AUTHOR=Wang Junjie , Chen Liling , Huang Zhidong , Lu Jin , Yang Yanfang , Zhao Xiaoli , Tu Jiabin , Pan Yuxiong , Bao Kunming , Chen Weihua , Xiu Jiaming , Liu Yong , Chen Longtian , Chen Shiqun , Chen Kaihong 

TITLE=A Synergistic Association Between Inflammation, Malnutrition, and Mortality in Patients With Diabetics

JOURNAL=Frontiers in Nutrition

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2022.872512

DOI=10.3389/fnut.2022.872512

ISSN=2296-861X

ABSTRACT=Background: Although inflammation is a known predictor for poor prognosis in diabetic patients, few data report the synergistic association between inflammation, malnutrition and mortality in diabetic patients. We aim to explore whether malnutrition modifies the predictor of inflammation on prognosis.
Methods: Nutritional status and inflammation were measured in 6,682 diabetic patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) between January 2007 to December 2018 from CIN database (Cardiorenal ImprovemeNt Registry). Malnutrition was defined as Controlling Nutritional Status (CONUT) score >1. High-sensitivity C-reactive protein (hs-CRP) exceeding the median was assessed as a high-risk inflammation. Cox regression models were used to estimate hazard ratios (HR) for mortality across combined hs-CRP and CONUT score categories. 
Results: During a median follow-up of 5.0 years (interquartile range: 3.0 to 7.6 years), 759 (11.36%) patients died. The mortality of the four groups (normal nutrition & low hs-CRP level, normal nutrition & high hs-CRP level, malnutrition & low hs-CRP level and malnutrition & high hs-CRP level) were 7.29%, 7.12%, 10.71% and 17.31%, respectively. Compared with normal nutrition and low hs-CRP level, an isolated condition of either malnutrition or high hs-CRP level was not associated with any significant risk for all-cause mortality. However, concomitant presence of both high hs-CRP level and malnutrition condition was associated with a significantly increased risk of all-cause mortality (HR: 1.51; 95% CI: 1.20-1.89; P < 0.001). P for interaction between nutritional status and hs-CRP level on all-cause mortality was 0.03. 
Conclusion: The interplay of inflammation and malnutrition in diabetic patients significantly amplifies the deleterious effects of each as distinct disease entities. A prospective randomized clinical trial is needed in the future to verify the results.