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Vol 3, No 2 (2018)
Original article
Published online: 2018-07-31
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The association between nutritional and functional status in patients undergoing endovascular intervention due to chronic lower limbs ischemia

Wioletta Banaś1, Beata Czerniak1, Jacek Budzyński1
·
Medical Research Journal 2018;3(2):55-62.
Affiliations
  1. Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland

open access

Vol 3, No 2 (2018)
ORIGINAL ARTICLES
Published online: 2018-07-31

Abstract

Background: The nutritional status and functional status of patients are important prognostic factors. The aim of the study was to assess the relationships between patients’ nutritional status and the outcome of endovascular intervention in patients with chronic lower limb ischemia during one-year follow-up.

Materials and methods: In 79 consecutive patients subjected to endovascular intervention due to chronic leg ischemia following examinations were performed before and after 3 and 12 month after surgery: physical examination, Minimal Nutritional Assessment (MNA) score, Nutritional Risk Screening 2002 score (NRS2002), Barthel, ADL, IADL scale, ankle-brachial index (ABI), claudication distance on the treadmill and handgrip strength.

Results: More than half of patients were initially overweight or obese. Following 3 months after the surgery, improvement in lower limb symptoms was observed, together with significant increase in ABI, claudication distance, total MNA score and IADL scale. The risk associated with malnutrition (MNA questionnaire), Barthel score and hand grip strength showed a statistically significant relationship with the subjective feeling of improvement after surgery. Its absence was more frequent in patients characterized by higher risk of malnutrition, with less muscular strength and poorer fitness.

Conclusions: Endovascular treatment of lower limbs ischemia improved not only symptoms of leg ischemia but also the general functional status of patients. The initial nutritional status, functional status and hand grip strength of patients with chronic lower limb ischemia were associated with a better clinical outcome of endovascular intervention.

Abstract

Background: The nutritional status and functional status of patients are important prognostic factors. The aim of the study was to assess the relationships between patients’ nutritional status and the outcome of endovascular intervention in patients with chronic lower limb ischemia during one-year follow-up.

Materials and methods: In 79 consecutive patients subjected to endovascular intervention due to chronic leg ischemia following examinations were performed before and after 3 and 12 month after surgery: physical examination, Minimal Nutritional Assessment (MNA) score, Nutritional Risk Screening 2002 score (NRS2002), Barthel, ADL, IADL scale, ankle-brachial index (ABI), claudication distance on the treadmill and handgrip strength.

Results: More than half of patients were initially overweight or obese. Following 3 months after the surgery, improvement in lower limb symptoms was observed, together with significant increase in ABI, claudication distance, total MNA score and IADL scale. The risk associated with malnutrition (MNA questionnaire), Barthel score and hand grip strength showed a statistically significant relationship with the subjective feeling of improvement after surgery. Its absence was more frequent in patients characterized by higher risk of malnutrition, with less muscular strength and poorer fitness.

Conclusions: Endovascular treatment of lower limbs ischemia improved not only symptoms of leg ischemia but also the general functional status of patients. The initial nutritional status, functional status and hand grip strength of patients with chronic lower limb ischemia were associated with a better clinical outcome of endovascular intervention.

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Keywords

nutritional status, functional status, lower limbs ischemia, revascularization, endovascular treatment

About this article
Title

The association between nutritional and functional status in patients undergoing endovascular intervention due to chronic lower limbs ischemia

Journal

Medical Research Journal

Issue

Vol 3, No 2 (2018)

Article type

Original article

Pages

55-62

Published online

2018-07-31

Page views

734

Article views/downloads

746

DOI

10.5603/MRJ.2018.0010

Bibliographic record

Medical Research Journal 2018;3(2):55-62.

Keywords

nutritional status
functional status
lower limbs ischemia
revascularization
endovascular treatment

