Associations between Geriatric Nutrition Risk Index, bone mineral density and body composition in type 2 diabetes patients

Table 1 Comparison of baseline characteristics among type 2 diabetes mellitus patients stratified by tertiles of the Geriatric Nutritional Risk Index

Characteristics	Total (n = 689)	GNRI tertile 1 (n = 230)	GNRI tertile 2 (n = 230)	GNRI tertile 3 (n = 229)	F/H/χ2	P value
Women [n (%)]	295 (42.8)	109 (47.4)	96 (41.7)	90 (39.3)	3.065	0.080
Age (yr)	55.59 ± 10.88	58.02 ± 10.49	56.00 ± 10.84	52.74 ± 10.69	28.071	< 0.001
Height (cm)	166.89 ± 8.24	165.25 ± 7.88	167.10 ± 8.52	168.33 ± 8.06	16.410	< 0.001
Weight (kg)	70.00 (62.00-80.00)	62.00 (56.00-69.00)	71.00 (64.75-78.85)	80.00 (72.75-90.00)	16.636	< 0.001
Diabetes duration (yr)	7.33 ± 6.20	8.96 ± 6.42	7.58 ± 6.44	5.45 ± 5.15	38.741	< 0.001
BMI (kg/m2)	25.39 (23.23-27.78)	22.92 (21.31-24.49)	25.53 (24.20-26.93)	28.28 (26.62-30.47)	19.284	< 0.001
SBP (mmHg)	133.84 ± 15.34	132.96 ± 16.80	133.89 ± 15.98	134.67 ± 12.98	1.420	0.234
DBP (mmHg)	81.00 ± 9.88	79.44 ± 10.19	80.76 ± 9.50	82.79 ± 9.70	13.343	< 0.001
Hypertension [n (%)]	333 (48.3)	112 (48.7)	117 (50.9)	104 (45.4)	0.492	0.483
GNRI (score)	105.61 (99.64-112.01)	97.09 (93.02-99.66)	105.62 (103.73-107.68)	114.25 (112.01-119.37)	27.818	< 0.001
Glucose-lowering therapies [n (%)]
Lifestyle alone	121 (17.6)	31 (13.5)	36 (15.7)	54 (23.6)	8.071	0.004
Insulin treatments	248 (36.0)	102 (44.3)	89 (38.7)	57 (24.9)	18.817	< 0.001
Insulin secretagogues	222 (32.2)	83 (36.1)	78 (33.9)	61 (26.6)	4.681	0.030
Insulin sensitizers	79 (11.5)	25 (10.9)	28 (12.2)	26 (11.4)	0.027	0.870
Metformin	322 (46.7)	88 (38.3)	110 (47.8)	124 (54.1)	11.622	< 0.001
AGIs	105 (15.2)	23 (10.0)	33 (14.3)	49 (21.4)	11.519	< 0.001
DPP-4Is	57 (8.3)	18 (7.8)	23 (10.0)	16 (7.0)	0.105	0.745
SGLT-2Is	93 (13.5)	28 (12.2)	35 (15.2)	30 (13.1)	0.085	0.771
