Malnutrition in elderly patients with type 2 diabetes mellitus in a Nigerian tertiary hospital: A cross-sectional study

Prevalence of Malnutrition and Associated Factors Among the Elderly With Type 2 Diabetes Using MNA Form

Objective: This study has been conducted to identify the frequency of malnutrition and different factors associated with it among elderly people with Type 2 diabetes. Methods: This cross-sectional study was conducted in the National Institute of Diabetes and Endocrinology (NIDE), DUHS, Karachi, between January 2023 and October 2023. A total of 325 elderly participants aged ≥ 60 years with Type 2 diabetes were included. Mini Nutritional Assessment (MNA) was used for data collection. Results: Nutritional assessment of older diabetic patients according to the MNA revealed that 226 (69.5%) patients were at risk of malnutrition whereas 53 (16.3%) were malnourished. A total of 325 Type 2 diabetic patients were included in the study with a mean age of 65.7 ± 5.5 years, where 135 (41.5%) were male and 190 (58.5%) were female. Older patients (mean age: 65 years) were significantly more malnourished compared to those with normal nutrition (mean age: 62 years; p=0.021). Employed patients were less likely to have the risk of malnutrition as compared to housewives (p=0.005). Patients who had low family income were eight times more likely to be malnourished as compared to those who had better family income (p=0.003). It was also found that patients with low BMI and calf circumference will be more prone to be malnourished as compared to those with high levels of BMI (p=0.003) and calf circumference (p=0.013). Conclusion: The majority of study participants were at risk of malnourishment, with associated factors such as rapid weight loss, poor health status, decline in physical activity, and food intake. Therefore, these findings highlight the importance of tailored interventions for at-risk individuals, including regular screening and nutritional support.

A randomized multi-arm open labelled comparative clinical trial report of Pankajakasthuri DiabetEaze powder, a novel polyherbal formulation on the nutritional management and glycemic control in type 2 diabetic and prediabetic patients

Background and aims

Recently Diabetes Mellitus (DM) has been associated with heightened susceptibility to malnutrition, suggesting that augmenting nutritional intake stands out as a potent therapeutic strategy for addressing malnutrition in individuals with DM. The aim of this clinical investigation was to evaluate the effect of DiabetEaze powder, a polyherbal nutritional formulation developed by us for nutritional management and glycaemic control, on patients with diabetic and prediabetic conditions.

Methods

A total of 143 type II diabetic (T2D) patients who were managing their diabetic condition through modern medicine, AYUSH medicine, lifestyle modification and 68 pre-diabetic patients, aged between 40 and 65 years, were randomly assigned into six groups: control, modern, AYUSH, lifestyle, prediabetic control and prediabetic trial. The treatment groups were administered 5 g of DiabetEaze powder two times a day after food for 6 months. Microminerals, vitamins, glycaemic parameters, Quality of Life (QoL), hematology, lipid profiles, Renal Function Test (RFT) and Liver Function Test (LFL) parameters, and electrolytes were evaluated at Day 0, Day 90, and Day 180.

Results

Out of 211 enrolled patients, 189 individuals successfully completed the entire 180-day duration of the study, indicating a retention rate of approximately 89.6 %. In our study, we observed a statistically significant elevation in the levels of vitamin D, B2, and B6 across all treatment groups. Besides, the treatment groups displayed a notable increase in zinc and manganese levels compared to the other minerals tested. Notably, the treatment groups demonstrated distinct mineral and vitamin profiles. In terms of metabolic markers, significant reductions in Fasting Blood Sugar (FBS)/Post Prandial Blood Sugar (PPBS) were observed across the modern, AYUSH, and lifestyle groups, while the modern group also showed a marked decrease in glycated haemoglobin (HbA1c) levels. Furthermore, overall QoL among the tested groups was also statistically significant. The consistent maintenance of normal LFT and RFT parameters and electrolyte levels across trial groups throughout the study duration indicates that the supplement does not induce liver toxicity or negatively impact hepatic function.