Authors

Wioletta Banaś
Beata Czerniak
Jacek Budzyński

References (34)
  1. Tojek K, Wustrau B, Czerniak B, et al. Body mass index as a biomarker for the evaluation of the "Obesity Paradox" among inpatients. Clin Nutr. 2017 [Epub ahead of print].
  2. Winter JE, MacInnis RJ, Nowson CA, et al. BMI and all-cause mortality in older adults: a meta-analysis. Am J Clin Nutr. 2014; 99(4): 875–890.
  3. Galyfos G, Geropapas GI, Kerasidis S, et al. The effect of body mass index on major outcomes after vascular surgery. J Vasc Surg. 2017; 65(4): 1193–1207.
  4. Budzyński J, Anaszewicz M. The associations between atrial fibrillation and parameters of nutritional status assessment in the general hospital population - a cross-sectional analysis of medical documentation. Kardiol Pol. 2017; 75(3): 231–239.
  5. Anaszewicz M, Budzyński J. Clinical significance of nutritional status in patients with atrial fibrillation: An overview of current evidence. J Cardiol. 2017; 69(5): 719–730.
  6. Kwon Y, Kim HJ, Park S, et al. Body Mass Index-Related Mortality in Patients with Type 2 Diabetes and Heterogeneity in Obesity Paradox Studies: A Dose-Response Meta-Analysis. PLoS One. 2017; 12(1): e0168247.
  7. Antonopoulos AS, Oikonomou EK, Antoniades C, et al. From the BMI paradox to the obesity paradox: the obesity-mortality association in coronary heart disease. Obes Rev. 2016; 17(10): 989–1000.
  8. Shaparin N, Widyn J, Nair S, et al. Does the obesity paradox apply to early postoperative complications after hip surgery? A retrospective chart review. J Clin Anesth. 2016; 32: 84–91.
  9. Veronese N, Cereda E, Solmi M, et al. Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects. Obes Rev. 2015; 16(11): 1001–1015.
  10. Spychalska-Zwolińska M, Zwoliński T, Anaszewicz M, et al. The influence of patients' nutritional status on the prevalence, course and treatment outcomes of lower limb ischemia: an overview of current evidence. Int Angiol. 2018; 37(2): 100–111.
  11. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010; 39(4): 412–423.
  12. Santilli V, Bernetti A, Mangone M, et al. Clinical definition of sarcopenia. Clin Cases Miner Bone Metab. 2014; 11(3): 177–180.
  13. Locquet M, Beaudart C, Reginster JY, et al. Comparison of the performance of five screening methods for sarcopenia. Clin Epidemiol. 2018; 10: 71–82.
  14. Han P, Yu H, Ma Y, et al. The increased risk of sarcopenia in patients with cardiovascular risk factors in Suburb-Dwelling older Chinese using the AWGS definition. Sci Rep. 2017; 7(1): 9592.
  15. Stoever K, Heber A, Eichberg S, et al. Sarcopenia and Predictors of Skeletal Muscle Mass in Elderly Men With and Without Obesity. Gerontol Geriatr Med. 2017; 3: 2333721417713637.
  16. Landry GJ, Esmonde NO, Lewis JR, et al. Objective measurement of lower extremity function and quality of life after surgical revascularization for critical lower extremity ischemia. J Vasc Surg. 2014; 60(1): 136–142.
  17. Yokoyama M, Watanabe T, Otaki Y, et al. Impact of Objective Malnutrition Status on the Clinical Outcomes in Patients With Peripheral Artery Disease Following Endovascular Therapy. Circ J. 2018; 82(3): 847–856.
  18. Peacock MR, Farber A, Eslami MH, et al. Hypoalbuminemia Predicts Perioperative Morbidity and Mortality after Infrainguinal Lower Extremity Bypass for Critical Limb Ischemia. Ann Vasc Surg. 2017; 41: 169–175.e4.
  19. Shiraki T, Iida O, Takahara M, et al. The Geriatric Nutritional Risk Index is Independently Associated with Prognosis in Patients with Critical Limb Ischemia Following Endovascular Therapy. Eur J Vasc Endovasc Surg. 2016; 52(2): 218–224.
  20. Chang SH, Tsai YJ, Huang HL, et al. Clinical predictors of long-term outcomes in patients with critical limb ischemia who have undergone endovascular therapy. Angiology. 2014; 65(4): 315–322.
  21. Raval Z, Liu K, Tian Lu, et al. Higher body mass index is associated with more adverse changes in calf muscle characteristics in peripheral arterial disease. J Vasc Surg. 2012; 55(4): 1015–1024.
  22. McDermott MM, Greenland P, Ferrucci L, et al. Lower extremity performance is associated with daily life physical activity in individuals with and without peripheral arterial disease. J Am Geriatr Soc. 2002; 50(2): 247–255.
  23. McDermott MM, Greenland P, Liu K, et al. The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study. Ann Intern Med. 2002; 136(12): 873–883.
  24. McDermott MM, Guralnik JM, Tian Lu, et al. Associations of borderline and low normal ankle-brachial index values with functional decline at 5-year follow-up: the WALCS (Walking and Leg Circulation Study). J Am Coll Cardiol. 2009; 53(12): 1056–1062.
  25. Ruo B, Liu K, Tian Lu, et al. Functional decline in peripheral arterial disease: associations with the ankle brachial index and leg symptoms. JAMA. 2004; 292(4): 453–461.
  26. McDermott MM, Tian Lu, Ferrucci L, et al. Associations between lower extremity ischemia, upper and lower extremity strength, and functional impairment with peripheral arterial disease. J Am Geriatr Soc. 2008; 56(4): 724–729.
  27. McDermott MM, Tian Lu, Liu K, et al. Prognostic value of functional performance for mortality in patients with peripheral artery disease. J Am Coll Cardiol. 2008; 51(15): 1482–1489.
  28. McDermott MM. Lower extremity manifestations of peripheral artery disease: the pathophysiologic and functional implications of leg ischemia. Circ Res. 2015; 116(9): 1540–1550.
  29. Mazari F, Khan JA, Carradice D, et al. Economic analysis of a randomized trial of percutaneous angioplasty, supervised exercise or combined treatment for intermittent claudication due to femoropopliteal arterial disease. British Journal of Surgery. 2013; 100(9): 1172–1179.
  30. Malgor RD, Alahdab F, Alalahdab F, et al. A systematic review of treatment of intermittent claudication in the lower extremities. J Vasc Surg. 2015; 61(3 Suppl): 54S–73S.
  31. Olin JW, White CJ, Armstrong EJ, et al. Peripheral Artery Disease: Evolving Role of Exercise, Medical Therapy, and Endovascular Options. J Am Coll Cardiol. 2016; 67(11): 1338–1357.
  32. Reynolds MR, Apruzzese P, Galper BZ, et al. Cost-effectiveness of supervised exercise, stenting, and optimal medical care for claudication: results from the Claudication: Exercise Versus Endoluminal Revascularization (CLEVER) trial. J Am Heart Assoc. 2014; 3(6): e001233.
  33. Stepaniak U, Micek A, Waśkiewicz A, et al. Prevalence of general and abdominal obesity and overweight among adults in Poland. Results of the WOBASZ II study (2013-2014) and comparison with the WOBASZ study (2003-2005). Pol Arch Med Wewn. 2016; 126(9): 662–671.
  34. Morisaki K, Yamaoka T, Iwasa K, et al. Influence of frailty on treatment outcomes after revascularization in patients with critical limb ischemia. J Vasc Surg. 2017; 66(6): 1758–1764.

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