Prevalence and prognostic significance of malnutrition in diabetic patients with coronary artery disease: a cohort study

Wei, Wen; Zhang, Lingyu; Li, Guode; Huang, Zhidong; Liu, Jin; Wu, Zhihuang; Wu, Yuanying; Lin, Jinrong; Zhang, Yunhan; Yu, Yigang; Huang, Haozhang; Li, Qiang; Wang, Bo; Liu, Yong; Tu, Mei; Chen, Shiqun

doi:10.1186/s12986-021-00626-4

Cited by 14 publications

(10 citation statements)

References 23 publications

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“…Malnutrition is a common risk factor for poor prognosis in various populations, whether assessed by subjective or objective tools or single biomarkers. [ 5 , 8 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ] Our findings confirmed its prognostic significance in patients with CAD and coexisting abnormal glycemic status. Notably, we presented a novel finding that the malnutrition-related risk for all-cause death and MACCE outweighed the diabetes-related risk.…”

Section: Discussionsupporting

confidence: 78%

“…Prior small-scale research has investigated malnutrition in older patients with diabetes [ 16 , 17 , 19 ] and patients with ACS [ 5 , 8 , 14 , 15 ], respectively, and may not have been epidemiologically representative of the general population with abnormal glycemic status and CAD. Only one study [ 13 ] reported malnutrition in CAD patients with diabetes. Little is known about the nutritional status of patients with diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…The growing population of patients with CAD and comorbid abnormal glycemic status has been a major public health problem in both developed and developing countries [ 11 , 12 ]. The current evidence raises awareness of the impact of nutritional status on the prognosis of patients with CAD [ 5 , 8 , 13 , 14 , 15 ] or diabetes [ 16 , 17 , 18 , 19 ]. However, most studies focused only on acute coronary syndrome (ACS) or elderly patients with diabetes lack the knowledge of the overall population with combined traits.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and Prognostic Significance of Malnutrition in Patients with Abnormal Glycemic Status and Coronary Artery Disease: A Multicenter Cohort Study in China

Wang²,

Liu

et al. 2023

Nutrients

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This study sought to investigate the prevalence and prognostic significance of malnutrition in patients with an abnormal glycemic status and coronary artery disease (CAD). This secondary analysis of a multicenter prospective cohort included 5710 CAD patients with prediabetes and 9328 with diabetes. Four objective tools were applied to assess the nutritional status of the study population. The primary endpoint was all-cause death. The association of malnutrition with clinical outcomes was examined using Cox proportional hazards regression. The proportion of malnutrition varied from 8% to 57% across the assessment tools. Diabetic patients were more likely to be malnourished than prediabetic patients. During a median follow-up of 2.1 years, 456 all-cause deaths occurred. The adjusted hazard ratios and 95% confidence interval for all-cause deaths of moderate–severe malnutrition defined by different tools ranged from 1.59 (1.03, 2.46) to 2.08 (0.92, 4.73) in prediabetic patients and 1.51 (1.00, 2.34) to 2.41 (1.78, 3.27) in diabetic patients. In conclusion, malnutrition is not rare in CAD patients with abnormal glycemic status. Moderate–severe malnutrition strongly predicted all-cause death regardless of the assessment tool. Assessing the nutritional status for all CAD patients with prediabetes and diabetes to identify individuals at high risk of all-cause death may help the risk assessment and prognosis improvement.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence and Prognostic Significance of Malnutrition in Patients with Abnormal Glycemic Status and Coronary Artery Disease: A Multicenter Cohort Study in China

Wang²,

Liu

et al. 2023

Nutrients

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“…Similarly, Tonet et al ( 36 ) showed that the percentage of ACS patients with malnutrition was 44% using the Mini Nutritional Assessment (MNA). Another recent study conducted to assess the magnitude of malnutrition in diabetic patients with CAD using the CONUT score demonstrated that 60.5% of patients with both CAD and diabetes suffered from malnutrition ( 37 ). Moreover, in concordant with our findings, malnutrition determined by the various malnutrition indices was significantly associated with adverse clinical outcomes in patients with CAD ( 11 , 38 – 40 ).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Potential of the Controlling Nutritional Status (CONUT) Score in Predicting All-Cause Mortality and Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease: A Meta-Analysis

Arero

Mohammed

et al. 2022

Front. Nutr.

