%CI 2.52-17.17), and both (OR = 7.24; 95%CI 2.19-23.90) remained associated with vitamin D deficiency.

CONCLUSIONS

Vitamin D deficiency was highly prevalent in patients with hypertension and type 2 diabetes and associated with higher systolic ABPM (daytime and 24-h), less physical activity, and no milk or fish intake.

Low Levels of Usual Physical Activity Are Associated with Higher 24 h Blood Pressure in Type 2 Diabetes Mellitus in a Cross-Sectional Study

The aim of this study is to evaluate the association between usual physical activity and 24 h blood pressure (BP) profile in people with type 2 diabetes mellitus (DM). This is a cross-sectional study of 151 participants with type 2 DM. Usual physical activity was assessed by step counting and self-reported questionnaire. BP was measured in office and by 24 h ambulatory BP monitoring (ABPM; 24 h, daytime and nighttime). Mean participant age was 61.1 ± 8.4 years, 64% was women, and mean duration of diabetes was 14.3 ± 8.5 years. Ninety-two percent of participants had hypertension, and office BP was 138 ± 18/78 ± 10 mmHg. Inverse correlations were observed between step count and 24 h BP (systolic, r = -0.186; p = 0.022), daytime BP (systolic, r = -0.198; p = 0.015), and nighttime BP (pulse pressure, r = -0.190; p = 0.019). People were categorized into tertiles of daily step count, and the 1st tertile had higher 24 h systolic BP, daytime systolic BP, daytime mean BP, and daytime systolic BP load than those in the other tertiles, even after adjusting for age and HbA1c. Participants with type 2 DM and low levels of physical activity exhibit higher 24 h and daytime systolic ambulatory BP values as compared with those who performed more steps per day, even after adjustments for confounding factors.

[Determinant factors associated with weight loss in adults on diet interventions]

OBJECTIVE

To analyze the determinants for weight loss (> 5%) resulting from outpatient individual appointments.

SUBJECTS AND METHODS

A retrospective cohort study was conduct in 318 overweight/obese patients seeking individual care to lose weight.

RESULTS

Fifteen percent of the patients did not lose weight; 35.1% had lost < 5%; 35.4% had lost between 5 and 10%; and 13.9% had lost > 10%. Patients who lost > 5% body weight (-7.6 ± 3.3 kg, n = 156) had a greater number of visits at a shorter interval, and greater frequency of visits with a registered dietitian and multidisciplinary care. This group had a lower prescription of anti-obesity drugs and their total calorie intake was higher than the other patients. In multivariate Cox regression, only the interval between appointments and the total number of visits remained inversely associated with weight loss.

CONCLUSIONS

The determinants of > 5% weight loss were fewer visits with a shorter interval between appointments.