Factors Associated with Malnutrition in Older Patients with Type 2 Diabetes in Bangkok, Thailand Malnutrition in Older Patients with T2DM
Main Article Content
Abstract
OBJECTIVE: Malnutrition is a widespread but often neglected concern among older individuals with type 2 diabetes mellitus (T2DM), especially in Thailand, where research on this issue is limited. In this group, malnutrition can result in adverse outcomes, such as diminished physical function, decreased quality of life, longer hospitalizations, and increased mortality. This study aimed to examine the prevalence of malnutrition and the factors contributing to it among older adults with T2DM.
METHODS: This cross-sectional study was conducted in August and September 2024 at our local hospital. Older patients diagnosed with T2DM for at least 6 months were included in the analysis. Nutritional status was evaluated using the Global Leadership Initiative on Malnutrition criteria, which assess weight loss, low body mass index, and reduced muscle mass. Logistic regression was used to determine predictors of malnutrition.
RESULTS: Of the 176 participants, 30.1% were malnourished. Factors significantly associated with malnutrition included being underweight (adjusted odds ratio [AOR]: 11.07, 95% CI: 2.69–45.53), being married (AOR: 5.29, 95% CI: 1.14–24.64), living with diabetes for more than 10 years (AOR: 2.99, 95% CI: 1.23–7.25), poor medication adherence (AOR: 2.55, 95% CI: 1.06–6.17), and having a glomerular filtration rate below 60 (AOR: 4.70, 95% CI: 1.95–11.34).
CONCLUSION: Malnutrition is prevalent in older individuals with T2DM. Routine nutritional evaluations should be implemented to reduce health risks and improve patient outcomes in this population.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
World Health Organisation. Noncommunicable diseases [internet]. 2023 [cited 2024 Sep 23]. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
Aekplakorn W, Stolk RP, Neal B, Suriyawongpaisal P, Chongsuvivatwong V, Cheepudomwit S, et al. The prevalence and management of diabetes in Thai adults: the international collaborative study of cardiovascular disease in Asia. Diabetes Care 2003;26(10):2758-63.
Mordarska K, Godziejewska-Zawada M. Diabetes in the elderly. Prz Menopauzalny 2017;16(2):38-43.
Cannon A, Handelsman Y, Heile M, Shannon M. Burden of illness in type 2 diabetes mellitus. J Manag Care Spec Pharm 2018;24(9-a Suppl):S5-13.
The lancet diabetes endocrinology. Undiagnosed type 2 diabetes: an invisible risk factor. Lancet Diabetes Endocrinol 2024;12(4):215.
Chen LK, Chen YM, Lin MH, Peng LN, Hwang SJ. Care of elderly patients with diabetes mellitus: a focus on frailty. Ageing Res Rev 2010;9 Suppl 1:S18-22.
Sanz-Cánovas J, López-Sampalo A, Cobos-Palacios L, Ricci M, Hernández-Negrín H, Mancebo-Sevilla JJ, et al. Management of type 2 diabetes mellitus in elderly patients with frailty and/or sarcopenia. Int J Environ Res Public Health 2022;19(14):8677.
Junaid OA, Ojo OA, Adejumo OA, Junaid FM, Ajiboye KJ, Ojo OE, et al. Malnutrition in elderly patients with type 2 diabetes mellitus in a Nigerian tertiary hospital: a cross-sectional study. Dialogues Health 2022;1:100030.
Thaenpramun R, Komolsuradej N, Buathong N, Srikrajang S. Association between glycaemic control and malnutrition in older adults with type 2 diabetes mellitus: a cross-sectional study. Br J Nutr 2024;131(9):1497-505.
Walker-Clarke A, Walase L, Meye C. Psychosocial factors influencing the eating behaviours of older adults: a systematic review. Ageing Res Rev 2022;77:101597.
Krishnasamy S, Abell TL. Diabetic gastroparesis: principles and current trends in management. Diabetes Ther 2018;9 Suppl 1:1-42.
Riddle E, Munoz N, Clark K, Collins N, Coltman A, Nasrallah L, et al. Prevention and treatment of malnutrition in older adults living in long-term care or the community: an evidence-based nutrition practice guideline. J Acad Nutr Diet 2024;124(7):896-916.
