Nutritional Status and the Relationship of Dietary and Serum Advanced Glycation End-Products with Inflammation, Oxidative Stress and Healing of Diabetic Foot Ulcers

Purpose: This study examined dietary and anthropometric components of diabetic patients with or without diabetic foot ulcers (DFU) and the association between advanced glycation end-products (AGE) and serum markers of oxidative stress and inflammation in diabetic patients with or without DFU. Methods: Eighty-two adult participants were recruited and assigned to one of three groups: 1) non-diabetic control; 2) diabetic participants without foot ulcers (DM); and 3) diabetic participants with foot ulcers (DFU). Twenty-four hour food recalls, pertinent history and blood samples were collected from each participant at the time of recruitment. Dietary intake was evaluated with Food Processor. Dietary and serum AGE as well as serum tumor necrosis factor-á (TNF-á), C-reactive protein (CRP), and thiobarbituric acid reactive substances (TBARS) were analyzed. Results: DFU subjects in this study were mostly overweight or obese. DFU had inadequate intakes in protein, fiber, vitamin B1, B2, B3, B6, C, D, and E; calcium, magnesium, phosphorus, potassium, selenium, and zinc. They had excessive intakes in saturated fat, trans fat, and sodium. The diabetic participants had significantly higher levels of dietary AGE per unit of energy, serum TNF-á, and TBARS compared to non-diabetic controls. BMI, body weight and TBARS were significantly higher in DFU than DM. DFU had significantly higher AGE per unit protein compared with DM and control. Serum AGE and TBARS were significantly correlated with dietary AGE. Serum TBARS predicted the duration of DFU (R2 = 0.52). Conclusions: Malnutrition is very common in the DM and DFU subjects. Vitamin supplementation may be beneficial in prevention and management of DM as well as DFU. Individuals with DFU had the highest levels of both dietary and serum AGE. Because dietary AGE causes a rise in serum AGE concentration, it is important to reduce the intake of foods containing AGE by promoting appropriate dietary choices in this population.