A nomogram model for predicting malnutrition among older hospitalized patients with type 2 diabetes: a cross-sectional study in China.

BACKGROUND: Malnutrition remains a pervasive issue among older adults, a prevalence that is markedly higher among those diagnosed with diabetes. The primary objective of this study was to develop and validate a risk prediction model that can accurately identify instances of malnutrition among elderly hospitalized patients with type 2 diabetes mellitus (T2DM) within a Chinese demographic. METHODS: This cross-sectional study was conducted between August 2021 and August 2022, we enrolled T2DM patients aged 65 years and above from endocrinology wards. The creation of a nomogram for predicting malnutrition was based on risk factors identified through univariate and multivariate logistic regression analyses. The predictive accuracy of the model was evaluated by the receiver operating characteristic curve (ROC),the area under the ROC (AUC), the concordance index (C-index), and calibration curves. RESULTS: The study included a total of 248 older T2DM patients, with a recorded malnutrition prevalence of 26.21%. The identified critical risk factors for malnutrition in this cohort were body mass index, albumin, impairment in activities of daily living, dietary habits, and glycosylated hemoglobin. The AUC of the nomogram model reached 0.914 (95% CI: 0.877-0.951), with an optimal cutoff value of 0.392. The model demonstrated a sensitivity of 80.0% and a specificity of 88.5%. Bootstrap-based internal verification results revealed a C-index of 0.891, while the calibration curves indicated a strong correlation between the actual and predicted malnutrition risks. CONCLUSIONS: This study underscores the critical need for early detection of malnutrition in older T2DM patients. The constructed nomogram represents a practical and reliable tool for the rapid identification of malnutrition among this vulnerable population.

Circulating C1q/TNF-related protein isoform 15 is a marker for the presence of metabolic syndrome.

BACKGROUND: C1q/TNF-related protein isoform 15 (CTRP15) has been reported to be related to glucose and lipid metabolism, but the results are inconsistent. Metabolic syndrome (MetS) is a cluster of metabolic disorders. The aim of this study is to determine circulating CTRP15 levels in individuals with MetS and investigate the association among circulating CTRP15 and markers for MetS as well as insulin resistance. METHODS: A total of 341 individuals were recruited for this cross-sectional study. These subjects were screened for MetS. Serum CTRP15 concentrations were measured by ELISA. RESULTS: Serum CTRP15 levels were significantly higher in MetS individuals relative to those of the healthy individuals. Circulating CTRP15 correlated positively with WHR, BMI, SBP, FAT %, 2 h-BG, FIns, 2 h-Ins, TG, FFA, HbA1c, HOMA-IR, and AUCglucose , while negatively with HDL-C and ISI. Multiple linear regression showed that HOMA-IR and HDL-C are independently related factors influencing serum CTRP15 concentrations. In addition, binary logistic regression analysis showed that serum CTRP15 concentrations were significantly related to MetS. When the mean concentrations of circulating CTRP15 in MetS subjects were stratified by the number of components of the MetS, circulating CTRP15 was found to increase progressively with increasing number of the MetS components. Finally, ROC curve analysis showed that the best cutoff values for circulating CTRP15 to predict MetS and insulin resistance were 63.6 and 64.0 µg/L. CONCLUSIONS: Serum CTRP15 concentrations were associated with the key components of MetS and insulin resistance.

Risk factors for malnutrition in patients with diabetic foot ulcer and its association with prolonged length of hospitalization.

PURPOSE: The study was designed to investigate the occurrence and risk factors of malnutrition in diabetic foot ulcers (DFU) patients and examine the association between malnutrition and length of stay (LOS). METHODS: This observational study included DFU hospitalized patients in two campuses of a hospital from January 2021 to June 2023. The diagnosis standard of malnutrition was established by using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Patients were followed up to ascertain the length of hospitalization, and hospital stays longer than 17 days were considered as prolonged LOS. To explore the risk factors of malnutrition and the association between malnutrition and LOS, univariate and multivariate logistic regression analyses were performed. RESULTS: Overall 219 DFU patients were enrolled, malnutrition was identified in 38.36% of patients according to GLIM criteria, and 92 patients (42%) were recognized as prolonged LOS. Logistic regression analyses showed that BMI (P <0.001), Alb (P = 0.002), HbA1c (P <0.001), ulcer infection (P <0.001), LOS (P = 0.010), and ABI (P = 0.024) were independent risk factors for malnutrition. Besides, malnutrition by GLIM criteria was closely related to prolonged LOS and malnourished DFU patients were 2.857 times (95% CI, 1.497-5.450; P = 0.001) likely to present prolonged LOS than that of normal nutrition. CONCLUSION: Malnutrition was considered to be extremely prevalent in DFU patients and was associated with approximately three times higher likelihood of prolonged LOS. Implementing and disseminating the diagnostic criteria during routine practice is crucial, given the predictive efficacy of GLIM criteria.

