Elsevier

Clinical Nutrition

Volume 35, Issue 6, December 2016, Pages 1564-1567
Clinical Nutrition

Short communication
Application of the new ESPEN definition of malnutrition in geriatric diabetic patients during hospitalization: A multicentric study

https://doi.org/10.1016/j.clnu.2016.02.018Get rights and content

Summary

Background & aims

The European Society for Clinical Nutrition and Metabolism (ESPEN) recently provided new diagnosis criteria of malnutrition and called to confirm those criteria in specific populations. The aims of our study were 1) to determine the prevalence of malnutrition according to the new ESPEN definition in elder hospitalized diabetic patients, and 2) to evaluate whether this new diagnosis of malnutrition predicted clinical outcomes in these patients.

Methods

1014 hospitalized diabetic patients (≥65 years) from 35 hospitals in Spain were screened for being at risk of malnutrition using the short version of the Mini Nutritional Assessment. Subsequently, at risk individuals were considered malnourished if they met at least one of the two options: 1) body mass index (BMI) < 18.5 kg/m2, or 2) unintentional weight loss >5% of their body weight with reduced BMI (<20 kg/m2 in subjects younger than 70 years or <22 kg/m2 in subjects older than 70 years).

Results

The new ESPEN definition, with MNA-SF as initial screening, identified 68 malnourished geriatric individuals with diabetes (6.73% of the cohort). Additionally, malnutrition lengthened the hospital stay, increased 2.7 times the odds of dying in hospital, and decreased to one third the odds of being discharged home.

Conclusions

Our study confirms that the new ESPEN definition for the diagnosis of malnutrition is a reliable tool that is capable of predicting clinical outcomes in a large population of elder hospitalized individuals with diabetes.

Introduction

In 2015, ∼60 million of individuals (9.1% of the adult population) were affected by diabetes mellitus (DM) in Europe [1]. Compelling evidence shows worsening of clinical outcomes when diabetes is associated with a poor nutritional status, [2]. Nevertheless, studies assessing the nutritional status in elderly patients with DM are scarce, despite of their increased fragility and susceptibility to DM's deleterious effects. A main reason for this is a lack of consensus on operational definition of malnutrition. It is, therefore, difficult to compare the prevalence rates of malnutrition in diabetic patients across different chronic diseases and in different settings (healthy, institutionalized, hospitalized, home care). Recently, the European Society for Clinical Nutrition and Metabolism (ESPEN) provided novel consensus criteria for the diagnosis of malnutrition and called for validation studies that may confirm the new criteria in specific populations [3].

The aims of our study were i) to determine the prevalence of malnutrition according to the new ESPEN definition in 1014 hospitalized diabetic patients (aged ≥ 65 years) recruited from 35 hospitals in Spain, and ii) evaluate if malnutrition at hospital admission predicted clinical outcomes such as length of stay and in-hospital mortality.

Section snippets

Sample and data collection

The VIDA study is an observational and multicentric study that examines the prevalence of malnutrition in diabetic patients older than 65 years admitted to the internal medicine wards of any of the 35 participating Spanish hospitals. Study design and cohort characteristics have been previously reported [2]. In brief, all patients were included between May 2007 and May 2008 and the nutritional evaluation was carried out within the first 24–72 h of admission. The Clinical Research Ethics

Prevalence of malnutrition in geriatric diabetic patients

We used the MNA-SF to nutritionally-assess 1014 hospitalized diabetic patients whose length of hospital stay was known (Table 1). Individuals were considered as malnourished or at risk of malnutrition according to the new ESPEN consensus [3]. Impaired nutritional status showed a sex-dependent variation and more women than men appeared to be at risk (65% vs. 55.3%, respectively, p = 0.002).

Individuals who fulfilled the ESPEN criterion of being at risk were further examined for potential

Discussion

There is no evidence yet to support the suitability of the new ESPEN approach in defining malnutrition for hospitalized geriatric patients with diabetes. As malnutrition leads to deleterious effects on health outcomes, we posited that a tool to predict malnutrition should be able to foretell these adverse outcomes too. Indeed, malnourished patients, according to the ESPEN definition, had significantly larger LOS in comparison to their well-nourished counterparts. Likewise, malnutrition,

Funding sources

The VIDA study was funded by a grant from Abbott Laboratories. JMA-M is supported by the Instituto de Salud Carlos III (Madrid, Spain) with a Miguel Servet fellowship and a grant (Acción Estratégica en Salud, PI14/00508). The Diputación General de Aragón (Spain) and the Marie-Curie Action APOMET from the European Commission also provide financial support.

Statement of authorship

AS-P, CG-C, AM-P, JMG-A, RB-P, and PM-M designed the study and collected the data. AS-P and JMA-M analyzed the data. AS-P and JMA-M wrote the manuscript. All authors approved the final manuscript and take public responsibility for the content of the article.

Conflict of interest

None.

Acknowledgments

We thank Prof. Ralf Kohler for his critical reading of the manuscript and Prof. Roberto Iniesta for his guidance and inspiring comments.

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