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BackgroundAs defined by the Controlling Nutrition Status (CONUT) score, the prognostic significance of nutritional status has attracted attention in patients with cardiovascular disease. This meta-analysis aimed to determine the importance of CONUT score for prediction of all-cause mortality and major adverse cardiovascular events (MACE) in adult patients with coronary artery disease (CAD).MethodsObservational studies conducted to evaluate the association of CONUT score with adverse clinical outcomes in patients with CAD were included. We searched MEDLINE, Embase, Scopus, Cochrane library, Google scholar, medRxiv pre-print as well as Science Direct search engine for studies published from the inception of each database until March 21, 2022. Studies reporting the utility of CONUT score in prediction of all-cause mortality and MACE among patients with CAD were eligible. Predictive potential of the CONUT score were summarized by pooling the multivariable adjusted hazard ratio (aHR) with 95% CI for the malnourished vs. normal nutritional status or per point CONUT score increase.ResultsOf 2,547 screened citation, nine observational studies involving 81,257 patients with CAD were analyzed. Malnutrition defined by the CONUT score was associated with significantly increased risk of all-cause mortality when compared with the normal nutritional state (aHR for mild, moderate, and severe malnutrition, respectively: (1.21 [95% CI: 1.15–1.27], I2 = 0%), (1.53 [95% CI: 1.26–1.84], I2 = 84%), and (2.24 [95% CI: 1.57–3.19], I2 = 77%). Similarly, moderate (aHR 1.71 [95% CI: 1.44–2.03], I2 = 0%) and severe (aHR 2.66 [95% CI: 1.82–3.89], I2 = 0%) malnutrition was associated with a significantly higher risk of MACE compared with the normal nutritional state. Additionally, per point increase in the CONUT score was correlated with 20 and 23% additional risk of all-cause mortality and MACE, respectively.ConclusionAs defined by the CONUT score, malnutrition is an independent predictor of all-cause mortality and MACE in CAD patients. Nutritional assessment with CONUT score could allow clinicians to identify patients with CAD at high risk for adverse clinical outcomes.

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“…The muscle mass may reflect nutritional status, and definitions of malnutrition include low muscle mass within its diagnostic criteria [ 27 – 29 ]. Previous studies showed that malnutrition was correlated with increased mortality and cardiovascular events of acute coronary syndrome (ACS), heart failure and diabetes [ 30 – 33 ]. Moreover, higher cystatin C levels have been observed in patients with chronic inflammation.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of creatinine-to-cystatin c ratio in patients with type 2 diabetes mellitus: a cohort study

Wei

Liu

et al. 2022

Diabetol Metab Syndr

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Background The serum creatinine-to-cystatin C ratio (Scr/Scys) has been suggested as a surrogate marker of muscle mass and a predictor of adverse outcomes in many diseases. However, the prognostic value of Scr/Scys in patients with type 2 diabetes mellitus (T2DM) is unknown. The aim of this study is to assess the prognostic value of Scr/Scys in patients with T2DM. Methods In this retrospective observational study, we enrolled 3668 T2DM patients undergoing coronary angiography (CAG). Serum creatinine (Scr) and serum cystatin C (Scys) levels were measured at admission. The study population was separated into low muscle mass (low-MM) and normal muscle mass (normal-MM) groups by Scr/Scys cut-off point. The association between muscle mass and long-term all-cause mortality was examined using Cox regression analysis. Results During a median follow-up of 4.9 (3.0–7.1) years, a total of 352 (9.6%) patients died. The mortality was higher in patients with low-MM as compared with patients with normal-MM (11.1% vs. 7.3%; p < 0.001). Low muscle mass was associated with increased risk for long-term all-cause mortality, regardless of whether Scr/Scys were used as a continuous variable (adjusted hazard ratio: 1.08 [95% confidence interval (CI) 1.03 to 1.13]; p = 0.009) or a categorial variable (adjusted hazard ratio: 1.36 [95% CI 1.03 to 1.75]; p = 0.021). Conclusion Low muscle mass assessed by Scr/Scys was associated with increased risk of long-term all-cause mortality in diabetic patients.

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Prevalence and prognostic significance of malnutrition in diabetic patients with coronary artery disease: a cohort study

Cited by 14 publications

References 23 publications

Prevalence and Prognostic Significance of Malnutrition in Patients with Abnormal Glycemic Status and Coronary Artery Disease: A Multicenter Cohort Study in China

Prevalence and Prognostic Significance of Malnutrition in Patients with Abnormal Glycemic Status and Coronary Artery Disease: A Multicenter Cohort Study in China

Prognostic Potential of the Controlling Nutritional Status (CONUT) Score in Predicting All-Cause Mortality and Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease: A Meta-Analysis

Prognostic value of creatinine-to-cystatin c ratio in patients with type 2 diabetes mellitus: a cohort study

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