Introduction
Methods
Study Population
Working Protocol
Total (n = 546) | T2DM (n = 215) | Controls (n = 331) |
p
| |
---|---|---|---|---|
Age, mean (SD), years, (min–max) | 74.9 (6.3) (65–96) | 75 (6.1) (65–94) | 74.9 (6.5) (65–96) | 0.868 |
Gender, female, n (%) | 388 (71.1) | 151 (70.2) | 237 (71.6) | 0.730 |
BMI, kg/m2, mean (SD) | 30.6 (5.3) | 31.1 (5.5) | 30.2 (5.1) |
0.050
|
BMI < 25, n (%) | 67 (12.3) | 23 (10.7) | 44 (13.3) | 0.366 |
Smoking, n (%) | 151 (27.7) | 69 (32.1) | 82 (24.8) | 0.062 |
Hypertension, n (%) | 401 (73.4) | 177 (82.3) | 224 (67.7) |
< 0.001
|
LDL cholesterol, mean (SD) | 124.0 (35.4) | 117.8 (34.8) | 128.0 (35.2) |
0.001
|
Statin use, n (%) | 160 (29.3) | 88 (40.9) | 127 (21.8) |
< 0.001
|
CHD, n (%) | 111 (20.3) | 59 (27.4) | 52 (15.7) |
0.001
|
Stroke, n (%) | 17 (3.1) | 10 (4.7) | 7 (2.1) | 0.129 |
PAD, n (%) | 77 (14.1) | 39 (18.1) | 38 (11.5) |
0.029
|
CVD, total, n (%) | 175 (32.1) | 90 (41.9) | 85 (25.7) |
< 0.001
|
GFR < 60 ml/min, n (%) | 242 (44.3) | 91 (42.3) | 151 (45.6) | 0.449 |
Anemia, (F: < 13, M: < 12 g/dl), n (%) | 114 (20.9) | 60 (27.9) | 54 (16.3) |
0.001
|
Vitamin B12 insufficiency (< 350), n (%) | 220 (40.3) | 83 (38.6) | 137 (41.4) | 0.517 |
Folate insufficiency, n (%) | 43 (8.5) | 16 (8.1) | 27 (8.8) | 0.787 |
Vitamin D insufficiency (< 20), n (%) | 147 (45.4) | 59 (46.8) | 88 (44.4) | 0.675 |
Comorbidity count, mean (median) | 3.1 (3.0) | 3.5 (3.0) | 2.8 (3.0) |
< 0.001
|
Multimorbidity (≥ 3), n (%) | 370 (67.8) | 176 (81.9) | 194 (58.6) |
< 0.001
|
Education, years, mean (SD) | 6.9 (4.4) | 6.4 (4.3) | 7.2 (4.4) |
0.043
|
Lower education (< 8 years), n (%) | 314 (57.5) | 132 (61.4) | 182 (55.0) | 0.139 |
BADL score, mean (SD) | 91.3 (8.4) | 89.5 (9.4) | 92.5 (7.4) |
< 0.001
|
IADL score, mean (SD) | 14.2 (3.4) | 13.5 (4.0) | 14.7 (2.9) |
< 0.001
|
MMSE score, mean (SD) | 28 (2.5) | 27.7 (2.6) | 28.3 (2.4) |
0.002
|
GDS score, mean (SD) | 3.1 (3.1) | 3.8 (3.4) | 2.7 (2.8) |
< 0.001
|
Depression, n (%) | 104 (19.1) | 59 (27.4) | 45 (13.6) |
< 0.001
|
Medication count, mean (SD) | 4.8 (2.8) | 6 (2.8) | 4 (2.5) |
< 0.001
|
Polypharmacy, n (%) | 276 (50.5) | 154 (71.6) | 122 (36.9) |
< 0.001
|
MNA-SF score, mean (SD) | 12.1 (2.0) | 11.8 (2.1) | 12.3 (1.9) |
0.002
|
Undernutrition (MNA < 12), n (%) | 170 (31.1) | 79 (36.7) | 91 (27.5) |
0.023
|
At risk of malnutrition (MNA 8–11), n (%) | 153 (28.0) | 71 (33.0) | 82 (24.8) |
0.036
|
Malnourished (MNA 0–7) n (%) | 17 (3.1) | 8 (3.7) | 9 (2.7) | 0.616 |
Statistical Analyses
Results
Patient Description
Frequency of Undernutrition in the Total Sample
