Factors Contributing to Malnutrition in Patients with Diabetes

One in three patients with diabetes suffer from malnutrition and almost half of the diabetic population is at risk for malnutrition, suggests a systematic review and meta‐analysis published in the October 2024 issue of the Journal of Diabetes.1

The objective of the study was to estimate the prevalence of malnutrition in patients with diabetes and identify the factors that influence malnutrition in this population. Eight databases, including Embase, PubMed, Web of Science, The Cochrane Library, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM), and VIP, were searched from their inception until May 4, 2023 to select studies that had reported the prevalence of malnutrition in adult patients diagnosed with diabetes. These studies were carried out in several countries, including China, Japan, Belgium, Turkey, Spain, Brazil, Pakistan and Korea.

Forty-six studies involving 18,062 patients, aged 18 to 95 years, were included in the final review. Analysis revealed that the overall prevalence of malnutrition was 33% compared to the at-risk prevalence of 44%. Sixteen factors were identified that were potentially associated with malnutrition in these patients. These included: BMI, albumin, hemoglobin, triglycerides, HDL-C, HbA1c, CRP >10 mg/L, age, duration of diabetes, Wagner grades 3-5 (for diabetic foot ulcer), presence of CVD, using insulin, smoking, female gender, with diabetic foot infection and lower education level. The evidence was however inadequate to establish an association for smoking, gender, diabetic foot infection, and lower education level, with malnutrition in diabetic patients.

Spain had the highest prevalence of malnutrition at 50% followed by China (31%)  and Turkey (18%). Again, the prevalence of at‐risk for malnutrition was highest in Spain (60%), followed by China (49%), Japan (26%), and Turkey (20%).

Diabetic patients with chronic complications exhibited a 22% higher prevalence of malnutrition than those without complications.

While diabetes patients with malnutrition had elevated levels of HbA1c, they showed significantly lower levels of BMI, albumin, hemoglobin, triglycerides, and HDL-C compared to participants with normal nutrition. They were also older in age.

This meta-analysis highlights the prevalence of malnutrition and various risk factors associated with malnutrition in patients with diabetes. It also showed variation in the prevalence across different countries. Routine nutritional screening for at-risk individuals is essential for early identification and prompt intervention, which can significantly enhance their quality of life.

 Reference

1.          Zhang T, et al. Prevalence and influencing factors of malnutrition in diabetic patients: A systematic review and meta-analysis. J Diabetes. 2024 Oct;16(10):e13610. doi: 10.1111/1753-0407.13610.