Zahid SA, Tated R, Mathew M, Rajkumar D, Karnik SB, Pramod Roy A, et al. Diabetic gastroparesis and its emerging therapeutic options: a narrative review of the literature. Cureus 2023;15(9):e44870.
Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community. Clin Nutr 2019;38(1):1-9.
Ahmed I, Kaifi HM, Tahir H, Javed A. Malnutrition among patients with type-2 diabetes mellitus. Pak J Med Sci 2023;39(1):64-9.
Stajkovic S, Aitken EM, Holroyd-Leduc J. Unintentional weight loss in older adults. CMAJ 2011;183(4):443-9.
Weir CB, Jan A. BMI classification percentile and cut off points. In: Ackley WB, Adolphe TS, Aeby TC, Aeddula NR, Agadi S, Agasthi P, et al., editors. Statpearls. StatPearls Publishing;2023.
Lawongsa K, Srisuwan P, Tejavanija S, Gesakomol K. Sensitivity and specificity of Yubi-wakka (finger-ring) screening method for sarcopenia among older Thai adults. Geriatr Gerontol Int 2024;24(3):263-8.
Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2019;38(1):10-47.
Stumpf F, Keller B, Gressies C, Schuetz P. Inflammation and nutrition: friend or foe? Nutrients 2023;15(5):1159.
Domenica Cappellini M, Motta I. Anemia in clinical practice-definition and classification: does hemoglobin change with aging? Semin Hematol 2015;52(4):261–9.
Nah EH, Cho S, Kim S, Cho HI. Comparison of urine albumin-to-creatinine ratio (ACR) between ACR strip test and quantitative test in prediabetes and diabetes. Ann Lab Med 2017;37(1):28-33.
Vaidya S, Aeddula N. Chronic kidney disease. In: Ackley WB, Adolphe TS, Aeby TC, Aeddula NR, Agadi S, Agasthi P, et al., editors. Statpearls. StatPearls Publishing; 2023.
American Diabetes Association. Understanding A1C | ADA [internet]. 2023 [cited 2024 Sep 23]. Available from: https://diabetes.org/about-diabetes/a1c
Adebusoye L, Ajayi I, Dairo M, Ogunniyi A. Factors associated with undernutrition and overweight in elderly patients presenting at a primary care clinic in Nigeria. S Afr Fam Pract 2011;53:355-60.
Vural Keskinler M, Feyİzoglu G, Yildiz K, Oguz A. The frequency of malnutrition in patients with type 2 diabetes. Medeni Med J 2021;36(2):117-22.
Kalantar-Zadeh K, Streja E, Kovesdy CP, Oreopoulos A, Noori N, Jing J, et al. The obesity paradox and mortality associated with surrogates of body size and muscle mass in patients receiving hemodialysis. Mayo Clin Proc 2010;85:991-1001.
Kutob RM, Yuan NP, Wertheim BC, Sbarra DA, Loucks EB, Nassir R, et al. Relationship between marital transitions, health behaviors, and health indicators of postmenopausal women: results from the women’s health initiative. J Womens Health (Larchmt) 2017;26(4):313-20.
Kposowa AJ, Aly Ezzat D, Breault K. Diabetes mellitus and marital status: evidence from the National Longitudinal Mortality study on the effect of marital dissolution and the death of a spouse. Int J Gen Med 2021;14:1881-8.
Meneilly GS, Tessier D. Diabetes in elderly adults. J Gerontol A Biol Sci Med Sci 2001;56(1):M5-13.
Rhee MK, Slocum W, Ziemer DC, Culler SD, Cook CB, El-Kebbi IM, et al. Patient adherence improves glycemic control. Diabetes Educ 2005;31(2):240-50.
Kalantar-Zadeh K, Ikizler TA, Block G, Avram MM, Kopple JD. Malnutrition-inflammation complex syndrome in dialysis patients: causes and consequences. Am J Kidney Dis 2003;42(5):864-81.
Kopple JD. National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 2001;37(1 Suppl 2):S66-70.