What is the clinical evidence from this study?

Study design: Cohort. Population: Diabetes mellitus and coronary artery disease (n=12898). Intervention: Moderate to severe malnutrition vs. Normal nutritional status. Primary outcome: Long-term all-cause mortality (HR 1.63, 95% CI 1.18-2.24, p=0.003).

November 27, 2021Open Access

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

WWWen WeiFujian Medical University LZLingyu ZhangWeifang Medical University GLGuode LiSun Yat-sen University

Key Result

Moderate to severe malnutrition significantly increased the risk of long-term all-cause mortality (HR 1.63) compared to normal nutritional status in diabetic patients with coronary artery disease.

Study Design

Type

Cohort (n=12,898)

Multicenter

Structured PICO

Does malnutrition increase the risk of long-term all-cause mortality in diabetic patients with coronary artery disease?

Population

12,898 consecutive diabetic patients with angiographically proven coronary artery disease (CAD), mean age 63.9, 70.1% male, based in China. Excluded pregnant women and those with missing nutritional or follow-up data.

Intervention

Malnutrition as assessed by the Controlling Nutritional Status (CONUT) score (mild, moderate, or severe)

Comparator

Normal nutritional status (CONUT score 0-1)

Outcome

Long-term all-cause mortalityhard clinical

Malnutrition, as assessed by the CONUT score, is highly prevalent in diabetic patients with CAD and is independently associated with a significantly increased risk of long-term all-cause mortality.

Main Result

Effect estimate: HR 1.63 (95% CI 1.18-2.24)

p-value: p=0.003

Limitations

Observational nature inherent in the retrospectively collected database
Did not compare the prognostic value with more complex comprehensive nutritional screening tools
Did not investigate the changes in nutritional status over time
Lack of other endpoint events limits generalizability
Did not evaluate the relationship of malnutrition scores with inflammatory markers or with body mass index (BMI) due to lack of height and weight data

Abstract

BACKGROUND: Malnutrition is associated with poor prognosis in cardiovascular disease patients or in diabetic patients. However, the relationship between malnutrition and clinical outcomes in diabetic patients with coronary artery disease (CAD) is not well known. The aim of this study is to report the prevalence and prognostic consequences of malnutrition in diabetic patients with CAD. METHODS: In this retrospective observational study, the Controlling Nutritional Status (CONUT) score applied to 12,898 consecutive diabetic patients with CAD. The association between malnutrition and long-term all-cause mortality was examined using Cox proportional hazards regression analysis. RESULTS: According to CONUT score, 60.5% patients suffered from malnutrition; 46.4%, 13.2%, and 0.9% patients had mild, moderate, and severe malnutrition, respectively. During a median follow-up of 4.88 (2.83-7.51) years, 1973 (15.3%) patients died. After adjustment for confounders, malnutrition was associated with significantly increased risk for long-term all-cause mortality (adjusted hazard ratio for mild malnutrition and moderate to severe malnutrition, respectively: 1.38 95% confidence interval (CI) 1.07-1.77; P value = 0.012 and 1.63 95% CI 1.18-2.24; P value = 0.003). A similar association was observed around subgroups. CONCLUSIONS: Malnutrition is common in diabetic patients with CAD and is strongly associated with increased mortality. It is necessary to adequately assess the nutritional status and take the effective nutritional guidance to improve the prognosis of diabetic patients with CAD.

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