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Meta-Analysis
. 2023 Mar 29:14:1152854.
doi: 10.3389/fendo.2023.1152854. eCollection 2023.

The association between micronutrient levels and diabetic foot ulcer: A systematic review with meta-analysis

Shilia Jacob Kurian  1   2 , Tejaswini Baral  1   2 , Mazhuvancherry K Unnikrishnan  3 , Ruby Benson  1 , Murali Munisamy  4 , Kavitha Saravu  2   5 , Gabriel Sunil Rodrigues  6 , Mahadev Rao  1 , Amit Kumar  7 , Sonal Sekhar Miraj  1   2
Affiliations
Meta-Analysis

The association between micronutrient levels and diabetic foot ulcer: A systematic review with meta-analysis

Shilia Jacob Kurian et al. Front Endocrinol (Lausanne). .

Abstract

Background: Diabetic foot ulcers (DFU) are a major complication of diabetes mellitus (DM). Nutrient deficiencies are among the major risk factors in DFU development and healing. In this context, we aimed to investigate the possible association between micronutrient status and risk of DFU.

Methods: A systematic review (Prospero registration: CRD42021259817) of articles, published in PubMed, Web of Science, Scopus, CINAHL Complete, and Embase, that measured the status of micronutrients in DFU patients was performed.

Results: Thirty-seven studies were considered, of which thirty were included for meta-analysis. These studies reported levels of 11 micronutrients: vitamins B9, B12, C, D, E, calcium, magnesium, iron, selenium, copper, and zinc. DFU, compared to healthy controls (HC) had significantly lower vitamin D (MD: -10.82 14 ng/ml, 95% CI: -20.47, -1.16), magnesium (MD: -0.45 mg/dL, 95% CI: -0.78, -0.12) and selenium (MD: -0.33 µmol/L, 95% CI: -0.34, -0.32) levels. DFU, compared to DM patients without DFU, had significantly lower vitamin D (MD: -5.41 ng/ml, 95% CI: -8.06, -2.76), and magnesium (MD: -0.20 mg/dL, 95% CI: -0.25, -0.15) levels. The overall analysis showed lower levels of vitamin D [15.55ng/ml (95% CI:13.44, 17.65)], vitamin C [4.99µmol/L (95% CI:3.16, 6.83)], magnesium [1.53mg/dL (95% CI:1.28, 1.78)] and selenium [0.54µmol/L (95% CI:0.45, 0.64)].

Conclusion: This review provides evidence that micronutrient levels significantly differ in DFU patients, suggesting an association between micronutrient status and risk of DFU. Therefore, routine monitoring and supplementations are warranted in DFU patients. We suggest that personalized nutrition therapy may be considered in the DFU management guidelines.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=259817, identifier CRD42021259817.

Keywords: diabetic foot ulcers; micronutrients; minerals; risk; vitamins.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The PRISMA flow chart of screening and study selection.
Figure 2
Figure 2
Forest plot of pooled mean difference of micronutrient status in DFU patients compared to DM and HC (A) Micronutrient levels of DFU patients were compared against those with DM; (B) Micronutrient levels of DFU patients were compared against those with HC.
Figure 3
Figure 3
Summary of micronutrient levels in DFU patients. Forest plot of mean micronutrient status in DFU patients.
Figure 4
Figure 4
Subgroup analysis based on geographic location was assessed for vitamin D, zinc, and calcium. (A) Mean vitamin D levels across Middle East, Europe, and Asia/Pacific regions. (B) Mean zinc levels across Middle East, Asia/Pacific, and African regions. (C) Mean calcium levels across Europe and Asia/Pacific regions.
Figure 5
Figure 5
Forest plot for the sensitivity analysis. Sensitivity analysis was performed by eliminating results of two studies with the lowest risk assessment scores.
Figure 6
Figure 6
Funnel plot asymmetry test to assess publication bias.
See this image and copyright information in PMC

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