GLP-1RAs	41 (6.0)	3 (1.3)	14 (6.1)	24 (10.5)	17.240	< 0.001
Statins	122 (17.7)	37 (16.1)	45 (19.6)	40 (17.5)	0.151	0.698
Laboratory findings
HbA1c (%)	8.99 ± 1.85	9.50 ± 2.02	8.92 ± 1.63	8.53 ± 1.75	33.073	< 0.001
Albumin (g/L)	38.50 (36.20-41.30)	35.90 (33.88-37.63)	38.60 (37.00-40.60)	41.70 (39.45-44.00)	17.954	< 0.001
Cr (µmol/L)	58.51 ± 21.32	58.22 ± 25.22	57.85 ± 21.58	59.46 ± 16.26	0.386	0.535
UA (µmol/L)	312.68 ± 99.25	279.47 ± 103.09	314.02 ± 89.46	344.68 ± 94.19	53.222	< 0.001
TG (mmol/L)	1.89 (1.18-3.11)	1.46 (0.98-2.33)	1.81 (1.15-2.83)	2.38 (1.58-3.98)	7.626	< 0.001
TC (mmol/L)	4.41 ± 1.06	4.29 ± 1.01	4.33 ± 0.98	4.62 ± 1.15	10.890	0.001
HDL-C (mmol/L)	1.14 ± 0.27	1.15 ± 0.28	1.15 ± 0.25	1.10 ± 0.27	3.679	0.056
LDL-C (mmol/L)	2.81 ± 0.87	2.80 ± 0.88	2.80 ± 0.82	2.84 ± 0.91	0.309	0.578
TBil (µmol/L)	11.21 ± 4.71	10.25 ± 4.60	11.43 ± 4.68	11.95 ± 4.70	15.213	< 0.001
OS (ng/mL)	11.85 ± 3.99	12.06 ± 4.26	11.88 ± 3.89	11.60 ± 3.82	1.508	0.220
β-CTX (ng/mL)	0.45 ± 0.22	0.51 ± 0.25	0.44 ± 0.21	0.41 ± 0.19	25.645	< 0.001
TP1NP (ng/mL)	40.73 ± 14.53	41.00 ± 14.00	40.74 ± 14.66	40.45 ± 14.98	0.165	0.685
DXA parameters (g/cm2)
LS-BMD	0.97 ± 0.16	0.92 ± 0.14	0.99 ± 0.17	0.99 ± 0.15	22.118	< 0.001
FN-BMD	0.77 ± 0.12	0.73 ± 0.12	0.79 ± 0.13	0.81 ± 0.11	53.333	< 0.001
H-BMD	0.91 ± 0.13	0.85 ± 0.12	0.91 ± 0.13	0.95 ± 0.12	83.980	< 0.001
T-BMD	1.10 ± 0.12	1.07 ± 0.12	1.10 ± 0.12	1.12 ± 0.11	21.875	< 0.001
Body composition
Total body fat (%)	31.03 ± 6.56	29.03 ± 6.55	30.80 ± 5.83	33.26 ± 6.62	51.017	< 0.001
Android/gynoid ratio	1.31 ± 0.22	1.23 ± 0.22	1.33 ± 0.21	1.36 ± 0.20	49.682	< 0.001
Fat mass index (kg/m2)	7.53 (6.20-9.09)	6.33 (5.08-7.53)	7.54 (6.44-8.74)	8.91 (7.51-10.75)	13.010	< 0.001
Lean mass index (kg/m2)	16.95 (15.53-18.54)	15.66 (14.44-16.83)	17.11 (15.92-18.39)	18.60 (16.99-19.90)	14.055	< 0.001
ASMI (kg/m2)	7.09 ± 1.17	6.38 ± 0.91	7.09 ± 0.97	7.79 ± 1.1	218.066	< 0.001

