Sarcopenia with co-existent type 2 diabetes mellitus is associated with worse clinical outcomes among hospitalised cardiac patients.

BACKGROUND & AIMS: Sarcopenia has been shown associated with functional decline, disability, poorer quality of life and mortality. However, there are limited studies among hospitalised cardiac patients in Malaysia. This study aimed to identify the association of sarcopenia and type 2 diabetes mellitus (T2DM) with clinical outcomes among hospitalised cardiac patients. METHODS: This prospective observational study assessed 100 patients who were admitted to the general wards at the National Heart Institute. We measured handgrip strength, body composition using bioelectrical impedance analysis (BIA) and recorded the length of stay (LOS), unplanned readmission and incidence of infection within 90 days after discharge. Logistic regression analysis at a significant level p < 0.05 was used to identify the association between sarcopenia and clinical outcomes. RESULTS: The prevalence of sarcopenia was 63%, and this was similar in patients with or without T2DM. After adjustment, sarcopenia was significantly associated with 90-day unplanned readmission (adjusted OR 3.5; 95%CI 1.40-8.77; p = 0.007) and LOS (AOR 0.4; 95%CI 0.16-0.88; p = 0.026). After adjustment, the co-existent of T2DM and sarcopenia was significantly associated with 90-day unplanned readmission (AOR 7.3; 95%CI 1.82-29.66; p = 0.005) and 90-day incidence of infection (AOR 4.4; 95%CI 1.12-17.52; p = 0.033). CONCLUSION: Sarcopenia with co-existent T2DM was associated with increased risk for readmission and infection among hospitalised cardiac patients. Early identification of sarcopenia is important for timely intervention to improve prognosis in hospitalised cardiac patients with T2DM.

Factors influencing adequate protein and energy delivery among critically ill children with heart disease in pediatric intensive care unit.

BACKGROUND & AIMS: Inadequate nutrition delivery in critically ill children has shown associated with poor clinical outcomes. Therefore, identifying barriers to deliver adequate nutrition is vital. The aim of this study was to identify factors influencing adequate protein and energy delivery among critically ill children with heart disease in pediatric intensive care unit (PICU). METHODS: This single-centre prospective study, involved children aged from birth to 3 years old, admitted to PICU longer than 72 hours. They received either enteral nutrition (EN) or combination of EN and partial parenteral nutrition (PPN). Clinical and nutrition delivery characteristics were recorded from admission until transferred out of PICU. Multiple regression analysis at significant level p < 0.05 were used to identify independent risk factors for lower protein and energy intake. RESULTS: One hundred and thirty-nine patients were included in this study with median age 6.5 (1.8-20.6) months and median PICU length of stay of 6 (4-7) days. The median energy and protein adequacy were 83.2% and 46.7%, respectively. In multivariable analysis, children who underwent surgery (AOR 0.97; 95% CI 0.27-0.75; p = 0.041), with fluid restriction (AOR 0.97; 95% CI 0.25-0.73; p = 0.041), longer length of PICU stay (AOR 0.35; 95% CI 0.18-0.64; p = 0.001) and longer feeding interruptions (AOR 3.57; 95% CI 1.39-9.15; p = 0.008) were more likely to have lower energy intake. Children at risk of malnutrition (weight-for-age Z score of < -2 SD) (AOR 2.54; 95% CI 1.12 to 5.77; p = 0.026) and longer duration of mechanical ventilation (AOR 0.73; 95% CI 0.53 to 0.98; p = 0.041) were more likely to have lower protein intake. CONCLUSION: This study highlighted the factors influencing adequate protein and energy delivery in critically ill children with heart disease in PICU. Strategies to improve the nutrition delivery in this group of patients should be outlined and implemented by the dietitians along with multidisciplinary team.