IMPACT OF DIABETES ON THE PREVALENCE OF MALNUTRITION AND SARCOPENIA IN AGED HOSPITALIZED PATIENTS

Abstract

The prevalence of diabetes is expected to rise sharply worldwide in the coming decades, due not only to obesity and sedentary lifestyles, but also to aging per se. Diabetes is associated with a higher incidence of decreased skeletal muscle mass (sarcopenia) and physical disabilities. Sarcopenia and physical disabilities may be due to the combined effects of reduced physical activity, inflammation, obesity and insulin resistance. Further, malnutrition may be frequent in very old diabetic patients, and contribute to the risk of sarcopenia and physical disabilities. At the same time it may paradoxically lead to a “false” improvement in insulin sensitivity and glycemic control, in a phenomenon of reverse causality. Results were prospectively collected during a case-control study involving 580 consecutively hospitalized patients with a bioimpedance assessment. Age ranged from 70.2 to 101.8 years (84.8 ± 6.2), with 184/396 male/female. The prevalence of malnutrition, assessed by the Mini Nutritional Assessment (MNA), was similar in diabetic (13.1%) and control patients (11.2%). Sarcopenia, was previously defined by a Fat Free Mass Index <15.1 kg/m2 and 17.5 kg/m2 in European women and men, respectively. Its prevalence in our cohort amounts to 57.2% in the 383 control versus 34.5% in the 197 diabetic patients (p < 0.0001). Diabetics were 2.7 years younger and counted more men, but even after adjusting for age and sex in a logistic regression model the odds ratio of sarcopenia remained unchanged at 0.41 (95% CI: 0.28 - 0.59).