EVIDENCES IN ENTERAL NUTRITION OF THE DIABETIC PATIENT

Compelling evidence shows impaired clinical outcomes and survival when diabetes is associated with a poor nutrition status. Recently, the Global Leadership Initiative on Malnutrition (GLIM) provided a 2-step approach for the malnutrition diagnosis. According to the GLIM criteria, we observed that the 35.8% and 16.3% of the VIDA-survival cohort were categorized as having moderate and severe malnutrition, respectively. Severe malnutrition was associated with increased mortality (hazard ratio [HR]=2.09; 95% CI, 1.29–3.38), compared with non-malnourished participants. Moderate malnutrition had a neutral effect on all-cause mortality (HR= 1.30; 95% CI, 0.88–1.92). Low plasma albumin levels, a surrogate marker of inflammation, were strongly associated with early mortality.
A systematic review and meta-analysis were conducted through a literature search about Diabetes-specific formulas high in monounsaturated fatty acids and metabolic outcomes in patients with diabetes or hyperglycaemia. Of 385 references reviewed, 18 studies involving 845 adults met our inclusion criteria and contributed to the meta-analysis. Use of a high Monounsaturated fatty acids Diabetes specific formulae compared with a Standard formulas was associated with a statistically significant decrease in peak of postprandial glucose [SMD -1.53, 95% confidence interval (CI) -2.44 to -0.61], incremental glucose response (SMD -1.19, 95% CI -1.71 to -0.68), area under the curve of plasma insulin (SMD -0.65, 95% CI -1.03 to -0.26), mean blood glucose level (SMD -0.41, 95% CI -0.63 to -0.19), glycosylated haemoglobin (HbA1c) change (SMD -0.63, 95% CI -1.21 to -0.05), glucose variability (SMD -0.93, CI -1.55 to -0.31), mean administered insulin dose (SMD -0.49, 95% CI -0.85 to -0.14), mean blood triglycerides (SMD -0.34, 95% CI -0.65 to -0.03) and increase of mean blood high-density lipoproteins (SMD 0.42, 95% CI 0.08 to 0.76). Non-significant differences were found for tolerance [odds ratio (OR) 0.95, 95% CI 0.87 to 1.05]. This meta-analysis shows that a Diabetes specific formulae (oral supplements and tube feeds) high in Monounsaturated fatty acids can improve glucose control and metabolic risk factors among patients with diabetes or stress-induced hyperglycaemia compared with a Standard formulas.