Malnutrition and Metabolic Changes in Patients with Type 2 Diabetes

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Background/Aim: In patients with type 2 diabetes (T2D), malnutrition has been recognized as a serious health problem mainly in hospitalized conditions, but there is little data regarding malnutrition outside hospital settings. The aim of this study was to evaluate the risk of malnutrition and associated metabolic changes in ambulatory patients with T2D.

Material and methods: This analysis used data collected from 161 patients with T2D enrolled in a larger cross-sectional study. Several anthropometric and metabolic parameters were obtained. Nutritional status was evaluated using the Controlling Nutritional Status (CONUT) score. Correlations between nutritional status and metabolic and anthropometric parameters of interest were examined.

Results: Of all T2D patients, 29.8% had mild malnutrition (CONUT score 2–4). These patients presented lower triglyceride (124.8 ± 42.3 mg/dL vs. 165.7 ± 84.3 mg/dL, p <0.01) and LDL cholesterol concentrations (62.7 ± 20.0 mg/dL vs. 104.9 ± 30.6 mg/dL, p <0.0001), higher leptin levels (10.2 [1.6–44.9] ng/mL vs. 7.3 [0.9–49.8] ng/mL, p <0.05) and free leptin index (0.65 [0.04–2.88] vs. 0.36 [0.01–3.98], p <0.05) compared with patients with normal nutritional status. They also had higher total body adiposity. In patients with obesity, triglycerides levels were lower in those with mild malnutrition vs. those without malnutrition (mean difference: 27.26 mg/dL, p <0.05). Serum C peptide/leptin ratio was higher in T2D patients with normal nutritional status without obesity, the differences being significant vs. the two groups with obesity (with or without malnutrition, 0.71 ± 0.53, 0.42 ± 0.33, and 0.49 ± 0.68, respectively). HOMA-IR was lower in patients with normal nutritional status without obesity vs. those with obesity (mean difference: −0.7126, p <0.05), while in patients with mild malnutrition, HOMA-IR values were higher, but no differences were noted between the groups with or without obesity.

Conclusion: In patients with T2D, malnutrition associated with lower triglycerides concentrations, even in the presence of obesity. Malnutrition and/or obesity associated with higher HOMA-IR, serum leptin levels and lower C peptide/leptin ratio.

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