BMI: Body mass index; SBP: Systolic/diastolic blood pressure; DBP: Diastolic blood pressure; GNRI: Geriatric nutritional risk index; AGIs: α-glucosidase inhibitors; DPP-4Is: Dipeptidyl peptidase-4 inhibitors; SGLT-2Is: Sodium-glucose cotransporter-2 inhibitors; GLP-1RAs: Glucagon-like peptide-1 receptor agonists; Cr: Creatinine; UA: Uric acid; TG: Triglyceride; TC: Total cholesterol; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; TBil: Total bilirubin; OS: Osteocalcin; β-CTX: β-collagen special sequence; TP1NP: Total type I procollagen N-terminal extension peptide; DXA: Dual energy X-ray absorptiometry; LS-BMD: Lumbar spine (L1-L4) bone mineral density; FN-BMD: Femoral neck bone mineral density; H-BMD: Hip bone mineral density; T-BMD: Total (whole-body) bone mineral density; ASMI: Appendicular skeletal muscle index.

Table 2 Comparison of baseline characteristics among type 2 diabetes mellitus patients stratified by the tertiles of age

Characteristics	Total (n = 689)	Younger1 (n = 219)	Older2 (n = 470)	χ2/t/z	P value
Women [n (%)]	295 (42.8)	111 (50.7)	184 (39.1)	8.120	0.004
Age (yr)	55.59 ± 10.88	43.71 ± 7.23	61.12 ± 7.25	-29.374	< 0.001
Height (cm)	166.89 ± 8.24	167.33 ± 8.55	166.69 ± 8.1	0.951	0.342
Weight (kg)	70.00 (62.00-80.00)	71.00 (62.00-82.00)	70.00 (62.00-80.00)	-1.178	0.239
Diabetes duration (yr)	7.33 ± 6.20	4.44 ± 3.82	8.68 ± 6.62	-10.603	< 0.001
BMI (kg/m2)	25.39 (23.23-27.78)	25.42 (23.11-28.34)	25.39 (23.32-27.55)	-1.001	0.317
SBP (mmHg)	133.84 ± 15.34	128.84 ± 13.78	136.16 ± 15.49	-5.977	< 0.001
DBP (mmHg)	81.00 ± 9.88	81.74 ± 10.15	80.65 ± 9.75	1.342	0.180
Hypertension [n (%)]	333 (48.3)	66 (30.1)	267 (56.8)	42.556	< 0.001
GNRI (score)	105.61 (99.64-112.01)	107.2 (101.18-113.56)	105.09 (98.93-110.98)	-2.880	0.004
Glucose-lowering therapies
Lifestyle alone [n (%)]	121 (17.6)	58 (26.5)	63 (13.4)	17.653	< 0.001
Insulin treatments [n (%)]	248 (36.0)	73 (33.3)	175 (37.2)	0.987	0.321
Insulin secretagogues [n (%)]	222 (32.2)	44 (20.1)	178 (37.9)	21.627	< 0.001
Insulin sensitizers [n (%)]	79 (11.5)	20 (9.1)	59 (12.6)	1.722	1.189
Metformin [n (%)]	322 (46.7)	92 (42.0)	230 (48.9)	2.880	0.090
AGIs [n (%)]	105 (15.2)	29 (13.2)	76 (16.2)	0.992	0.319
DPP-4Is [n (%)]	57 (8.3)	19 (8.7)	38 (8.1)	0.069	0.793
SGLT-2Is [n (%)]	93 (13.5)	26 (11.9)	67 (14.3)	0.727	0.394
GLP-1RAs [n (%)]	41 (6.0)	15 (6.8)	26 (5.5)	0.463	0.496
Statins [n (%)]	122 (17.7)	38 (17.4)	84 (17.9)	0.028	0.868
Laboratory findings
HbA1c (%)	8.99 ± 1.85	8.99 ± 1.9	8.98 ± 1.82	0.075	0.941
Albumin (g/L)	38.50 (36.20-41.30)	39.00 (36.8-41.6)	38.25 (35.8-41)	-2.470	0.014
Cr (µmol/L)	58.51 ± 21.32	52.09 ± 12.75	61.5 ± 23.74	-6.750	< 0.001
UA (µmol/L)	312.68 ± 99.25	317.68 ± 112.65	310.35 ± 92.39	0.903	0.367
TG (mmol/L)	1.89 (1.18-3.11)	1.99 (1.28-3.41)	1.78 (1.15-2.87)	-1.940	0.052
TC (mmol/L)	4.41 ± 1.06	4.5 ± 1.09	4.37 ± 1.04	1.475	0.141
HDL-C (mmol/L)	1.14 ± 0.27	1.09 ± 0.25	1.16 ± 0.27	-3.049	0.002
LDL-C (mmol/L)	2.81 ± 0.87	2.85 ± 0.87	2.79 ± 0.87	0.803	0.422
TBil (µmol/L)	11.21 ± 4.71	10.99 ± 4.28	11.31 ± 4.89	-0.836	0.404
OS (ng/mL)	11.85 ± 3.99	11.93 ± 3.43	11.81 ± 4.23	0.409	0.683
β-CTX (ng/mL)	0.45 ± 0.22	0.47 ± 0.21	0.45 ± 0.23	1.137	0.256
TP1NP (ng/mL)	40.73 ± 14.53	41.58 ± 13.84	40.34 ± 14.84	1.044	0.297
DXA parameters (g/cm2)
LS-BMD	0.97 ± 0.16	1.00 ± 0.14	0.95 ± 0.16	4.126	< 0.001
FN-BMD	0.77 ± 0.12	0.82 ± 0.12	0.75 ± 0.12	6.360	< 0.001
H-BMD	0.91 ± 0.13	0.94 ± 0.12	0.89 ± 0.13	5.441	< 0.001
T-BMD	1.10 ± 0.12	1.13 ± 0.1	1.08 ± 0.12	4.643	< 0.001
Body composition
Total body fat (%)	31.03 ± 6.56	31.76 ± 6.25	30.69 ± 6.68	2.001	0.046
Android/gynoid ratio	1.31 ± 0.22	1.3 ± 0.22	1.31 ± 0.21	-0.107	0.915
Fat mass index (kg/m2)	7.53 (6.20-9.09)	7.94 (6.55-9.26)	7.32 (6.17-8.99)	-2.621	0.009
Lean mass index (kg/m2)	16.95 (15.53-18.54)	17.01 (15.45-18.66)	16.94 (15.56-18.51)	-0.952	0.341
ASMI (kg/m2)	7.09 ± 1.17	7.23 ± 1.31	7.02 ± 1.09	2.026	0.043

¹Men aged < 50 years and women aged < 55 years.