Conclusion

In conclusion, the nutrients present in the DiabetEaze powder contribute to the effective management of nutritional status in diabetic people and thus effectively reduce sugar spikes by regulating PPBS and HbA1c levels, which is a critical aspect of its role in diabetes management. These properties benefit in managing diabetes-related outcomes and overall quality of life.

Clinical trial registry of India under registration no

CTRI/2021/04/032956 on 20/04/2021.

Malnutrition and Fall Risk in Older Adults: A Comprehensive Assessment Across Different Living Situations

BACKGROUND

Malnutrition among older adults is associated with numerous adverse effects, including increased morbidity, mortality, prolonged hospital stays, and a heightened risk of falls. This study aims to investigate the prevalence of malnutrition in different groups of older adults using the F-MNA, anthropometry, and s-albumin and the association between nutritional status and fall risk.

METHODS

A total of 228 participants aged 60 years and older were divided into three groups: (1) patients in an internal medicine ward, (2) individuals living in family homes, and (3) residents of care homes. Disease profiles, nutritional status (assessed using the F-MNA and SNAQ), body composition, fall risk, and biochemical markers were evaluated.

RESULTS

The results indicated the highest prevalence of malnutrition among hospitalized individuals. Fall risk was associated with age, calf circumference, the F-MNA, the SNAQ, serum albumin levels, residence in a care home, comorbidities, and the number of medications taken daily. Regression analysis revealed that age, calf circumference, and residence in a care home were independent predictors of fall risk in older adults.

CONCLUSION

Older adults are at significant risk of malnutrition, with the risk notably increasing during hospitalization and long-term stays in care homes. Hospitalized individuals had the poorest nutritional status and were at significant risk of further weight loss, underscoring the importance of post-discharge care and rehabilitation.

Correlation between serum sex hormone-binding globulin levels and nutrition indicators and malnutrition exposure risk in men and postmenopausal women with type 2 diabetes

BACKGROUND

This study sought to investigate the correlation between serum sex hormone-binding globulin (SHBG) levels and nutrition indicators and the malnutrition exposure risk in men and postmenopausal women with type 2 diabetes mellitus (T2DM).

METHODS

A cross-sectional analysis was conducted, involving patients diagnosed with T2DM at the Guangdong Provincial People's Hospital between May 2018 and December 2019.

RESULTS

The study comprised 551 participants (363 men, mean age of 55.55 ± 11.57 years), among whom 167 (30.31%) were classified as with malnutrition exposure risk (GNRI ≤ 98). Multivariable logistic regression analysis revealed that SHBG (OR = 1.04, 95% CI: 1.02-1.05, P < 0.001), glycated hemoglobin (OR = 1.36, 95% CI: 1.22-1.51, P < 0.001), hemoglobin (OR = 0.96, 95% CI: 0.94-0.97, P < 0.001), and non-alcoholic fatty liver disease (OR = 0.41, 95% CI: 0.23-0.73, P < 0.003) were independently associated with the malnutrition exposure risk. SHBG was inversely correlated with body mass index (males: r = -0.34; postmenopausal females: r = -0.22), albumin (males: r = -0.30; postmenopausal females: r = -0.20), transferrin (males: r = -0.28; postmenopausal females: r = -0.19), and prealbumin (males: r = -0.35; postmenopausal females: r = -0.30) (all P < 0.05).

CONCLUSIONS

Serum SHBG levels are correlated with nutritional indicators and the risk of malnutrition in men and postmenopausal women with T2DM. A multicenter prospective study is imperative to verify this result in the future.

Comparison of muscle and fat parameters measured by ultrasonography and dual-energy x-ray absorptiometry between older palliative care patients with and without type 2 diabetes mellitus

BACKGROUND AND AIMS

There are limited data on the comparison of body compositions between diabetic and non-diabetic patients. We aimed to compare the muscle mass and fat parameters measured by ultrasonography (USG) and dual-energy x-ray absorptiometry (DXA) between older palliative care patients with and without type 2 diabetes mellitus (DM).

