Nutrition Department of University Hospital Miguel Servet, Zaragoza, Spain.
Nutrition Department of Hospital San Pedro, Logrono, Spain.
JPEN J Parenter Enteral Nutr. 2020 Nov;44(8):1492-1500. doi: 10.1002/jpen.1781. Epub 2020 Feb 6.
Diabetes and older age are associated with an increased risk of malnutrition and mortality. Recently, the Global Leadership Initiative on Malnutrition (GLIM) provided a 2-step approach for the malnutrition diagnosis. In this study, we aimed to determine whether GLIM nutrition status at admission was associated with long-term survival in elderly patients with type 2 diabetes mellitus (T2DM). Additionally, we aimed to identify which GLIM criteria were more able to become prognostic indicators of early or late death.
Our study included a convenience sample of 159 patients with T2DM older than 65 years and admitted to the internal medicine wards of different Spanish hospitals: the VIDA-survival cohort. Nutrition status was retrospectively assessed with the new GLIM criteria. The main outcome was long-term mortality in the cohort during an 8-year follow-up. Bivariate tables summarized the variables of interest. Kaplan-Meier survival curves and adjusted Cox regressions were also performed.
According to the GLIM criteria, we observed that the 35.8% and 16.3% of the VIDA-survival cohort were categorized as having moderate and severe malnutrition, respectively. Severe malnutrition was associated with increased mortality (hazard ratio [HR] = 2.09; 95% CI, 1.29-3.38), compared with nonmalnourished participants. Moderate malnutrition had a neutral effect on all-cause mortality (HR = 1.30; 95% CI, 0.88-1.92). Low plasma albumin levels, a surrogate marker of inflammation, were strongly associated with early mortality.
Our study provides evidence that severe malnutrition according to GLIM criteria is associated with increased long-term all-cause mortality among elderly individuals with T2DM.
糖尿病和年龄增长与营养不良和死亡率升高相关。最近，全球营养不良领导倡议（GLIM）提出了两步法用于营养不良诊断。本研究旨在确定入院时 GLIM 营养状况是否与 2 型糖尿病老年患者的长期生存相关。此外，我们旨在确定哪些 GLIM 标准更能成为早期或晚期死亡的预后指标。
本研究纳入了来自西班牙不同医院内科病房的 159 例年龄＞65 岁的 2 型糖尿病患者，即 VIDA 生存队列，采用新 GLIM 标准进行回顾性营养评估。主要结局为该队列在 8 年随访期间的长期死亡率。使用双变量表总结了感兴趣的变量。还进行了 Kaplan-Meier 生存曲线和调整后的 Cox 回归分析。
根据 GLIM 标准，我们观察到 VIDA 生存队列中有 35.8%和 16.3%的患者分别被归类为存在中度和重度营养不良。与非营养不良患者相比，重度营养不良与死亡率升高相关（风险比 [HR] = 2.09；95%可信区间 [CI]，1.29-3.38）。中度营养不良对全因死亡率无影响（HR = 1.30；95%CI，0.88-1.92）。低血浆白蛋白水平（炎症的替代标志物）与早期死亡率密切相关。
本研究提供的证据表明，根据 GLIM 标准，严重营养不良与 2 型糖尿病老年患者的长期全因死亡率升高相关。