²Men aged ≥ 50 years and postmenopausal women aged ≥ 55 years.

BMI: Body mass index; SBP: Systolic/diastolic blood pressure; DBP: Diastolic blood pressure; GNRI: Geriatric nutritional risk index; AGIs: α-glucosidase inhibitors; DPP-4Is: Dipeptidyl peptidase-4 inhibitors; SGLT-2Is: Sodium-glucose cotransporter-2 inhibitors; GLP-1RAs: Glucagon-like peptide-1 receptor agonists; Cr: Creatinine; UA: Uric acid; TG: Triglyceride; TC: Total cholesterol; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; TBil: Total bilirubin; OS: Osteocalcin; β-CTX: β-collagen special sequence; TP1NP: Total type I procollagen N-terminal extension peptide; DXA: Dual energy X-ray absorptiometry; LS-BMD: Lumbar spine (L1-L4) bone mineral density; FN-BMD: Femoral neck bone mineral density; H-BMD: Hip bone mineral density; T-BMD: Total (whole-body) bone mineral density; ASMI: Appendicular skeletal muscle index.

Table 3 Comparison of baseline characteristics among younger type 2 diabetes mellitus patients

Characteristics	Total (n = 219)	GNRI tertile 1 (n = 63)	GNRI tertile 2 (n = 68)	GNRI tertile 3 (n = 88)	F/H/χ2	P value
Women [n (%)]	111 (50.7)	40 (63.5)	33 (48.5)	38 (43.5)	5.786	0.016
Age (yr)	43.71 ± 7.23	45.87 ± 6.84	43.04 ± 6.45	42.67 ± 7.80	6.880	0.009
Height (cm)	167.33 ± 8.55	164.57 ± 8.13	167.1 ± 8.49	169.48 ± 8.38	12.759	< 0.001
Weight (kg)	71.00 (62.00-82.00)	60.00 (56.00-66.70)	70.00 (64.00-76.85)	83.05 (74.25-93.20)	10.568	< 0.001
Diabetes duration (yr)	4.44 ± 3.82	5.84 ± 3.91	4.82 ± 4.03	3.15 ± 3.14	20.524	< 0.001
BMI (kg/m2)	25.42 (23.11-28.34)	22.72 (21.10-23.88)	25.32 (23.84-26.57)	28.60 (26.97-31.73)	11.641	< 0.001
SBP (mmHg)	128.84 ± 13.78	126.62 ± 13.78	123.6 ± 13.08	134.49 ± 12.31	16.237	< 0.001
DBP (mmHg)	81.74 ± 10.15	80.22 ± 10.41	77.99 ± 7.75	85.72 ± 10.30	14.496	< 0.001
Hypertension [n (%)]	66 (30.1)	17 (27.0)	21 (30.9)	28 (31.8)	0.383	0.536
GNRI (score)	107.2 (101.18-113.56)	97.28 (92.85-99.92)	105.69 (104.20-107.71)	114.90 (112.15-120.21)	15.551	< 0.001
Glucose-lowering therapies [n (%)]
Lifestyle alone	58 (26.5)	14 (22.2)	12 (17.6)	32 (36.4)	4.469	0.035
Insulin treatments	73 (33.3)	28 (44.4)	30 (44.1)	15 (17.0)	13.761	< 0.001
Insulin secretagogues	44 (20.1)	12 (19.0)	18 (26.5)	14 (15.9)	0.382	0.536
Insulin sensitizers	20 (9.1)	6 (9.5)	6 (8.8)	8 (9.1)	0.006	0.936
Metformin	92 (42.0)	20 (31.7)	31 (45.6)	41 (46.6)	2.617	0.106
AGIs	29 (13.2)	6 (9.5)	7 (10.3)	16 (18.2)	11.519	< 0.001
DPP-4Is	19 (8.7)	4 (6.3)	9 (13.2)	6 (6.8)	0.002	0.961
SGLT-2Is	26 (11.9)	11 (17.5)	8 (11.8)	7 (8.0)	3.118	0.077
GLP-1RAs	15 (6.8)	0 (0.0)	5 (7.4)	10 (11.4)	7.234	0.007
Statins	38 (17.4)	12 (19.0)	12 (17.6)	14 (15.9)	0.256	0.613
