ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Clinical Diabetes
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1654831
Association of inflammation and nutrition based indicators and diabetic foot ulcers: A cross-sectional study and a retrospective study
Provisionally accepted
- 1Shanghai Jiao Tong University, Shanghai, China
- 2Civil Aviation Hospital of Shanghai, Shanghai, China
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Background: Inflammation and nutrition status have emerged as important factors in impaired wound healing in diabetes. However, the association between inflammation and nutrition based indicators and diabetic foot ulcer (DFU) has not been reported. Methods: This study used a cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES) database and a clinical retrospective study to investigate the association between the inflammation and nutrition based indicators and DFU. We analyzed data from 31126 individuals in the NHANES data between 1999 and 2004. Inflammation and nutrition based indicators included Neutrophil-albumin ratio (NAR), Monocyte-albumin ratio (MAR), Red cell distribution width-albumin ratio (RAR), The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP), and Prognostic nutritional index (PNI). Binary logistic regression on single and multiple variables and restricted cubic spline were conducted to assess the association and non-linear relationship between these biomarkers and the prevalence of DFU. Subgroup analyses were performed to evaluate the stability of the associations. Additionally, a retrospective study was conducted to further assess the associations between NAR, MAR, RAR, HALP, PNI and the prevalence of DFU using binary logistic regression analysis. Results: 129 participants with DFUs and 1515 without DFUs were included in this cross-sectional study. NAR, MAR, RAR, HALP, PNI, and DFU are significantly associated with the prevalence of DFU. After adjusting for all covariates (model 3), the third tertile of NAR (OR = 1.73 [1.09-2.74]), MAR (OR = 1.71 [1.05-2.79]), and RAR (OR = 4.47 [2.57-7.77]) were positively linked with DFU, compared to the first tertile. The third tertile of HALP (OR = 0.50 [0.31-0.80]) and PNI (OR = 0.42 [0.26-0.67]) were negatively linked with DFU, compared to the first tertile. The RCS curves showed a nonlinear relationship between RAR and prevalence of DFU, with an
Keywords: Inflammation, nutrition, biomarker, DFU, NHANES, Retrospective study
Received: 01 Jul 2025; Accepted: 25 Aug 2025.
Copyright: © 2025 Chen, Zhou and Dai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jiezhi Dai, Shanghai Jiao Tong University, Shanghai, China
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