C1q/TNF-related protein-6 is associated with insulin resistance and the development of diabetes in Chinese population.

AIMS: C1q/tumor necrosis factor-related protein-6 (CTRP6) is a novel adipokine and has emerged as an important mediator for lipid and glucose metabolism. However, to date, the relationship between CTRP6 and T2DM in humans has not been demonstrated. Our objective is to investigate the association of circulating CTRP6 with T2DM in a cross-sectional study. METHODS: 118 patients with newly diagnosed T2DM, 98 subjects with impaired glucose tolerant (IGT) and 132 healthy subjects were recruited for this study. OGTT were performed in 48 healthy individuals to investigate the association of CTRP6 with glucose, insulin and other adipokines. Circulating CTRP6, TNF-α and Adipoq were measured by ELISA. RESULTS: IGT and T2DM individuals had higher serum CTRP6 levels than healthy controls (406.2 ± 136.6 and 539.1 ± 169.7 vs. 354.3 ± 117.2 ng/mL; both P < 0.01), whereas serum CTRP6 concentrations were further increased in T2DM patients compared with IGT individuals (P < 0.01). Serum CTRP6 levels were found to be related positively to BMI, WHR, FAT%, TC, TG, HbA1c, FBG, 2 h-OGTT, fasting insulin (FIns), 2 h-Ins, HOMA-IR and TNF-α, and negatively with HDL-C and Adipoq in all individuals (P < 0.05 or P < 0.01). Multivariate logistic regression analysis demonstrated that CTRP6 was correlated with both IGT and T2DM. After an oral glucose challenge, serum CTRP6 concentrations exhibited a similar change with blood glucose, insulin, TNF-α and Adipoq. CONCLUSIONS: CTRP6 may be a metabolism- and nutrition-related adipokine and may be related to insulin resistance and T2DM. TRIAL REGISTRATIONS: Clinical Trial Registration Number: ChiCTR-OCC-11001422. Registration name: Plasma cytokines and endothelial function in type 2 diabetes.

C1q/TNF-Related Protein5 (CTRP5) as a Biomarker to Predict Metabolic Syndrome and Each of Its Components.

OBJECTIVE: C1q/TNF-related protein5 (CTRP5) is a member of the C1q/tumor necrosis factor α- (TNF-α-) related protein family and has been reported to be associated with the regulation of glucose and lipid metabolism. However, the clinical association between CTRP5 and metabolic syndrome (MetS) has not been reported. The aim of the current study is to investigate the association between CTRP5 and MetS by a cross-sectional study. METHODS: We performed a cross-sectional study in a Chinese population including 89 controls and 88 MetS individuals. Serum CTRP5 concentrations were determined by ELISA. The relationship between circulating CTRP5 and MetS and insulin resistance (IR) was assessed by Spearman's correlation and multiple stepwise regression analysis. RESULTS: Circulating CTRP5 concentrations were markedly decreased in MetS individuals relative to normal adults. Overweight/obese individuals (BMI ≥ 25 kg/m2) showed a lower serum CTRP5 level than lean subjects (BMI < 25 kg/m2) in the study population (124.1 (99.12-147.37) vs. 103.9 (79.15-124.25) µg/L; P < 0.01). Circulating CTRP5 was found to be correlated negatively with BMI, FAT%, FBG, WHR, SBP, HbA1c, TG, 2-hour blood glucose after glucose overload (2-hOGTT), FIns, and HOMA-IR and positively with HDL-C (P < 0.05 or P < 0.01). Binary logistic regression revealed that serum CTRP5 levels were associated with MetS. In addition, serum CTRP5 levels gradually decreased with the increase in MetS components. CONCLUSIONS: Circulating CTRP5 is relative to the elevated risk of MetS in humans and may be in part through the effect of insulin resistance. This trial is registered with ChiCTR-OCS-13003185.