METHODS

We conducted a prospective, cross-sectional study. We recorded the demographics, comorbidities, blood pressures, microvascular complications, pressure injuries, ambulation and nutritional status, and laboratory parameters. We measured the handgrip strength with a hand dynamometer and anthropometric parameters. We analyzed the subcutaneous fat thickness, muscle thickness (MT), and cross-sectional area (CSA) of the rectus femoris (RF) and biceps brachii muscles by USG and the total and regional muscle mass and fat parameters by DXA. We performed a regression analysis to examine the independently associated factors of DM.

RESULTS

We included 55 patients (mean age: 79.0 ± 8.0 years, 56.4%: female). 43.6% had type 2 DM. The patients with DM had significantly higher glucose and HbA1c levels and lower RFMT and RFCSA values than the patients without DM (p < 0.01, for all). The RFMT was independently associated with DM after adjusting age, sex, and body mass index (Odds ratio = 0.735, 95% confidence interval = 0.565-0.956, p = 0.022).

CONCLUSION

Our study demonstrated that the RFMT might be associated with type 2 DM. This was the first study comparing the body compositions measured by USG and DXA between older diabetic and non-diabetic palliative patients with a wide range of laboratory evaluations. Longitudinal, multi-center studies are warranted to understand the underlying mechanisms.

Association between glycaemic control and malnutrition in older adults with type 2 diabetes mellitus: a cross-sectional study

Malnutrition is a major problem among older adults with type 2 diabetes mellitus (T2DM). Some studies suggest that well glycaemic control increases the risk of frailty due to reduced intake. Therefore, it could be hypothesised that adequate glycaemic controlled patients may be at risk of malnutrition. This study aimed to examine, in older adults with T2DM, the association between adequate glycaemic control and malnutrition as well as identify the risk factors for malnutrition. Data including general characteristics, health status, depression, functional abilities, cognition and nutrition status were analysed. Poor nutritional status is defined as participants assessed with the Mini Nutritional Assessment as being at risk of malnutrition or malnourished. Adequate glycaemic control refers to an HbA1c level that meets the target base in the American Diabetes Association 2022 guidelines with individualised criteria. There were 287 participants with a median (interquartile range) age of 64 (61-70) years, a prevalence of poor nutrition, 15 %, and adequate glycaemic control, 83·6 %. This study found no association between adequate glycaemic control and poor nutrition (P = 0·67). The factors associated with poor nutritional status were low monthly income (adjusted OR (AOR) 4·66, 95 % CI 1·28, 16·98 for income < £118 and AOR 7·80, 95 % CI 1·74, 34·89 for income £118-355), unemployment (AOR 4·23, 95 % CI 1·51, 11·85) and cognitive impairment (AOR 5·28, 95 % CI 1·56, 17·93). These findings support the notion that older adults with T2DM should be encouraged to maintain adequate glycaemic control without concern for malnutrition, especially those who have low income, unemployment or decreased cognitive functions.

Meta-analysis and moderator analysis of the prevalence of malnutrition and malnutrition risk among older adults with dementia

BACKGROUND

Aging and dementia are common and closely related health problems in older adults, affecting their ability to maintain a healthy diet and ultimately resulting in malnutrition.

OBJECTIVE

In this study, we estimated the global prevalence of malnutrition and malnutrition risk in older adults with dementia.

DESIGN

Meta-analysis.

DATA SOURCES

Embase, Ovid MEDLINE, PubMed, CINAHL, Scopus, and Web of Science were comprehensively searched for articles published from database inception to October 2022.

METHODS

Pooled prevalence analysis was conducted using a generalized linear mixed model and a random-effects model. I2 and Cochran's Q statistics were used for identifying heterogeneity. Publication bias was evaluated using Peters' regression test and a funnel plot. Moderator analyses were conducted to investigate variations in the prevalence estimates of the included studies. All statistical analyses were conducted using R software.

RESULTS

A total of 16 studies involving a total of 6513 older adults with dementia were included in the analysis. The results indicated that 32.52 % (95 % confidence interval: 19.55-45.49) of all included older adults with dementia had malnutrition, whereas 46.80 % (95 % confidence interval: 38.90-54.70) had a risk of malnutrition. The prevalence of malnutrition was found to be high among older patients living in institutionalized settings (46.59 %) and those with Alzheimer's disease (12.26 %). The factors moderating the prevalence of malnutrition included adequate vitamin B12 consumption, risk behaviors, medical comorbidities, and certain neuropsychiatric symptoms. The prevalence of malnutrition risk was high among women (29.84 %) and patients with Alzheimer's disease (26.29 %). The factors moderating the prevalence of malnutrition risk included total cholesterol level, vitamin B12 consumption, risk behaviors, medical comorbidities, and certain neuropsychiatric symptoms.

