Malnutrition is Common in Patients Utilizing Glucagon-Like Peptide-1 Agonists Prior to Total Joint Arthroplasty

The rising prevalence of obesity and the increased use of glucagon-like-peptide-1 (GLP-1) receptor agonists for weight loss and diabetes has led to more patients qualifying for elective total joint arthroplasty (TJA). While these medications promote weight reduction, they may predispose patients to nutritional deficiencies. This study aims to evaluate the preoperative nutritional status of GLP-1 users undergoing TJA compared to nonusers.

A retrospective chart review was conducted at a high-volume center on patients who underwent elective primary TJA between January 1 and May 1, 2025. Patients were included if they had complete preoperative nutritional labs. Nutritional markers included hemoglobin, albumin, total protein, prealbumin, calcium, alkaline phosphatase, and 25-hydroxy vitamin D. Malnutrition was defined as ≥1 laboratory deficiency; severe malnutrition as ≥2 deficiencies. GLP-1 use, indication, and duration were recorded. Statistical analyses included t-tests, chi-square tests, and odds ratio calculations.

A total of 165 patients met inclusion criteria, with 29 (17.6%) actively using GLP-1 receptor agonists. The cohorts were matched for comorbidities. GLP-1 users had higher rates of malnutrition (38% vs 8.8%, P < .001; odds ratio = 6.2), severe malnutrition (17.2% vs 2.9%, P = .009; odds ratio = 6.88), and lower albumin (P < .001), prealbumin (P = .003), and total protein (P = .024) levels compared to controls.

GLP-1 agonist use is associated with significantly higher rates of preoperative nutritional deficiencies in patients undergoing elective TJA. Given the high risk of malnutrition in this growing patient population, targeted nutritional screening and optimization should be considered standard practice in the preoperative evaluation of GLP-1 users.