Short communicationApplication of the new ESPEN definition of malnutrition in geriatric diabetic patients during hospitalization: A multicentric study
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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Malnutrition according to ESPEN definition predicts long-term mortality in general older population: Findings from the EPIDOS study-Toulouse cohort
2019, Clinical NutritionCitation Excerpt :The observed prevalence of malnutrition agreed with previous studies conducted in geriatric outpatients using the ESPEN consensus definition (6.3%) [20], but was much lower than has been reported in acute diabetic inpatient settings (21%) [3] or in postacute care (19–20%) [21]. The effects of malnutrition and nutrient deficiencies on clinical adverse outcomes and short-term mortality is long-established and well-described in older adults, mainly in patients with comorbidities [3,4,22]. Recent studies have analyzed the capability of the ESPEN definition of malnutrition to predict short-term mortality, reporting a nearly three-fold increased risk of mortality at 6 and 9 months in malnourished patients with chronic obstructive pulmonary disease [22] and in patients discharged from acute geriatric wards [4].
ASPEN-AND-ESPEN: A postacute-care comparison of the basic definition of malnutrition from the American Society of Parenteral and Enteral Nutrition and Academy of Nutrition and Dietetics with the European Society for Clinical Nutrition and Metabolism definition
2019, Clinical NutritionCitation Excerpt :The prevalence of malnutrition identified by the ESPEN definition (20.2%) was much lower than that reported using the ASPEN/AND definition (63.2%). This low prevalence is in consonance with previously reported rates obtained by applying the ESPEN consensus definition: 6.7% in diabetic inpatients [1], 15.1% in acute geriatric wards [25], 21% in acute chronic obstructive pulmonary disease inpatients [26], and 20% in postacute care [15,16]. All malnutrition variables considered in ESPEN, except body mass index, are included in ASPEN/AND [27].
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