Undernutrition and Normal Nutritional Status in Patients with T2DM
Undernutrition (n = 79) | Normal nutrition (n = 136) |
p
| |
---|---|---|---|
Age, years, mean (SD) | 74.7 (6.2) | 75.2 ± (6.0) | 0.551 |
Gender, female, n (%) | 66 (83.5) | 85 (62.5) |
0.001
|
BMI, kg/m2, mean (SD) | 31.1 (5.5) | 30.2 (5.1) |
0.050
|
BMI < 25, n (%) | 23 (10.7) | 44 (13.3) | 0.366 |
WHR, mean (SD) | 0.98 (0.07) | 0.98 (0.08) | 0.702 |
WHR increased, n (%) | 76 (96.2) | 130 (95.6) | 0.828 |
Smoking, n (%) | 24 (30.4) | 45 (33.1) | 0.682 |
Hypertension, n (%) | 65 (82.3) | 112 (82.4) | 0.989 |
LDL cholesterol, mean (SD) | 116.1 (32.2) | 118.8 (36.0) | 0.575 |
Statin use, n (%) | 37 (46.8) | 51 (37.5) | 0.180 |
CHD, n (%) | 29 (36.7) | 30 (22.1) |
0.020
|
Stroke, n (%) | 4 (5.1) | 6 (4.4) | 0.827 |
PAD, n (%) | 21 (26.6) | 18 (13.2) |
0.014
|
CVD, total, n (%) | 41 (51.9) | 49 (36.0) |
0.023
|
GFR < 60 ml/min, n (%) | 36 (45.6) | 55 (40.4) | 0.463 |
Anemia, n (%) (Hb:F < 12, M < 13) | 26 (32.9) | 22 (16.2) |
0.004
|
Vitamin B12 insufficiency (< 350), n (%) | 54 (36.7) | 29 (39.7) | 0.663 |
Folate insufficiency, n (%) | 5 (6.7) | 11 (8.9) | 0.569 |
Vitamin D insufficiency (< 20), n (%) | 48.7 (48.7) | 40 (46.0) | 0.776 |
Comorbidity count, mean (median) | 4.0 (1.6) | 3.3 (1.2) |
0.001
|
Multimorbidity (≥ 3), n (%) | 176 (81.9) | 194 (58.6) |
< 0.001
|
Education, years, mean (SD) | 5.1 (4.0) | 4.0 (1.6) |
0.001
|
Lower education (< 8 years), n (%) | 132 (61.4) | 182 (55) | 0.139 |
MNA-SF score, mean (SD) | 9.6 (1.7) | 13.1 (0.9) |
< 0.001
|
MMSE score, mean (SD) | 26.7 (3.3) | 28.3 (1.9) |
< 0.001
|
BADL score, mean (SD) | 85.3 (11.7) | 92.0 (6.8) |
< 0.001
|
IADL score, mean (SD) | 26.7 (3.3) | 28.3 (1.9) |
< 0.001
|
GDS, mean (SD) | 5.7 (3.5) | 2.7 (2.8) |
< 0.001
|
Depression, n (%) | 37 (46.8) | 22 (16.6) |
< 0.001
|
Medication count, mean (SD) | 6 (2.8) | 4 (2.5) |
< 0.001
|
Polypharmacy, n (%) | 154 (71.6) | 122 (36.9) |
< 0.001
|
FPG, mean (SD) | 145.0 (60.7) | 129.4 (45.7) |
0.033
|
HbA1c, mean (SD) | 7.3 (2.1) | 6.7 (1.4) | 0.104 |
Length of DM diagnosis, years, mean (SD) | 12.2 (9.9) | 9.9 (8.6) | 0.116 |
Multiple antihyperglycemic use, n (%) | 62 (78.5) | 81 (59.6) |
0.005
|
Insulin-based treatment, n (%) | 22 (27.8) | 28 (20.6) | 0.224 |
DM overtreatment, n (%) | 39 (59.1) | 80 (71.4) | 0.091 |
DM undertreatment, n (%) | 16 (24.2) | 15 (13.4) | 0.065 |
Multiple Antihyperglycemic Use and its Association with Undernutrition
Predictor variable | Univariate | Multivariate | ||
---|---|---|---|---|
OR (95% CI) |
p
| OR (95% CI) |
p
| |
DM | 1.53 (1.06–2.21) |
0.023
| 1.05 (0.66–1.67) | 0.846 |
Age | 1.00 (0.97–1.03) | 0.969 | – | |
