Uncomplicated diabetes does not accelerate age-related sarcopenia

BACKGROUND

Diabetes is reported to accelerate sarcopenia (age-related loss of muscle mass and function). We aimed to assess muscle mass and strength in elderly diabetics, elderly non-diabetics, younger diabetics and healthy subjects, and to define correlates of muscle mass and strength in these subjects.

METHODS

Sixteen elderly diabetics, 16 younger diabetics, 16 elderly non-diabetics and 18 younger non-diabetics were included. Elderly and diabetic subjects were first evaluated with exercise testing. Isokinetic leg extension and flexion tests were performed using a Cybex 350 dynamometer. Muscle mass was calculated using bioelectric impedance analysis.

RESULTS

Muscle mass was similar between all groups; however, muscle strength was significantly lower in diabetic and non-diabetic elderly subjects compared with younger diabetic subjects and non-diabetics. Muscle strength was positively correlated with albumin, metabolic equivalent and hemoglobin, and inversely correlated with age, HbA1c, functional capacity and CRP. Independent correlates of muscle strength were age and hemoglobin. There was no clinically significant correlate of muscle mass. Presence or duration of diabetes was not associated with muscle mass or strength.

CONCLUSIONS

Uncomplicated diabetes does not seem to accelerate aging-related muscle mass or strength loss. Exercise test parameters may be useful markers in the screening of sarcopenia.

Arterial stiffness parameters associated with vitamin D deficiency and supplementation in patients with normal cardiac functions

OBJECTIVE

Arterial stiffness parameters including pulse wave velocity (PWV) and augmentation index (AIx) are associated with increased risk of cardiovascular disease. A close relationship has been demonstrated between vitamin D deficiency and cardiovascular disease. The aim of the present study was to investigate effects of vitamin D deficiency and supplementation on arterial stiffness parameters in patients with normal cardiac functions.

METHODS

Study population consisted of 45 patients with vitamin D deficiency and normal cardiac functions. Median age (interquartile range) was 45.0 (12.00) years, and 33 patients were female. Patients were treated with oral administration of vitamin D3. Arterial stiffness parameters were evaluated using Mobil-O-Graph arteriograph system, which detected signals from the brachial artery before and after treatment.

RESULTS

Vitamin D levels significantly increased after treatment (9.0 [6.00] nmol/L vs 29.0 [11.50] nmol/L, p<0.001). No significant difference was observed among conventional echocardiographic parameters before or after treatment. Post-treatment PVW and AIx were significantly lower than baseline measurements (6.8 [1.55] m/s vs 6.4 [1.30] m/s, p<0.001 and 23.0 [22.00]% vs 31.0 [14.50]%, p<0.001, respectively). Baseline vitamin D levels significantly correlated with PWV (r=-0.352, p=0.018). Post-treatment vitamin D levels also significantly correlated with post-treatment PWV (r=-0.442, p=0.002) and AIx (r=-0.419, p=0.004). Multivariate linear regression analysis revealed no independent predictor of baseline log-transformed PWV.

CONCLUSION

Vitamin D supplementation has beneficial effects on arterial stiffness. Arterial stiffness parameters may aid in the assessment of cardiovascular risk in patients with vitamin D deficiency.

One-Year Mortality After Percutaneous Endoscopic Gastrostomy: The Prognostic Role of Nutritional Biomarkers and Care Settings

Background/Objectives: This study aimed to evaluate the clinical outcomes, complications, and one-year mortality of patients undergoing percutaneous endoscopic gastrostomy (PEG) in different care settings (hospital, nursing home, and home). Additionally, we investigated the comparative prognostic role of the prognostic nutritional index (PNI) and the CRP-to-albumin ratio (CAR) in predicting mortality among these patients. Methods: A retrospective analysis of 236 adult patients who underwent PEG placement between January 2022 and December 2023 was performed. Demographic, clinical, and laboratory data were collected. The PNI was calculated according to the following formula: PNI = 10 × (albumin) + 0.005 × (lymphocyte count). The CAR was obtained by the ratio of the CRP level to the albumin level. Patients were categorized based on their post-PEG care settings. Results: Neurologic disorders were the most common indication for PEG (69.9%). The one-year mortality was 32.2%, with a median survival of 38 weeks (95% CI: 35-41). In the multivariable model, a lower PNI (HR = 0.93, 95% CI: 0.89-0.97, p < 0.001), as well as being followed in a hospital setting, emerged as independent predictors of mortality. Patients with timely PEG tube replacement showed a reduced mortality risk. The ROC analysis showed that the PNI had a higher AUROC (0.78 ± 0.04) compared to the CAR (0.69 ± 0.04), indicating superior prognostic accuracy for predicting one-year mortality. Conclusions: Care settings significantly influence survival outcomes, with better mortality rates observed in nursing homes and home environments. The PNI was superior to the CAR in predicting one-year mortality, emphasizing its clinical utility in risk stratification for PEG patients. Proactive tube management and individualized care strategies are critical for improving the prognosis in this population.

