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

: 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.

[1]  R. Júarez-Vela,et al.  The Association between Nutritional Status and Length of Hospital Stay among Patients with Hypertension , 2022, International journal of environmental research and public health.

[2]  G. Goliasch,et al.  Malnutrition outweighs the effect of the obesity paradox , 2022, Journal of cachexia, sarcopenia and muscle.

[3]  Yu-jie Zhou,et al.  Nutritional Risk Index Improves the GRACE Score Prediction of Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention , 2021, Frontiers in Cardiovascular Medicine.

[4]  F. Panza,et al.  Associations between nutritional frailty and 8‐year all‐cause mortality in older adults: The Salus in Apulia Study , 2021, Journal of internal medicine.

[5]  C. Lam,et al.  Associations of obesity and malnutrition with cardiac remodeling and cardiovascular outcomes in Asian adults: A cohort study , 2021, PLoS medicine.

[6]  Zhao Liming,et al.  Prognostic nutritional index and the risk of mortality in patients with hypertrophic cardiomyopathy. , 2021, International journal of cardiology.

[7]  Hailin Yin,et al.  Normal reference intervals of prognostic nutritional index in healthy adults: A large multi‐center observational study from Western China , 2021, Journal of clinical laboratory analysis.

[8]  R. Júarez-Vela,et al.  The Association between Nutritional Status and In-Hospital Mortality among Patients with Acute Coronary Syndrome—A Result of the Retrospective Nutritional Status Heart Study (NSHS) , 2020, Nutrients.

[9]  F. Panza,et al.  Nutritional domains in frailty tools: Working towards an operational definition of nutritional frailty , 2020, Ageing Research Reviews.

[10]  M. Lesiak,et al.  Relationship between Nutritional Status and Clinical and Biochemical Parameters in Hospitalized Patients with Heart Failure with Reduced Ejection Fraction, with 1-year Follow-Up , 2020, Nutrients.

[11]  E. Blaak Current metabolic perspective on malnutrition in obesity: towards more subgroup-based nutritional approaches? , 2020, Proceedings of the Nutrition Society.

[12]  J. Arbonés-Mainar,et al.  GLIM Criteria at Hospital Admission Predict 8-Year All-Cause Mortality in Elderly Patients With Type 2 Diabetes Mellitus: Results From VIDA Study. , 2020, JPEN. Journal of parenteral and enteral nutrition.

[13]  Jiyan Chen,et al.  The prognostic nutritional index might predict clinical outcomes in patients with idiopathic dilated cardiomyopathy. , 2019, Nutrition, metabolism, and cardiovascular diseases : NMCD.

[14]  J. Bell,et al.  Evaluating the concurrent validity of body mass index (BMI) in the identification of malnutrition in older hospital inpatients. , 2019, Clinical nutrition.

[15]  M. Saintrain,et al.  Nutritional assessment of older adults with diabetes mellitus. , 2019, Diabetes research and clinical practice.

[16]  N. Rodondi,et al.  Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial , 2019, The Lancet.

[17]  P. Matia Martin,et al.  Effectiveness of an oral diabetes-specific supplement on nutritional status, metabolic control, quality or life, and functional status in elderly patients. A multicentre study. , 2019, Clinical nutrition.

[18]  Laura R. Saslow,et al.  Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report , 2019, Diabetes Care.

[19]  A. Gossum,et al.  GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community , 2019, Journal of cachexia, sarcopenia and muscle.

[20]  T. Einarson,et al.  Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017 , 2018, Cardiovascular Diabetology.

[21]  J. Mechanick,et al.  Impact of malnutrition on survival and healthcare utilization in Medicare beneficiaries with diabetes: a retrospective cohort analysis , 2018, BMJ Open Diabetes Research & Care.

[22]  A. Mitra,et al.  Rising trend of diabetes mellitus amongst the undernourished: State -of- the -art review. , 2017, Diabetes & metabolic syndrome.

[23]  A. Pfeiffer,et al.  Glycaemic response after intake of a high energy, high protein, diabetes-specific formula in older malnourished or at risk of malnutrition type 2 diabetes patients. , 2017, Clinical nutrition.

[24]  D. Lobo,et al.  ESPEN expert group recommendations for action against cancer-related malnutrition. , 2017, Clinical nutrition.

[25]  Kun Yang,et al.  Pilot study of the Mini Nutritional Assessment on predicting outcomes in older adults with type 2 diabetes , 2017, Geriatrics & gerontology international.

[26]  T. Keskin,et al.  A novel and useful predictive indicator of prognosis in ST-segment elevation myocardial infarction, the prognostic nutritional index. , 2017, Nutrition, metabolism, and cardiovascular diseases : NMCD.

[27]  A. Cruz-Jentoft,et al.  Health-Care Costs, Glycemic Control and Nutritional Status in Malnourished Older Diabetics Treated with a Hypercaloric Diabetes-Specific Enteral Nutritional Formula , 2016, Nutrients.

[28]  B. Astor,et al.  Malnutrition-inflammation modifies the relationship of cholesterol with cardiovascular disease. , 2010, Journal of the American Society of Nephrology : JASN.

[29]  Ioannis Nicolis,et al.  Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. , 2005, The American journal of clinical nutrition.

[30]  J. Perennec,et al.  Value of body mass index in the detection of severe malnutrition: influence of the pathology and changes in anthropometric parameters. , 2004, Clinical nutrition.

[31]  G. Kōsaki,et al.  [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. , 1984, Nihon Geka Gakkai zasshi.

[32]  R. Ma,et al.  Epidemiology of diabetes and diabetic complications in China , 2018, Diabetologia.

[33]  J Ignacio de Ulíbarri,et al.  CONUT: a tool for controlling nutritional status. First validation in a hospital population. , 2005, Nutricion hospitalaria.