The impact of nutritional status on treatment outcomes of patients with limb-threatening diabetic foot ulcers.
OBJECTIVE
This study aimed to investigate the nutritional status of patients with limb-threatening diabetic foot ulcers (DFUs) and its impact on treatment outcomes.


METHODS
A total of 478 consecutive patients (mean age, 65.4years) treated for limb-threatening DFUs were enrolled. Nutritional status assessment using the Mini Nutritional Assessment (MNA) and Geriatric Nutritional Risk Index (GNRI) was performed by three qualified dieticians within 48hours of admission. Limb-preservation outcomes were stratified into major lower extremity amputation (LEA) (above the ankle, n=33), minor LEA (distal to ankle, n=117) and no amputation (non-LEA, n=328).


RESULTS
Most patients were identified as being at risk of malnutrition (70.5%) or malnourished (14.6%) (mean MNA score, 20.6±3.4). MNA scores decreased with increasing severity of LEA (mean, 21.1, 20.0, and 17.9, respectively; P for linear trend <0.001), associated inversely with the tendency to require LEA (P for linear trend was 0.001), and associated independently with both major and minor LEA outcomes (adjusted odds ratio [aOR]=0.80, 95% confidence interval [CI], 0.65-0.99, P=0.042 and aOR=0.89, 95% CI, 0.80-0.99, P=0.032, respectively). The predictive value was sustained in patients younger than age 65years. Though GNRI results had similar associations with outcomes, its predictive value was limited in minor LEA and younger population.


CONCLUSIONS
Patients' nutritional status was shown to have significant influence on limb-preservation outcomes for limb-threatening DFUs. Nutritional assessment of this patient population using the MNA is recommended.
Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan; Division of Endocrinology and Metabolism, DaLin Tzu Chi Buddhist Hospital, Tzu Chi University, Taiwan.
Bing-Ru
BR
Gau
Medical Nutrition Therapy, Chang Gung Memorial Hospital, Chang Gung University, Taiwan.
Hsin-Yun
HY
Chen
Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan.
Shih-Yuan
SY
Hung
Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan.
Hui-Mei
HM
Yang
Division of Trauma, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taiwan.
Jiun-Ting
JT
Yeh
Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan.
Chung-Huei
CH
Huang
Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan.
Jui-Hung
JH
Sun
Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan. Electronic address: yyh@cgmh.org.tw.
Yu-Yao
YY
Huang
D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects; D015992:Body Mass Index; D003131:Combined Modality Therapy / Q000009:adverse effects; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000178:diet therapy* / Q000628:therapy; D017719:Diabetic Foot / Q000601:surgery / Q000628:therapy*; D003927:Diet, Diabetic / Q000009:adverse effects*; D005260:Female; D015577:Geriatric Assessment; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D015596:Nutrition Assessment; D018673:Nutrition Policy; D009752:Nutritional Status; D050177:Overweight / Q000150:complications; D010349:Patient Compliance; D012306:Risk; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
Amputation; Diabetes; Foot ulcer; Geriatric Nutritional Risk Index (GNRI); Mini Nutritional Assessment (MNA); Nutrition