Diet Quality and Nutritional Risk in Patients with Wilson's Disease: A Cross-Sectional Study

Shou-hong LinMei-ling YangYi ZengTing-ting Wu^*

• First Affiliated Hospital of Fujian Medical University, Fuzhou, China

Objective:This study aimed to evaluate diet quality in patients with Wilson's disease (WD), identify associated factors, and investigate the relationship between diet quality and nutritional risk in this population. Methods: This cross-sectional study enrolled patients with WD at a tertiary hospital in Fujian Province from November 2023 to February 2025. Dietary quality was evaluated using the Dietary Quality Index-International (DQI-I), and nutritional risk was assessed with the Mini Nutritional Assessment (MNA). A DQI-I score of 61 (median) was used to dichotomize dietary quality. Logistic regression identified factors associated with lower DQI-I scores. Associations between DQI-I and nutritional risk were examined using three models: unadjusted (Model 1); adjusted for age, sex, and BMI (Model 2); and further adjusted for educational attainment, disease duration, smoking, clinical classification, comorbidities, chelator, zinc preparation, self-reported medication adherence, liver damage, 24-hour urinary copper, and albumin (Model 3). A linear regression scatterplot was used to visualize the association. Results: A total of 91 patients with WD were included, with a mean DQI-I score of 59.51 ± 7.42. Overall, 74.7% were either malnourished or at risk of malnutrition. Lower DQI-I scores were significantly associated with female sex, lower educational attainment, longer disease duration, and smoking (all P < 0.05). In the unadjusted model (Model 1), a DQI-I score ≤61 was associated with a 34.83-fold increased risk of malnutrition and a 4.98-fold increased risk of nutritional risk (both P < 0.05), compared to scores >61. These associations remained significant after multivariable adjustment (Models 2 and 3). DQI-I scores were moderately correlated with nutritional risk (r = 0.448, P < 0.001). Conclusion: Patients with WD exhibit suboptimal dietary quality and a high prevalence of nutritional risk. Lower DQI-I scores independently predict malnutrition, emphasizing the utility of diet quality assessment in clinical care. Early identification of at-risk individuals, coupled with targeted, dietitian-led interventions, may improve dietary variety, mitigate nutritional risk, and support better long-term outcomes.