Assessing the association between optimal energy intake and all‐cause mortality in older patients with diabetes mellitus using the Japanese Elderly Diabetes Intervention Trial

Abstract

AimSelecting optimal energy intake during diet therapy for older patients with diabetes mellitus is difficult because of the large differences in physical function and comorbid diseases. In Japan, although requirements for total energy intake are calculated by multiplying a person's standard bodyweight (BW) by the amount of physical activity, evidence supporting the application of this method among older people is limited. Therefore, we aimed to assess optimal energy intake by evaluating the relationship between energy intake and mortality in older patients.MethodsWe evaluated data from a 6‐year prospective follow up of 756 older patients with diabetes mellitus, and the association between baseline nutrient intake and mortality. Total energy intake and nutrients were evaluated, and energy intake per actual BW was categorized into quartiles (Q). Cox regression analysis was used for statistical analyses. Energy intake per standard BW or age‐related target BW was statistically analyzed using the same protocol.ResultsAnalysis of energy intake per actual BW showed that hazard ratios for mortality was significantly higher in Q1 and Q4. Similar associations were found for energy intake per standard or target BW. Subgroup analysis showed that mortality rate was the lowest in Q2 in the young‐old population and in Q3 in the old‐old population.ConclusionsA U‐shaped relationship was observed between energy intake per BW and mortality in older patients with diabetes mellitus, which suggests that the optimal energy intake per actual or target BW should encompass a wide range to prevent malnutrition and excessive nutrition in these patients. Geriatr Gerontol Int 2020; 20: 59–65.

Nutrition Management in Older Adults with Diabetes: A Review on the Importance of Shifting Prevention Strategies from Metabolic Syndrome to Frailty

“…The 2019 diabetes care guidelines of the Japan Diabetes Society recommend that the total energy intake requirement in older adults should be calculated using age-dependent target body weight (kg) = (22-25 kg/m 2 × height [m] 2 ) multiplied by coefficients of physical activity [117]. Using a target body weight set based on age-dependent coefficients (23.5 and 25.0 kg/m 2 for ages < 75 and ≥ 75 years, respectively), we found a U-shaped association between energy intake per target body weight and mortality similar to that reported for the association between energy intake per real body weight and mortality [116].…”

“…The mortality risk was higher in Q1 (<24.85 kcal/kg body weight/day) and Q4 (≥34.79 kcal/kg body weight/day) than in Q2 (24.86-29.73 kcal/kg body weight/day) and Q3 (29.74-34.78 kcal/kg body weight/day) The risk of Q1 against Q3 was significant, whereas the risk of Q4 against Q3 was not. The lowest mortality risk was observed in Q2 comprising younger old patients (<75 years), whereas the lowest risk in older old patients (≥75 years) was observed in Q3 [116]. These results indicate that low energy intake is a mortality risk for older patients with diabetes and that energy requirement per actual body weight should be set higher in older old patients than in younger ones.…”

Evaluation of Oral Nutritional Supplementation in the Management of Frailty among the Elderly at Facilities of Community Care for the Elderly

“…In particular, dietary intake has the greatest effect on the status of frailty [ 14 15 ]. Previous studies reported that the intake of total energy, protein, vitamin D, and calcium determined frailty, hospitalization rate, and mortality [ 16 17 18 19 20 ]. The elderly population consuming enough protein and vitamin D showed improved physical function and increased muscle mass [ 21 22 ].…”

Energy intake during hospital stay predicts all-cause mortality after discharge independently of nutritional status in elderly heart failure patients

“…The relationship between energy intake and the mortality is highly complex due to the cross-study heterogeneity including differences in study subjects (healthy vs. ill), study periods, and proportions of specific macronutrients (carbohydrates, protein, and fat), which cannot be easily adjusted for meta-analyses. In general, greater energy intake is associated with increased risk of mortality including risk of cardiovascular and cancer death in the general population and in patients with chronic diseases such as type 2 diabetes mellitus and end-stage CKD [17,19,30], whereas it is associated with lower mortality in critically ill patients with low BMI [31]. On the other hand, lower energy intake increases the risk of mortality in patients with chronic diseases [17,19] and in elderly people [32], and a favorable effect of lower energy intake on longevity that has been observed in animal studies remains controversial in human studies [33,34].…”