Overweight yet Undernourished: A Common Juxtaposition in the Specialist Diabetes Foot Service

Abstract

Aims

To describe the nutritional status of people with diabetes-related foot complications and explore the association between nutrition and ulceration healing.

Methods

This retrospective cohort study included attendees of a diabetes foot service who completed a dietary questionnaire. Diet was compared to guideline recommendations and biochemical measures were recorded. Associations between dietary intake and biochemical measures were analysed using non-parametric tests, and their relationship with being ulcer-free at 12 weeks analysed by binary logistic regression.

Results

Of 102 participants, 83% were men, mean age 68 (SD 12), body mass index 28.6 (SD 6.1) kg/m², and 86% had type 2 diabetes. Complications included 154 ulcerations and 7 active Charcot feet. Recommended fruit, vegetable and protein intake was seldom attained. Common insufficiencies were 25-hydroxy-vitamin D (40%), zinc (27%), iron (23%) and vitamin C (21%). Vitamin C was higher in the upper (vs lower) tertile of fruit/vegetable intake (62 [95%CI 33–88] vs 30 [13–46] umol/L, p = 0.04), and zinc higher in those meeting protein requirements (12.3 [95%CI 11.1–12.8] vs 10.6 [9.8–11.5] umol/L, p = 0.04). Haemoglobin was the only predictor of becoming ulcer-free (OR 1.03 [95%CI 1.00–1.06], p = 0.03).

Conclusion

Nutritional inadequacies are common in people with diabetes-related foot complications; however, the benefit of assessing nutrition remains uncertain.