Case Control Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2024; 15(3): 403-417
Published online Mar 15, 2024. doi: 10.4239/wjd.v15.i3.403
Associations between Geriatric Nutrition Risk Index, bone mineral density and body composition in type 2 diabetes patients
Xiao-Xiao Zhu, Kai-Feng Yao, Hai-Yan Huang, Li-Hua Wang
Xiao-Xiao Zhu, Department of Pediatrics, The Second Affiliated Hospital of Nantong University, First People’s Hospital of Nantong City, Nantong 226001, Jiangsu Province, China
Kai-Feng Yao, Li-Hua Wang, Department of Nursing, The Second Affiliated Hospital of Nantong University, First People’s Hospital of Nantong City, Nantong 226001, Jiangsu Province, China
Hai-Yan Huang, Department of Endocrinology, The Second Affiliated Hospital of Nantong University, First People’s Hospital of Nantong City, Nantong 226001, Jiangsu Province, China
Author contributions: Zhu XX and Wang LH designed the research; Zhu XX and Yao KF collected the data; Zhu XX and Huang HY analyzed the data; Zhu XX and Yao KF wrote the paper; Wang LH reviewed the paper.
Supported by Social Development Projects of Nantong, No. MS22021008 and No. QNZ2022005.
Institutional review board statement: The study was approved by the institutional review board of The Second Affiliated Hospital of Nantong University, First People’s Hospital of Nantong City (approval number: 2021KT063).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Hua Wang, MNurs, Chief Nurse, Department of Nursing, The Second Affiliated Hospital of Nantong University, First People’s Hospital of Nantong City, No. 666 Shengli Road, Nantong 226001, Jiangsu Province, China. wlh512512@163.com
Received: August 24, 2023
Peer-review started: August 24, 2023
First decision: November 21, 2023
Revised: December 8, 2023
Accepted: January 24, 2024
Article in press: January 24, 2024
Published online: March 15, 2024
Abstract
BACKGROUND

Type 2 diabetes mellitus (T2DM), a fast-growing issue in public health, is one of the most common chronic metabolic disorders in older individuals. Osteoporosis and sarcopenia are highly prevalent in T2DM patients and may result in fractures and disabilities. In people with T2DM, the association between nutrition, sarcopenia, and osteoporosis has rarely been explored.

AIM

To evaluate the connections among nutrition, bone mineral density (BMD) and body composition in patients with T2DM.

METHODS

We enrolled 689 patients with T2DM for this cross-sectional study. All patients underwent dual energy X-ray absorptiometry (DXA) examination and were categorized according to baseline Geriatric Nutritional Risk Index (GNRI) values calculated from serum albumin levels and body weight. The GNRI was used to evaluate nutritional status, and DXA was used to investigate BMD and body composition. Multivariate forward linear regression analysis was used to identify the factors associated with BMD and skeletal muscle mass index.

RESULTS

Of the total patients, 394 were men and 295 were women. Compared with patients in tertile 1, those in tertile 3 who had a high GNRI tended to be younger and had lower HbA1c, higher BMD at all bone sites, and higher appendicular skeletal muscle index (ASMI). These important trends persisted even when the patients were divided into younger and older subgroups. The GNRI was positively related to ASMI (men: r = 0.644, P < 0.001; women: r = 0.649, P < 0.001), total body fat (men: r = 0.453, P < 0.001; women: r = 0.557, P < 0.001), BMD at all bone sites, lumbar spine (L1-L4) BMD (men: r = 0.110, P = 0.029; women: r = 0.256, P < 0.001), FN-BMD (men: r = 0.293, P < 0.001; women: r = 0.273, P < 0.001), and hip BMD (men: r = 0.358, P < 0.001; women: r = 0.377, P < 0.001). After adjustment for other clinical parameters, the GNRI was still significantly associated with BMD at the lumbar spine and femoral neck. Additionally, a low lean mass index and higher β-collagen special sequence were associated with low BMD at all bone sites. Age was negatively correlated with ASMI, whereas weight was positively correlated with ASMI.

CONCLUSION

Poor nutrition, as indicated by a low GNRI, was associated with low levels of ASMI and BMD at all bone sites in T2DM patients. Using the GNRI to evaluate nutritional status and using DXA to investigate body composition in patients with T2DM is of value in assessing bone health and physical performance.

Keywords: Geriatric Nutrition Risk Index, Bone mineral density, Skeletal muscle mass, Type 2 diabetes

Core Tip: Osteoporosis and sarcopenia are highly prevalent in type 2 diabetes mellitus (T2DM) patients. In people with T2DM, the association between nutrition, sarcopenia, and osteoporosis has rarely been explored. We observed that poor nutrition, as indicated by a low Geriatric Nutritional Risk Index (GNRI), was associated with low levels of ASMI and bone mineral density at all bone sites in T2DM patients. Using the GNRI to evaluate nutritional status and using dual energy X-ray absorptiometry to investigate body composition in patients with T2DM is of value in assessing bone health and physical performance.