Assessment of Enteral Nutrition Adequacy in Patients Hospitalised in Adult Intensive Care Units: A Cross-Sectional Study

INTRODUCTION

In the principles of intensive care, nutritional support is an important part of critical care. This study was conducted to evaluate the adequacy of enteral nutrition in patients hospitalised in adult intensive care units.

METHODS

The present study was designed as a cross-sectional study, and it was carried out on 124 patients who received enteral nutrition in the adult intensive care unit of a training and research hospital between March 1, 2022, and April 1, 2022. Patients who received parenteral nutrition during the 1-month follow-up were excluded from the study. The study used the enteral nutrition information form and the baseline NRS-2002 score. Energy needs of patients were calculated by Schofield method and addition of stress factors. Daily energy intake was recorded for each patient every day during hospitalisation. Backward stepwise logistic regression analysis, Shapiro-Wilk, Student's t, Mann-Whitney U, Kruskal-Wallis, Dunn-Bonferroni, Pearson chi-squared, and Fisher's exact tests were used to evaluate the data.

RESULTS

Mean age of the patients was 70.9 ± 16.7 years (range 21-98), and 58.9% were male. The mean baseline NRS-2002 score was 5.88 ± 1.23. Enteral nutrition started an average of 2.4 ± 2.2 days (range 0-18) after ICU hospitalisation. The mean target energy intake according to Schofield method was 1,772.9 ± 284.3 kcal, while the actual intake was 1,463.5 ± 386.2 kcal. Only 37.1% of patients achieved the target dose, taking an average of 4.5 ± 4.2 days (1-20) to reach it. In 25% of patients, feeding was interrupted due to residual volumes exceeding 500 mL, with 54.8% of these receiving hypercaloric products. Patients with neurological and cardiac diagnoses had significantly higher rates of reaching the target dose (p = 0.001), while those with interruptions due to high residual volumes had lower rates (p = 0.003). Finally, the overall mortality rate was 59.7%.

CONCLUSION

More than half of the patients did not meet the goals set for enteral nutrition therapy. A lower baseline NRS-2002 score and low energy requirements facilitated goal attainment. Patients with cardiac or neurological conditions were more likely to reach the target nutritional dose. However, those fed with hypercaloric products experienced more interruptions due to excess residue and achieved the nutritional target less frequently.

The Overlooked Threat of Malnutrition: A Point Prevalence Study Based on NRS-2002 Screening in a Tertiary Care Hospital

Background: Malnutrition is increasingly prevalent due to rising life expectancy, oncological cases, and chronic diseases. Early detection is crucial for rehabilitation, complication prevention, and cost reduction. However, nutritional support is often suboptimal. This study aimed to determine malnutrition prevalence and nutritional support status within our hospital. Methods: A point prevalence study was conducted in adult inpatient clinics (excluding pediatrics, infectious diseases, and intensive care) by a 12-member team following ethical approval. NRS-2002 scores, arm/calf circumferences, BMI, and laboratory data (albumin, leukocytes, lymphocytes, neutrophils, hemoglobin, CRP, creatinine) were assessed. Enteral and parenteral nutrition treatments were recorded. Patients with NRS-2002 scores ≥ 3 were classified as at risk of malnutrition. Results: Among 178 patients, 24.7% were at risk of malnutrition. Surgical clinics had a higher malnutrition risk (32.3%) than internal medicine clinics (20.3%). Only 27.1% of at-risk patients received nutritional support (surgical: 19%, internal medicine: 44%). Patients at risk of malnutrition exhibited significantly lower arm circumference (p: 0.000), calf circumference (p: 0.002), lymphocyte counts (p: 0.000), hemoglobin (p: 0.018), albumin (p: 0.001), and BMI (p: 0.038), as well as significantly higher age (p: 0.000) and CRP levels (p: 0.000). Conclusions: Nutritional support remains inadequate despite increased attention to malnutrition. Intensified nutrition education, particularly in surgical inpatient clinics, is needed to improve patient rehabilitation and outcomes.

An Examination of the Self-Efficacy and Factors Influencing Foot Care Behaviors in Individuals with Type 2 Diabetes Mellitus

The present descriptive study investigates the general and foot-care self-efficacy and the level of foot-care knowledge of 151 participants who presented to the internal medicine ward and diabetes nursing unit of a training and research hospital in Türkiye. The mean Diabetes Management Self-Efficacy Scale score of the participants was 69.0 ± 15.0 (min: 20, max: 100), the mean Diabetic Foot Care Self-Efficacy Scale score was 56.2 ± 23.1 (min: 9, max: 90) and the mean Diabetes Foot Self-Care Behavior Scale score was 51.5 ± 13.6 (min: 15, max: 75). The total Diabetes Management Self-Efficacy Scale, Diabetic Foot Care Self-Efficacy Scale and Diabetes Foot Self-Care Behavior Scale scores were noted to be higher in the participants who underwent regular health check-ups and used their medication regularly than in those who did not (p < 0.05). People with diabetes should be provided with counseling on the benefits of developing positive behaviors related to self-efficacy and foot self-care, and the prevention of wound development through education, support and the effective self-management of their condition.