Laboratory findings
HbA1c (%)	8.99 ± 1.9	9.58 ± 2.26	9.07 ± 1.66	8.52 ± 1.69	12.151	0.001
Albumin (g/L)	39.00 (36.8-41.6)	36.20 (34.60-37.90)	39.15 (37.20-40.75)	41.60 (39.00-44.23)	9.497	< 0.001
Cr (µmol/L)	52.09 ± 12.75	48.4 ± 13.54	51.31 ± 10.27	55.35 ± 13.2	11.693	0.001
UA (µmol/L)	317.68 ± 112.65	270.22 ± 140.24	313.84 ± 90.09	354.62 ± 92.24	22.682	< 0.001
TG (mmol/L)	1.99 (1.28-3.41)	1.50 (0.98-2.02)	2.03 (1.12-3.52)	2.46 (1.84-4.42)	5.412	< 0.001
TC (mmol/L)	4.5 ± 1.09	4.37 ± 0.94	4.3 ± 0.85	4.75 ± 1.30	5.389	0.021
HDL-C (mmol/L)	1.09 ± 0.25	1.15 ± 0.26	1.08 ± 0.21	1.06 ± 0.26	4.644	0.032
LDL-C (mmol/L)	2.85 ± 0.87	2.92 ± 0.91	2.86 ± 0.79	2.79 ± 0.92	0.850	0.358
TBil (µmol/L)	10.99 ± 4.28	9.78 ± 3.67	11.11 ± 4.15	11.76 ± 4.63	7.855	0.006
OS (ng/mL)	11.93 ± 3.43	12.05 ± 3.14	11.77 ± 3.07	11.98 ± 3.90	0.008	0.931
β-CTX (ng/mL)	0.47 ± 0.21	0.53 ± 0.24	0.45 ± 0.19	0.44 ± 0.20	5.436	0.021
TP1NP (ng/mL)	41.58 ± 13.84	41.95 ± 11.58	40.21 ± 13.02	42.37 ± 15.87	0.075	0.784
DXA parameters (g/cm2)
LS-BMD	1.00 ± 0.14	0.96 ± 0.14	1.01 ± 0.13	1.02 ± 0.15	7.426	0.007
FN-BMD	0.82 ± 0.12	0.77 ± 0.11	0.82 ± 0.12	0.85 ± 0.11	18.433	< 0.001
H-BMD	0.94 ± 0.12	0.88 ± 0.11	0.94 ± 0.11	0.99 ± 0.11	34.357	< 0.001
T-BMD	1.13 ± 0.1	1.1 ± 0.11	1.12 ± 0.09	1.15 ± 0.10	8.681	0.004
Body composition
Total body fat (%)	31.76 ± 6.25	29.85 ± 5.69	31.24 ± 5.90	33.53 ± 6.49	13.922	< 0.001
Android/gynoid ratio	1.3 ± 0.22	1.21 ± 0.22	1.31 ± 0.19	1.37 ± 0.21	22.631	< 0.001
Fat mass index (kg/m2)	7.94 (6.55-9.26)	6.56 (5.61-7.63)	7.89 (6.52-8.88)	9.13 (7.71-11.21)	7.905	< 0.001
Lean mass index (kg/m2)	17.01 (15.45-18.66)	15.25 (14.14-16.62)	16.93 (15.82-18.37)	18.65 (17.26-20.34)	9.380	< 0.001
ASMI (kg/m2)	7.23 ± 1.31	6.23 ± 0.90	7.09 ± 1.00	8.04 ± 1.24	105.442	< 0.001

BMI: Body mass index; SBP: Systolic/diastolic blood pressure; DBP: Diastolic blood pressure; GNRI: Geriatric nutritional risk index; AGIs: α-glucosidase inhibitors; DPP-4Is: Dipeptidyl peptidase-4 inhibitors; SGLT-2Is: Sodium-glucose cotransporter-2 inhibitors; GLP-1RAs: Glucagon-like peptide-1 receptor agonists; Cr: Creatinine; UA: Uric acid; TG: Triglyceride; TC: Total cholesterol; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; TBil: Total bilirubin; OS: Osteocalcin; β-CTX: β-collagen special sequence; TP1NP: Total type I procollagen N-terminal extension peptide; DXA: Dual energy X-ray absorptiometry; LS-BMD: Lumbar spine (L1-L4) bone mineral density; FN-BMD: Femoral neck bone mineral density; H-BMD: Hip bone mineral density; T-BMD: Total (whole-body) bone mineral density; ASMI: Appendicular skeletal muscle index.

