Propuesta de abordaje nutricional y dietoterapéutico basado en evidencia para el manejo integral de un paciente con pie diabético, hipertensión arterial y enfermedad renal crónico estadio I.

Abstract

Diabetic foot is one of the most clinically complex complications associated with type 2 diabetes mellitus, particularly when it co-occurs with soft-tissue infection, arterial hypertension, and chronic kidney disease. These conditions can alter tissue perfusion, immune response, wound healing, and metabolism, thereby increasing the risk of complications, surgical procedures, prolonged hospital stays, and nutritional deterioration. This study aimed to design an individualized nutritional approach for a 66-year-old male patient with an infected diabetic foot. A descriptive clinical case study with a qualitative-documentary approach was conducted, based on an analysis of the patient's medical history and a review of scientific evidence from specialized databases. The proposal was structured using the Nutrition Care Process, integrating nutritional assessment, nutritional diagnosis, requirement estimation, diet-therapeutic intervention, and the establishment of monitoring strategies. Comprehensive assessment revealed severe malnutrition, characterized by a 22.2% involuntary weight loss over four months, reduced muscle mass, and associated biochemical abnormalities. Although the BMI was 25.09 kg/m² and calf circumference was 29.2 cm, results from the Subjective Global Assessment and GLIM criteria confirmed nutritional deterioration. Estimated requirements were set at approximately 1890 kcal/day and 1.5 g/kg/day of protein, supplemented by oral nutritional supplements due to insufficient intake. Additionally, it was recommended to reduce fasting periods associated with surgical procedures by implementing ERAS-based strategies. Monitoring protocols were suggested to track intake, tolerance, glycemic control, renal function, anthropometric changes, and the preservation of muscle mass.