Is diabetes mellitus associated with malnutrition in patients in intensive care unit? Diabetes and malnutrition.

Year 2020, , 43 - 47, 02.03.2020

Şakir Keşkek , Avsar Zerman

https://doi.org/10.30565/medalanya.639335

Abstract

Aim: Types of diseases and treatment modalities can also lead to the exacerbation of malnutrition. The aim of this study was to investigate nutritional status of patients with diabetes mellitus in the intensive care unit of a tertiary hospital.

Materials and methods: One hundred and ninety-two patients were enrolled and divided into two groups. The study group comprised of 77 patients with type 2 diabetes and the control group comprised of 115 patients without diabetes. The nutritional risk assessment was tested with NRS (Nutritional Risk Screening) 2002, Nutric score, MNA (Mini-Nutritional Assessment) and MUST (Malnutrition Universal Screening Tool). 

Results: The groups were comparable according to the NRS 2002 (3.37 ± 1.84 vs. 3.93 ± 1.72, p = 0.075), Nutric score (4.61 ± 1.85 vs. 4.56 ± 1.85, p = 0.869), MNA (8.0 ± 3.1 vs. 7.1 ± 3.2, p = 0.068) and MUST score (1.62 ± 1.46 vs. 1.81 ± 1.59, p = 0.456). 

Conclusion: In this study, the risk of malnutrition is comparable in both groups. This result may suggest that malnutrition is also related to co-morbidities in addition to diabetes.

Keywords

Diabetes mellitus, malnutrition, intensive care unit

Yoğun bakım hastalarında diyabetes mellitus malnütrisyonla ilişkili midir? Diyabet ve malnütrisyon

Abstract

Amaç: Hastalık türleri ve tedavi yöntemleri yetersiz beslenmenin alevlenmesine yol açabilir. Bu çalışmada, üçüncü basamak bir hastanenin yoğun bakım ünitesinde (YBÜ) diyabetes mellituslu hastaların beslenme durumunun araştırılması amaçlandı.

Yöntem: Yüz doksan iki hasta çalışmaya dahil edildi ve iki gruba ayrıldı. Çalışma grubuna tip 2 diyabetli 77 hasta, kontrol grubuna ise diyabeti olmayan 115 hasta alındı. Beslenme durumu ve riski NRS (Nutritional Risk Screening) 2002, Nutric skoru, MNA (Mini-Nutritional Assessment) ve MUST (Malnutrition Universal Screening Tool) testleri ile değerlendirildi.

Bulgular: Gruplar NRS 2002 (3.37 ± 1.84 vs. 3.93 ± 1.72, p = 0.075), Nutric skoru (4.61 ± 1.85 vs. 4.56 ± 1.85, p = 0.869), MNA (8.0 ± 3.1 vs. 7.1 ± 3.2, p = 0.068) ve MUST skoruna (1.62 ± 1.46 vs. 1.81 ± 1.59, p = 0.456) göre benzer bulundu.

Sonuç: Bu çalışmada, malnütrisyon riski her iki grupta benzer bulundu. Bu sonuç malnütrisyonun diyabete ek olarak eşlik eden diğer hastalıklarla da ilişkili olduğunu düşündürmektedir.