Table 4 Comparison of baseline characteristics among older type 2 diabetes mellitus patients

Characteristics	Total (n = 470)	GNRI tertile 1 (n = 167)	GNRI tertile 2 (n = 162)	GNRI tertile 3 (n = 141)	F/H/χ2	P value
Women [n (%)]	184 (39.1)	69 (41.3)	63 (38.9)	52 (36.9)	0.636	0.425
Age (yr)	61.12 ± 7.25	62.6 ± 7.56	61.43 ± 7.01	59.02 ± 6.70	18.962	< 0.001
Height (cm)	166.69 ± 8.1	165.5 ± 7.80	167.1 ± 8.55	167.62 ± 7.79	5.425	0.020
Weight (kg)	70.00 (62.00-80.00)	62.00 (57.00-70.00)	72.50 (65.00-80.00)	80.00 (72.00-85.50)	12.768	< 0.001
Diabetes duration (yr)	8.68 ± 6.62	10.13 ± 6.79	8.74 ± 6.90	6.89 ± 5.62	18.945	< 0.001
BMI (kg/m2)	25.39 (23.32-27.55)	23.05 (21.34-24.57)	25.71 (24.33-27.11)	28.01 (26.51-29.75)	15.296	< 0.001
SBP (mmHg)	136.16 ± 15.49	135.35 ± 17.25	138.2 ± 15.13	134.78 ± 13.42	0.049	0.825
DBP (mmHg)	80.65 ± 9.75	79.15 ± 10.12	81.93 ± 9.93	80.96 ± 8.86	2.998	0.084
Hypertension [n (%)]	267 (56.8)	95 (56.9)	96 (59.3)	76 (53.9)	0.237	0.626
GNRI (score)	105.09 (98.93-110.98)	97.09 (93.08-99.55)	105.57 (103.59-107.63)	113.94 (111.77-118.57)	22.930	< 0.001
Glucose-lowering therapies [n (%)]
Lifestyle alone	63 (13.4)	17 (10.2)	24 (14.8)	22 (15.6)	2.019	0.155
Insulin treatments	175 (37.2)	74 (44.3)	59 (36.4)	42 (29.8)	6.938	0.008
Insulin secretagogues	178 (37.9)	71 (42.5)	60 (37.0)	47 (33.3)	2.771	0.096
Insulin sensitizers	59 (12.6)	19 (11.4)	22 (13.6)	18 (12.8)	0.152	0.697
Metformin	230 (48.9)	68 (40.7)	79 (48.8)	83 (58.9)	10.012	0.002
AGIs	76 (16.2)	17 (10.2)	26 (16.0)	33 (23.4)	9.802	0.002
DPP-4Is	38 (8.1)	14 (8.4)	14 (8.6)	10 (7.1)	0.158	0.691
SGLT-2Is	67 (14.3)	17 (10.2)	27 (16.7)	23 (16.3)	2.509	0.113
GLP-1RAs	26 (5.5)	3 (1.8)	9 (5.6)	14 (9.9)	9.636	0.002
Statins	84 (17.9)	25 (15.0)	33 (20.4)	26 (18.4)	0.707	0.400
Laboratory findings
HbA1c (%)	8.98 ± 1.82	9.47 ± 1.93	8.86 ± 1.61	8.54 ± 1.79	21.198	< 0.001
Albumin (g/L)	38.25 (35.8-41)	35.80 (33.50-37.30)	38.40 (36.70-40.60)	41.70 (39.70-44.00)	15.071	< 0.001
Cr (µmol/L)	61.5 ± 23.74	61.93 ± 27.54	60.59 ± 24.35	62.03 ± 17.46	0.000	0.994
UA (µmol/L)	310.35 ± 92.39	282.96 ± 85.27	314.1 ± 89.47	338.47 ± 95.18	29.509	< 0.001
TG (mmol/L)	1.78 (1.15-2.87)	1.42 (0.97-2.44)	1.75 (1.18-2.62)	2.29 (1.41-3.83)	5.347	< 0.001
TC (mmol/L)	4.37 ± 1.04	4.27 ± 1.04	4.34 ± 1.03	4.53 ± 1.04	4.991	0.026
HDL-C (mmol/L)	1.16 ± 0.27	1.15 ± 0.29	1.18 ± 0.26	1.13 ± 0.27	0.348	0.555
LDL-C (mmol/L)	2.79 ± 0.87	2.75 ± 0.87	2.77 ± 0.84	2.87 ± 0.9	1.525	0.218
TBil (µmol/L)	11.31 ± 4.89	10.43 ± 4.91	11.56 ± 4.89	12.06 ± 4.75	8.890	0.003
OS (ng/mL)	11.81 ± 4.23	12.07 ± 4.63	11.93 ± 4.19	11.37 ± 3.76	1.992	0.159
β-CTX (ng/mL)	0.45 ± 0.23	0.5 ± 0.25	0.44 ± 0.22	0.39 ± 0.18	22.076	< 0.001
TP1NP (ng/mL)	40.34 ± 14.84	40.65 ± 14.83	40.96 ± 15.33	39.26 ± 14.33	0.617	0.433
DXA parameters (g/cm2)
LS-BMD	0.95 ± 0.16	0.91 ± 0.15	0.98 ± 0.18	0.97 ± 0.14	12.015	0.001
FN-BMD	0.75 ± 0.12	0.71 ± 0.11	0.77 ± 0.13	0.78 ± 0.10	29.138	< 0.001
H-BMD	0.89 ± 0.13	0.84 ± 0.12	0.9 ± 0.14	0.93 ± 0.11	45.242	< 0.001
T-BMD	1.08 ± 0.12	1.06 ± 0.12	1.09 ± 0.13	1.1 ± 0.11	10.818	0.001
Body composition
Total body fat (%)	30.69 ± 6.68	28.72 ± 6.83	30.62 ± 5.81	33.09 ± 6.71	34.740	< 0.001
Android/gynoid ratio	1.31 ± 0.21	1.24 ± 0.22	1.33 ± 0.21	1.36 ± 0.19	28.386	< 0.001
Fat mass index (kg/m2)	7.32 (6.17-8.99)	6.26 (4.97-7.51)	7.38 (6.42-8.59)	8.70 (7.20-10.56)	10.212	< 0.001
Lean mass index (kg/m2)	16.94 (15.56-18.51)	15.82 (14.71-17.03)	17.17 (15.92-18.43)	18.56 (16.77-19.81)	10.488	< 0.001
ASMI (kg/m2)	7.02 ± 1.09	6.44 ± 0.91	7.09 ± 0.97	7.63 ± 1.08	112.733	< 0.001

