Nutritional status deteriorates as the severity of diabetic foot ulcers increases and independently associates with prognosis

Abstract

The prognosis for diabetic foot ulcers (DFUs) remains poor. Nutritional status has not been identified as one of the factors affecting the outcome of DFUs. Therefore, indicators correlated with nutritional status and outcome were analyzed to investigate their relationship. A total of 192 hospitalized patients with Wagner grade 1–5 ulcers and 60 patients with Wagner grade 0 ulcers (all had type 2 diabetes) were assessed by the following: subjective global assessment (SGA), anthropometric measurements, biochemical indicators and physical examinations to evaluate nutritional status, severity of infection and complications. Patient outcome was recorded as healing of the ulcer and the patients were followed up for 6 months or until the wound was healed. The percentage of malnutrition was 62.0% in the DFU patients. The SGA was closely correlated with infection (r=0.64), outcome (r=0.37) and BMI (r=−0.36), all P<0.001. The risk of poor outcome increased with malnutrition [odds ratio (OR), 10.6, P<0.001]. The nutritional status of the DFU patients was independently correlated with the severity of infection and outcome (both P<0.001) and Wagner grades and nutritional status (SGA) were independent risk factors for patient outcome (both P<0.001). Nutritional status deteriorated as the severity of the DFU increased, and malnutrition was a predictor of poor prognosis.

Pilot study of the Mini Nutritional Assessment on predicting outcomes in older adults with type 2 diabetes

“…To date, few studies have focused on the relationship between diabetic complications and malnutrition. In univariate analysis, studies have shown that diabetes patients with macrovascular complications or diabetic feet have a higher prevalence of malnutrition . Furthermore, Alejandro's study showed the presence of diabetic complications to be independently associated with malnutrition in multivariate analysis .…”

<p>Factors Related to Severity of Diabetic Foot Ulcer: A Systematic Review</p>

“…24 DFU is a source of major suffering and financial costs for the patient, and also places a considerable burden on the patient's family, health-care professionals and facilities, and society, and malnutrition in general. 25,26 Diabetic foot ulcer severity is a more significant factor of subsequent mortality than coronary artery disease, peripheral arterial disease or stroke. 18 80% of non-traumatic limb amputations are attributable to diabetes, of which 85% are due to DFU.…”

The Geriatric Nutritional Risk Index Independently Predicts Mortality in Diabetic Foot Ulcers Patients Undergoing Amputations

“…Subsequently, the predictive value of GNRI for prognosis has also been demonstrated for older age, dialysis patients, and cardiovascular patients [10–13]. The Mini-Nutritional Assessment (MNA) is a well-validated nutritional screening tool with high sensitivity and specificity and is widely used in clinical practice to measure nutritional status [23].…”

“…Malnutrition is common in patients with limb-threatening DFU and has a significant influence on prognosis [10], including delayed wound healing [28], longer hospital stay, and increased mortality [7, 8, 29]. Moreover, as nutritional status is related to immunity, patients with poor nutritional status more commonly suffer from infection [30].…”

“…Nutritional deficiencies and poor food intake play a major role in the impaired nutritional status of patients with diabetes-related complications, including renal failure and foot infection [9]. DFU patients, who have a high occurrence of infection and vascular complications, more commonly suffer from malnutrition compared with patients without DFU [10]. …”