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

Shan-Shan Zhang,Lei Xu,Guang Ning,Hong-Jie Qian,Zheng-Yi Tang,Ping Fang

doi:10.3892/etm.2012.780

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.

Highlights

IntroductionThe number of patients with diabetes mellitus (DM) has been increasing rapidly worldwide; the prevalence of DM has
The number of patients with diabetes mellitus (DM) has been increasing rapidly worldwide; the prevalence of DM hasKey words: nutritional status, diabetic foot ulcers, complication, infection increased from 2.5% in 1994 to 9.7% in 2008 in China [1,2], and the incidence of diabetic foot ulcers (DFUs) has increased concurrently [3]
Fewer DFU patients achieved blood glucose targets and a greater number suffer from vascular complications and infection, or reveal a poor nutritional status compared with non-DFU patients

Summary

Introduction

The number of patients with diabetes mellitus (DM) has been increasing rapidly worldwide; the prevalence of DM has. Patients with DM are generally considered to have excessive food intake and medical nutrition therapy is required to aid individuals with diabetes to achieve blood glucose targets [6]. Fewer DFU patients achieved blood glucose targets and a greater number suffer from vascular complications and infection, or reveal a poor nutritional status compared with non-DFU patients. These cause greater difficulties in treatment; calorie intake should be restricted to achieve targets for blood glucose and related metabolic markers while protein intake should be confined to reduce proteinuria and improve the prognosis for diabetic nephropathy (DN). The additional energy expenditure due to infection requires increased energy intake, and following surgery, patients require sufficient nutrients to recover [11]

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