BMI: Body mass index; SBP: Systolic/diastolic blood pressure; DBP: Diastolic blood pressure; GNRI: Geriatric nutritional risk index; AGIs: α-glucosidase inhibitors; DPP-4Is: Dipeptidyl peptidase-4 inhibitors; SGLT-2Is: Sodium-glucose cotransporter-2 inhibitors; GLP-1RAs: Glucagon-like peptide-1 receptor agonists; Cr: Creatinine; UA: Uric acid; TG: Triglyceride; TC: Total cholesterol; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; TBil: Total bilirubin; OS: Osteocalcin; β-CTX: β-collagen special sequence; TP1NP: Total type I procollagen N-terminal extension peptide; DXA: Dual energy X-ray absorptiometry; LS-BMD: Lumbar spine (L1-L4) bone mineral density; FN-BMD: Femoral neck bone mineral density; H-BMD: Hip bone mineral density; T-BMD: Total (whole-body) bone mineral density; ASMI: Appendicular skeletal muscle index.

Table 5 Multiple linear regression models displaying associations of the Geriatric Nutritional Risk Index with bone mineral density

Models	B (95%CI)	β	t value	P value	Adjusted R2 for model
Lumbar spine BMD
Model 01	0.003 (0.002 to 0.004)	0.186	4.952	< 0.001	0.033
Model 12	-0.002 (-0.004 to 0.000)	-0.113	-1.919	0.055	0.150
Model 23	-0.002 (-0.004 to 0.000)	-0.105	-1.765	0.078	0.153
Model 34	0.040 (0.008 to 0.071)	2.402	2.492	0.013	0.197
Femoral neck BMD
Model 01	0.004 (0.003 to 0.005)	0.281	7.664	< 0.001	0.077
Model 12	-0.001 (-0.002 to 0.000)	-0.071	-1.32	0.187	0.293
Model 23	-0.001 (-0.002 to 0.000)	-0.06	-1.12	0.263	0.306
Model 34	0.027 (0.004 to 0.049)	2.047	2.345	0.019	0.341
Total hip BMD
Model 01	0.005 (0.004 to 0.006)	0.363	10.213	< 0.001	0.131
Model 12	0.000 (-0.002 to 0.001)	-0.034	-0.636	0.525	0.312
Model 23	0.000 (-0.002 to 0.001)	-0.025	-0.477	0.634	0.318
Model 34	0.021 (-0.003 to 0.044)	1.52	1.745	0.082	0.343

¹Unadjusted model.