CONCLUSIONS

Approximately one-third of older adults with dementia are malnourished and nearly half of older adults are at a risk of malnutrition. Encouraging collaboration among health-care professionals and ensuring early assessment and effective management of malnutrition are crucial for maintaining a favorable nutritional status in older adults with dementia.

REGISTRATION

This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022369329).

TWEETABLE ABSTRACT

Globally, approximately 32.52 % of older adults with dementia are malnourished and approximately 46.80 % are at a risk of malnutrition.

Prevalence and associated factors of overweight and obesity among persons with type 2 diabetes in Africa: a systematic review and meta-analysis

BACKGROUND

Type 2 diabetes and obesity are serious public health concerns globally and a growing burden in Africa. Both conditions have serious repercussions on health when they co-occur, yet the extent of their co-occurrence in Africa remains unknown. Therefore, this review aimed to identify the prevalence and associated factors of overweight and obesity among persons with type 2 diabetes in Africa.

METHOD

A systematic search was conducted on PubMed, MEDLINE, Embase, African Index Medicus (AIM), and African Journals Online (AJOL) for observational studies that reported the prevalence of overweight and/or obesity among type 2 diabetes patients in Africa. The prevalence data from individual studies were aggregated through a random-effects meta-analysis. The I2 statistic was used to evaluate between-studies heterogeneity, while subgroup analysis and mixed-effects meta-regression were performed to identify sources of heterogeneity. We assessed publication bias using funnel plots and Egger's test. This review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.

RESULTS

Of 1753 records retrieved, 80 articles were eligible for this review, with 74 cross-sectional studies included in the meta-analysis. The pooled prevalence of overweight and obesity was 35.6% and 25.6% respectively, while the overall prevalence of both overweight and obesity was 61.4%. Also, the pooled prevalence of both overweight and obesity across the five geographical areas in Africa ranged from 56.9% in East Africa to 88.5% in Southern Africa. Nineteen factors were significantly associated with overweight and obesity among patients with type 2 diabetes.

CONCLUSION

The high prevalence of overweight and obesity among patients with type 2 diabetes is a significant public health concern that transcends geographical boundaries within Africa. The findings from this review highlight the need for innovative weight management interventions that are tailored to the cultural context of the African setting.KEY MESSAGESThere was a high prevalence of overweight and obesity among the type 2 diabetes patients.Nineteen factors were identified to be significantly associated with overweight and obesity among type 2 diabetes patients.Only 12 out of the 80 included studies primarily focused on the prevalence of overweight and/or obesity which reflects a dearth of interest in this topic.

Prevalence of sarcopenia and its association with diet and physical activity in older adults with type 2 diabetes: A cross-sectional study

This cross-sectional study explored the prevalence of sarcopenia in older adults with type 2 diabetes and investigated the effects of diet and physical activity on sarcopenia. In total, 577 older adults with diabetes were recruited from a teaching hospital in Taiwan. Diet and physical activity were assessed using self-rated questionnaires, including the Healthy Diet Inventory, the Mini Nutritional Assessment-Short Form, and the International Physical Activity Questionnaire-Short Form. Sarcopenia was defined in accordance with the Asian Working Group for Sarcopenia 2019 guidelines. In total, 51.12% of participants had either possible sarcopenia, sarcopenia, or severe sarcopenia. Participants who were female, old age, prolonged sedentary times, poor nutritional status, and lower level of moderate-to-vigorous physical activity were identified as risk factors for possible to severe sarcopenia. Older adults with diabetes and possible to severe sarcopenia had poor nutrition status and engaged in inadequate physical activity. The findings indicate that sarcopenia may be related to nutrition status and physical activity, especially in older adults with diabetes.