What a Recent Study Reveals About Revascularization for CLTI in Patients Who Live in Food Deserts
15. June 2021
Jeff Hall, Senior Contributing Editor

A recently published study in the Annals of Vascular Surgery found that patients who live in food deserts had nearly double the rate of 30-day readmission after revascularization for chronic limb-threatening ischemia (CLTI).1

In the retrospective study of open and endovascular infrainguinal revascularization for the treatment of CLTI, researchers assessed the outcomes of 152 patients with 17 percent of the cases involving patients who live in food deserts.1 In addition to the higher rate of 30-day readmission, patients in food deserts had a 24 percent higher proportion of wound complications.

According to estimates from the United States Department of Agriculture, 18.8 million people in the U.S. live in low-income, low-access tracts that are more than one mile from “the nearest supermarket, supercenter or large grocery store” in an urban area and greater than 10 miles away from these markets in rural areas.2

“Pre-op nutrition screening for patients who have CLTI is essential to ensure optimal post-op recovery,” says Maritza Molina, RDN, an Outpatient Clinical Dietitian at the Keck Medical Center of the University of Southern California (USC).

In addition to uncontrolled diabetes and hypertension, Molina says other major factors that may affect post-op healing after revascularization for CLTI include dehydration, malnutrition, obesity, malnourishment or being underweight.

Molina says there are specific tools, such as the Nutrition Focused Physical Exam (NFPE), dietitians can utilize to assess a patient’s overall health status, and determine any acute/chronic weight loss/gain and/or malnutrition. These tools along with lab testing enable dietitians to identify any preexisting nutrition-related diseases and determine if they are under control or if the patient needs further intervention, according to Molina. 

“The role of nutrition assessment needs to be an essential part of the patient’s surgical clearance for revascularization procedures,” emphasizes Molina. “If a patient has any underlying uncontrolled nutrition-related health issue, the patient may be at risk for delayed wound healing and post-op complications.” 

Molina says patient education can not only have an impact in managing preexisting nutrition-related diseases but “may even provide a preventative shield and/or slow down the maturation of CLTI.” In general, Molina recommends having patients with CLTI focus on a lean and green low-fat diet with appropriate hydration and exercise as this emphasis may potentially decrease the risk of CTLI development and maturation of preexisting CLTI.

For patients who live in food deserts, Molina says there are challenges with access to whole fresh foods and potential affordability issues even if these foods are available. In these cases, Molina provides the following recommendations to these patients.

  • Purchase frozen vegetables and fruits.  
  • Purchase frozen proteins in the form of raw frozen chicken and fish.
  • Look for and emphasize “reduced sodium, low-sodium, reduced sugar or low-sugar” choices when purchasing canned goods.
  • Purchase produce or other products with a long shelf life (i.e. root vegetables like potatoes, beets, carrots and butternut squash, or foods such as uncooked beans, rice, legumes and nuts).
  • Purchase low-fat, low-sodium type foods when eating at fast food restaurants or choose salad options if they are available.

If there is a community garden available in these areas, Molina recommends that patients purchase fresh vegetables and fruits if they are available. Otherwise, if patients have the space outdoors, Molina encourages them to grow fruits and vegetables.

References

  1. Smith EJT, Ramirez JL, Wu B, et al. Living in a food desert is associated with 30-day readmission after revascularization for chronic limb-threatening ischemia. Ann Vasc Surg. 2021;70:36-42.
  2. Economic Research Service of the U.S. Department of Agriculture. Food access research atlas. https://www.ers.usda.gov/data-products/food-access-research-atlas/documentation/

Related Articles