²Adjusted for age, sex, diabetes duration, hypertension, SBP, DBP, and BMI.

³Additionally adjusted for antidiabetic treatments and statin medications.

⁴Additionally adjusted for HbA1c, Osteocalcin, β-collagen special sequence, total type I procollagen N-terminal extension peptide, albumin, Creatinine, uric acid, triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total bilirubin.

95%CI: 95% confidence interval; BMD: Bone mineral density.

Table 6 Determinants of bone mineral density using multivariate forward linear regression analysis

Factors	B	SE	t value	P value	95%CI
					Lower	Upper
Lumbar spine BMD
Age	-0.002	0.001	-3.754	< 0.001	-0.003	-0.001
Height	0.003	0.001	3.669	< 0.001	0.001	0.005
Diabetes duration	-0.003	0.001	-2.665	0.008	-0.005	-0.001
Albumin	-0.004	0.001	-2.864	0.004	-0.007	-0.001
Cr	0.001	0.000	1.983	0.048	0.000	0.001
β-CTX	-0.089	0.033	-2.724	0.007	-0.153	-0.025
TP1NP	-0.001	0.000	-1.633	0.103	-0.002	0.000
ASMI	-0.040	0.016	-2.449	0.015	-0.072	-0.008
Lean mass index	0.036	0.008	4.498	< 0.001	0.020	0.051
Femoral neck BMD
Age	-0.003	0	-6.8	< 0.001	-0.003	-0.002
Height	0.003	0.001	4.672	< 0.001	0.002	0.004
Diabetes duration	-0.002	0.001	-3.617	< 0.001	-0.004	-0.001
Albumin	-0.003	0.001	-2.698	0.007	-0.005	-0.001
β-CTX	-0.100	0.018	-5.589	< 0.001	-0.135	-0.065
Android/gynoid ratio	-0.045	0.02	-2.259	0.024	-0.084	-0.006
ASMI	0.011	0.012	0.963	0.336	-0.012	0.034
Lean mass index	0.014	0.006	2.457	0.014	0.003	0.025
Total hip BMD
Age	-0.002	0.000	-5.451	< 0.001	-0.003	-0.001
Weight	0.002	0.001	3.142	0.002	0.001	0.003
Diabetes duration	-0.002	0.001	-3.327	0.001	-0.004	-0.001
β-CTX	-0.082	0.019	-4.403	< 0.001	-0.118	-0.045
Android/gynoid ratio	-0.041	0.02	-2.003	0.046	-0.081	-0.001
Lean mass index	0.020	0.003	6.266	< 0.001	0.014	0.026

95%CI: 95% confidence interval; BMD: Bone mineral density; Cr: Creatinine; β-CTX: β-collagen special sequence; TP1NP: Total type I procollagen N-terminal extension peptide; ASMI: Appendicular skeletal muscle index.

Table 7 Determinants of appendicular skeletal muscle index using multivariate forward linear regression analysis

Factors	B	SE	t value	P value	95%CI
					Lower	Upper
Men
Age	-0.012	0.003	-3.721	< 0.001	-0.019	-0.006
Weight	0.019	0.006	2.983	0.003	0.006	0.031
Diabetes duration	-0.014	0.005	-2.587	0.010	-0.025	-0.003
BMI	0.136	0.022	6.238	< 0.001	0.093	0.178
HbA1c	-0.057	0.017	-3.449	0.001	-0.090	-0.025
Women
Age	-0.008	0.003	-2.811	0.005	-0.014	-0.003
Weight	0.066	0.003	20.846	< 0.001	0.059	0.072
Height	-0.030	0.007	-4.491	< 0.001	-0.043	-0.017
TBil	-0.017	0.007	-2.369	0.018	-0.032	-0.003
OS	0.019	0.009	2.147	0.033	0.002	0.037
β-CTX	-0.536	0.175	-3.059	0.002	-0.881	-0.191

95%CI: 95% confidence interval; BMI: Body mass index; TBil: Total bilirubin; OS: Osteocalcin; β-CTX: β-collagen special sequence.