The impact of nutritional status on treatment outcomes of patients with limb-threatening diabetic foot ulcers

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• 作者：Bing-Ru Gau^a ; ^b ; ¹ ; Hsin-Yun Chen^c ; ¹ ; Shih-Yuan Hung^a ; Hui-Mei Yang^a ; Jiun-Ting Yeh^d ; Chung-Huei Huang^a ; Jui-Hung Sun^a ; Yu-Yao Huang^a ; ^{yyh@cgmh.org.tw" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Amputation ; Diabetes ; Foot ulcer ; Geriatric Nutritional Risk Index (GNRI) ; Mini Nutritional Assessment (MNA) ; Nutrition
• 刊名：Journal of Diabetes and its Complications
• 出版年：2016
• 出版时间：January-February 2016
• 年：2016
• 卷：30
• 期：1
• 页码：138-142
• 全文大小：369 K

文摘

This study aimed to investigate the nutritional status of patients with limb-threatening diabetic foot ulcers (DFUs) and its impact on treatment outcomes.

Methods

A total of 478 consecutive patients (mean age, 65.4 years) treated for limb-threatening DFUs were enrolled. Nutritional status assessment using the Mini Nutritional Assessment (MNA) and Geriatric Nutritional Risk Index (GNRI) was performed by three qualified dieticians within 48 hours of admission. Limb-preservation outcomes were stratified into major lower extremity amputation (LEA) (above the ankle, n = 33), minor LEA (distal to ankle, n = 117) and no amputation (non-LEA, n = 328).

Results

Most patients were identified as being at risk of malnutrition (70.5%) or malnourished (14.6%) (mean MNA score, 20.6 ± 3.4). MNA scores decreased with increasing severity of LEA (mean, 21.1, 20.0, and 17.9, respectively; P for linear trend < 0.001), associated inversely with the tendency to require LEA (P for linear trend was 0.001), and associated independently with both major and minor LEA outcomes (adjusted odds ratio [aOR] = 0.80, 95% confidence interval [CI], 0.65–0.99, P = 0.042 and aOR = 0.89, 95% CI, 0.80–0.99, P = 0.032, respectively). The predictive value was sustained in patients younger than age 65 years. Though GNRI results had similar associations with outcomes, its predictive value was limited in minor LEA and younger population.

Conclusions

Patients' nutritional status was shown to have significant influence on limb-preservation outcomes for limb-threatening DFUs. Nutritional assessment of this patient population using the MNA is recommended.