Gender | 2.54 (1.62–3.99) |
< 0.001
| 1.57 (0.89–2.76) | 0.116 |
Lower education (< 8 years) | 2.17 (1.47–3.18) |
< 0.001
| 1.23 (0.75–2.01) | 0.410 |
BMI < 25 | 1.71 (1.01–2.87) |
0.046
| 2.66 (1.40–5.04) |
0.003
|
Smoking | 1.00 (0.67–1.50) | 0.998 | – | |
Hypertension | 1.01 (0.67–1.52) | 0.976 | – | |
Statin use | 1.62 (1.09–0.74) | 0.658 | – | |
CVD | 1.50 (1.02–2.19) |
0.038
| 1.04 (0.64–1.69) | 0.876 |
GFR < 60 ml/min | 1.13 (0.79–1.63) | 0.497 | – | |
Anemia | 1.53 (0.99–2.35) | 0.054 | 1.20 (0.70–2.06) | 0.500 |
Vitamin B12 insufficiency | 1.22 (0.84–1.75) | 0.300 | – | |
Folate insufficiency | 1.18 (0.61–2.27) | 0.631 | – | |
Vitamin D3 insufficiency | 1.12 (0.69–1.81) | 0.642 | – | |
Multimorbidity | 1.49 (0.99–2.22) | 0.053 | 0.75 (0.45–1.26) | 0.278 |
BADL score | 0.91 (0.89–0.94) |
< 0.001
| 0.93 (0.90–0.97) |
< 0.001
|
IADL score | 0.82 (0.77–0.87) |
< 0.001
| 1.01 (0.92–1.11) | 0.827 |
MMSE score | 0.79 (0.73–0.86) |
< 0.001
| 0.86 (0.78–0.95) |
0.002
|
Depression | 7.04 (4.42–11.23) |
< 0.001
| 4.36 (2.56– 7.43) |
< 0.001
|
Polypharmacy | 1.41 (0.98–2.03) | 0.063 | 1.11 (0.69–1.78) | 0.657 |
Predictor variable | Univariate | Multivariate | ||
---|---|---|---|---|
OR (95% CI) |
p
| OR (95% CI) |
p
| |
Age | 0.99 (0.94–1.03) | 0.545 | – | |
Gender | 3.05 (1.53–6.07) |
0.002
| 2.18 (0.89–5.33) | 0.087 |
Lower education (< 8 years) | 1.92 (1.06–3.47) |
0.030
| 1.07 (0.48–2.41) | 0.871 |
BMI < 25 | 2.04 (0.85–4.86) | 0.110 | 2.65 (0.85–8.29) | 0.094 |
Smoking | 0.88 (0.49–1.61) | 0.682 | – | |
Hypertension | 1.00 (0.48–2.06) | 0.989 | – | |
Statin use | 1.47 (0.84–2.58) | 0.180 | 1.70 (0.85–3.42) | 0.134 |
CVD | 1.92 (1.09–3.37) |
0.024
| 1.27 (0.62–2.61) | 0.516 |
GFR < 60 ml/min | 1.23 (0.70–2.16) | 0.463 | – | |
Anemia | 1.78 (0.97–3.23) | 0.062 | 2.21 (0.98–4.96) | 0.055 |
Vitamin B12 insufficiency | 0.88 (0.50–1.56) | 0.664 | – | |
Folate insufficiency | 0.73 (0.24–2.18) | 0.570 | – | |
Vitamin D3 insufficiency | 1.12 (0.52–2.38) | 0.776 | – | |
Multimorbidity | 1.87 (0.86–4.08) | 0.116 | 0.74 (0.27–2.01) | 0.551 |
BADL score | 0.92 (0.89–0.95) |
< 0.001
| 0.93 (0.88–0.98) |
0.007
|
IADL score | 0.84 (0.78–0.91) |
< 0.001
| 1.06 (0.93–1.21) | 0.375 |
MMSE score | 0.79 (0.70–0.89) |
< 0.001
| 0.87 (0.75–1.02) | 0.088 |
Depression | 4.57 (2.42–8.62) |
< 0.001
| 3.66 (1.72–7.82) |
0.001
|
Polypharmacy | 0.94 (0.51–1.74) | 0.854 | – | |
Length of diabetes | 1.11 (0.64–1.94) | 0.710 | – | |
Multiple antihyperglycemic use | 2.48 (1.31–4.68) |
0.005
| 2.40 (1.06–5.41) |
0.035
|
Insulin-based treatment | 1.49 (0.78–2.84) | 0.226 | 0.89 (0.37–2.11) | 0.786 |