Food induced complications in lymphedema : a case study of Thailand Lymphedema Day Care Center

Abstract

Background: Celluitis is the most serious complication and major concern of those involve in LE care. Currently, there is no cure for LE, therefore the prevention of repeated episode of acute subcutaneous tissue inflammation provide a long term resolution for LE. It is of great interest to identify potential factors that could decrease or prevent the episode of subcutaneous tissue inflammation among chronic LE. One such potential factor which simple and self dependent is dietary. Objectives: The purposes of this study were to (1) explore the association between dietary and complications in LE focusing in subcutaneous tissue inflammation, (2) identify the prevalence of cellulitis, (3) demonstrate association of hsCRP, dietary habit and cellulitis in patients with LE, (4) identify the independent risk factors for cellulitis in LE and (5) demonstrate the ethnology of recurrent cellulitis. Methods: Three sub-studies, cross-sectional, case-control and case report were utilized. In total, 103 new patients with LE and 2 case reports visited Thailand Lymphedema Day Care Center (TLDCC) during September 2010 to June 2011, and 358 medical records of patients with LE visited TLDCC from November 2009 to September 2011 were recruited and analyzed. Demographic, medical information and dietary intake were assessed using case record format and tested seven-day Food Frequency Interviewed Chart (FFIC). Serum high-sensitivity CRP was investigated. Descriptive statistic, univariate, bivariate and multivariate analyses were performed using statistical package software. Results: There was about 18.4% reported of food induced complications experiences (FIE). The most reported complication symptoms related with dietary felt by patients indicated a sign of subcutaneous tissue inflammation. The prevalence of cellulitis in LE at TLDCC was 47.6%. Levels of hsCRP (p =0.003), having deep fried food more than once a day (p =0.044), consumption frequency of animal more than vegetable products in patients with LE aged lower than 55 years old (p =0.048), and being female (p =0.025) were statistically associated with cellulitis. Multivariate analysis indicated the percentage difference in circumference of the limb (adjusted odds ratio (AOR) =1.07, 95% confidence interval (CI) =1.04-1.10), primary LE diagnosis (AOR =3.36, 95% CI=1.37-8.22), FIE (AOR=6.82, 95% CI=2.82-16.51) and systolic blood pressure (AOR=1.02, 95% CI=1.01-1.04) were risk factors for cellulitis. No association was observed with hypertension, diabetes mellitus, body mass index and the duration of LE. The ethnology of recurrent cellulitis related with meat intake was confirmed by two case reports, a distinct improvement was observed in the patient who followed the dietary advice for 6 months. Conclusions: Our data support the notion that dietary intake could be an important precipitating factor of subcutaneous tissue inflammation. We therefore suggest that the awareness in daily food intake in LE should be raised among health care provider and patients. Dietary guideline of how to limiting meat and fat consumption should be created.