Undernutrition is alarmingly prevalent in the dysvascular major lower limb amputation population: A prospective cohort study
9 affiliations
- 1Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- 2Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- 3Department of Gastroenterology and Hepatology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands
- 4Department Physiotherapy, Human Physiology and Anatomy, Research Unit Experimental Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
- 5Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- 6Department of Vascular Surgery, Martini Hospital, Groningen, The Netherlands
- 7Department of Surgery, Division of Vascular Surgery, Isala Hospital, Zwolle, The Netherlands
- 8Department of Surgery, Treant Hospital, Emmen, The Netherlands
- 9Department of Vascular Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
Abstract
Introduction: People who have undergone dysvascular major lower limb amputation (LLA) are at high risk for adverse clinical outcomes, including undernutrition. However, prevalence of undernutrition in this population is unknown. Therefore, the aim of this study was to determine the nutritional intake and prevalence of undernutrition post-LLA, and to identify determinants of undernutrition. Methods: In this prospective longitudinal observational study, adults who underwent a dysvascular major LLA were included in six hospitals (n = 81). At several measurement occasions following amputation (<12 days, 5 weeks, 6 months, 9 months), participants’ nutritional intake (24-hour recall) and nutritional status (Patient-Generated Subjective Global Assessment, body mass index, grip strength, mid upper arm circumference, and triceps skinfold) were determined. Furthermore, the Dutch Healthy Diet index was determined. Potential determinants of undernutrition, i.e., age, sex, Charlson comorbidity index, LLA level, uni/bilateral LLA, education level, living situation, smoking status, pain level, and physical activity level, were assessed using mixed effect models. Results: Median [Q1; Q3] energy intake was 1647 [1178; 2199], 2053 [1516; 2340], 1920 [1263; 2240], and 1797 [1343; 2211] kcal/day (p = 0.002), and protein intake was 76 [59; 100], 88 [68; 114], 84 [64; 101], and 75 [57; 97] grams/day (p = 0.017) at <12 days, 5 weeks, 6 months, and 9 months post-LLA, respectively. Prevalence of undernutrition was 83%, 56%, 28%, and 24%. Determinants of undernutrition were: living in a care facility (OR=6.2, p < 0.001) and lower physical activity (OR=0.96 for every hour of physical activity/week, p = 0.006). Need for nutritional intervention was present in 100%, 82%, 67% and 54% of participants at <12 days, 5 weeks, 6 months, and 9 months post-LLA. Conclusion: Inadequate nutritional intake and undernutrition are alarmingly prevalent post-LLA. Living in a care facility and lower physical activity are determinants of undernutrition. Interventions to improve nutritional status, to potentially optimize clinical outcomes in the dysvascular major LLA population are highly needed.
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BibTeX
@article{kolen2026undernutrition,
title = {{Undernutrition is alarmingly prevalent in the dysvascular major lower limb amputation population: A prospective cohort study}},
author = {Aniek M. Kolen and Leonie A. Krops and Harriët Jager-Wittenaar and Martijn L. Dijkstra and B. Paul J. A. Keller and Jacques Oskam and Bastiaan P. Vierhout and Jean-Paul P. M. de Vries and Laurens van Walraven and Wim P. Krijnen and Rienk Dekker and Jan H. B. Geertzen},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0342726},
url = {https://doi.org/10.1371/journal.pone.0342726},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Undernutrition is alarmingly prevalent in the dysvascular major lower limb amputation population: A prospective cohort study
AU - Aniek M. Kolen
AU - Leonie A. Krops
AU - Harriët Jager-Wittenaar
AU - Martijn L. Dijkstra
AU - B. Paul J. A. Keller
AU - Jacques Oskam
AU - Bastiaan P. Vierhout
AU - Jean-Paul P. M. de Vries
AU - Laurens van Walraven
AU - Wim P. Krijnen
AU - Rienk Dekker
AU - Jan H. B. Geertzen
PY - 2026
DA - 2026/09/28
JO - PLOS One
DO - 10.1371/journal.pone.0342726
UR - https://doi.org/10.1371/journal.pone.0342726
AB - Introduction: People who have undergone dysvascular major lower limb amputation (LLA) are at high risk for adverse clinical outcomes, including undernutrition. However, prevalence of undernutrition in this population is unknown. Therefore, the aim of this study was to determine the nutritional intake and prevalence of undernutrition post-LLA, and to identify determinants of undernutrition. Methods: In this prospective longitudinal observational study, adults who underwent a dysvascular major LLA were included in six hospitals (n = 81). At several measurement occasions following amputation (<12 days, 5 weeks, 6 months, 9 months), participants’ nutritional intake (24-hour recall) and nutritional status (Patient-Generated Subjective Global Assessment, body mass index, grip strength, mid upper arm circumference, and triceps skinfold) were determined. Furthermore, the Dutch Healthy Diet index was determined. Potential determinants of undernutrition, i.e., age, sex, Charlson comorbidity index, LLA level, uni/bilateral LLA, education level, living situation, smoking status, pain level, and physical activity level, were assessed using mixed effect models. Results: Median [Q1; Q3] energy intake was 1647 [1178; 2199], 2053 [1516; 2340], 1920 [1263; 2240], and 1797 [1343; 2211] kcal/day (p = 0.002), and protein intake was 76 [59; 100], 88 [68; 114], 84 [64; 101], and 75 [57; 97] grams/day (p = 0.017) at <12 days, 5 weeks, 6 months, and 9 months post-LLA, respectively. Prevalence of undernutrition was 83%, 56%, 28%, and 24%. Determinants of undernutrition were: living in a care facility (OR=6.2, p < 0.001) and lower physical activity (OR=0.96 for every hour of physical activity/week, p = 0.006). Need for nutritional intervention was present in 100%, 82%, 67% and 54% of participants at <12 days, 5 weeks, 6 months, and 9 months post-LLA. Conclusion: Inadequate nutritional intake and undernutrition are alarmingly prevalent post-LLA. Living in a care facility and lower physical activity are determinants of undernutrition. Interventions to improve nutritional status, to potentially optimize clinical outcomes in the dysvascular major LLA population are highly needed.
SN - 1932-6203
ER -