Keywords

Diabetes mellitus, malnutrition, yoğun bakım ünitesi

References

• 1. Sioson MS, Martindale R, Abayadeera A, Abouchaleh N, Aditianingsih D, Bhurayanontachai R et al. Nutrition therapy for critically ill patients across the Asia Pacific and Middle East regions: A consensus statement. Clin Nutr ESPEN. 2018;24:156-64. doi: 10.1016/j.clnesp.2017.11.008.
• 2. McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40:159-221. doi: 10.1177/0148607115621863.
• 3. Ghorabi S, Shariatpanahi ZV. Effect of early enteral nutrition on clinical outcomes in an intensive care unit. Thrita. 2014;3(3):e20905. doi: 10.5812/thrita.20905.
• 4. Lew CCH, Yandell R, Fraser RJL, Chua AP, Chong MFF, Miller M. Association between malnutrition and clinical outcomes in the intensive care unit: a systematic review. JPEN J Parenter Enteral Nutr.2017;41:744-58. doi: 10.1177/0148607115625638.
• 5. Nompleggi D. The basic principles of nutrition support in the intensive care unit. In: Irwin R, Rippe J, editors. Manual of Intensive Care Medicine. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 516–18.
• 6. Freijer K, Nuijten MJ, Schols JM. The budget impact of oral nutritional supplements for disease related malnutrition in elderly in the community setting. Front Pharmacol. 2012;3:78. doi: 10.3389/fphar.2012.00078.
• 7. Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: a narrative review. Maturitas. 2013;76:296–302. doi: 10.1016/j.maturitas.2013.07.013.
• 8. Rosenzweig JL. Diabetes and the health care system: economic and social costs. In: Kahn CR, Weir GC, King GL, editors. Joslin’s diabetes mellitus. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 777–92.
• 9. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). Clin Nutr. 2003;22(4):415-21. PMID:12880610
• 10. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form Mini-Nutritional Assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001;56(6): M366-72. DOI:10.1093/gerona/56.6.m366
• 11. Klein S, Kinney J, Jeejeebhoy K, Alpers D, Hellerstein M, Murray M et al. Nutrition support in clinical practice: review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. Am J Clin Nutr. 1997;66:683–706. DOI:10.1093/ajcn/66.3.683
• 12. Canales C, Elsayes A, Yeh DD, Belcher D, Nakayama A, McCarthy CM et al. Nutrition Risk in Critically Ill Versus the Nutritional Risk Screening 2002: Are They Comparable for Assessing Risk of Malnutrition in Critically Ill Patients? JPEN J Parenter Enteral Nutr. 2019;43(1):81-7. doi: 10.1002/jpen.1181.
• 13. de Vries MC, Koekkoek WK, Opdam MH, van Blokland D, van Zanten AR. Nutritional assessment of critically ill patients: validation of the modified NUTRIC score. Eur J Clin Nutr. 2018;72(3):428-435. doi: 10.1038/s41430-017-0008-7.
• 14. Ahmed N, Choe Y, Mustad VA, Chakraborty S, Goates S, Luo M. Impact of malnutrition on survival and healthcare utilization in Medicare beneficiaries with diabetes: a retrospective cohort analysis. BMJ Open Diab Res Care. 2018;6:e000471. doi:10.1136/ bmjdrc-2017-000471
• 15. Rasheed S, Woods RT. An investigation into the association between nutritional status and quality of life in older people admitted to hospital. J Hum Nutr Diet. 2014;27:142–51. doi: 10.1111/jhn.12072.
• 16. Sanz-Paris A, Boj-Carceller D, Lardies-Sanchez B, Perez-Fernandez L, Cruz-Jentoft AJ. Health-Care Costs, Glycemic Control and Nutritional Status in Malnourished Older Diabetics Treated with a Hypercaloric Diabetes-Specific Enteral Nutritional Formula. Nutrients. 2016;8(3):153. doi: 10.3390/nu8030153.
• 17. Söderström L, Rosenblad A, Thors Adolfsson E, Bergkvist L. Malnutrition is associated with increased mortality in older adults regardless of the cause of death. Br J Nutr. 2017;117(4):532-540. doi: 10.1017/S0007114517000435.
• 18. Dandona P, Aljada A, Bandyopadhyay A. Inflammation: The link between insulin resistance, obesity and diabetes. Trends Immunol. 2004;25:4–7. doi: 10.1016/j.it.2003.10.013.
• 19. Ahmed N, Choe Y, Mustad VA, Chakraborty S, Goates S, Luo M, et al. Impact of malnutrition on survival and healthcare utilization in Medicare beneficiaries with diabetes: a retrospective cohort analysis. BMJ Open Diabetes Res Care. 2018;6(1):e000471. doi: 10.1136/bmjdrc-2017-000471
• 20. Vanderwee K, Clays E, Bocquaert I, Gobert M, Folens B, Defloor T. Malnutrition and associated factors in elderly hospital patients: a Belgian cross-sectional, multi-center study. Clin Nutr. 2010;29(4):469-76. doi: 10.1016/j.clnu.2009.12.013.
• 21. Vischer UM, Frangos E, Graf C, Gold G, Weiss L, Herrmann FR, Zekry D. The prognostic significance of malnutrition as assessed by the Mini Nutritional Assessment (MNA) in older hospitalized patients with a heavy disease burden. Clin Nutr. 2012;31(1):113-7. doi: 10.1016/j.clnu.2011.09.010.
• 22. Leslie W, Hankey C. Aging, Nutritional Status and Health. Healthcare (Basel). 2015;3(3):648–58. doi: 10.3390/healthcare3030648.