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Background <p>Low muscle reserve combined with excess adiposity is clinically relevant in diabetes, but whether laboratory-based nutritional risk scores differ in their associations with this phenotype remains unclear.</p> Methods <p>This cross-sectional NHANES 2011–2018 analysis included U.S. adults aged 20–59 years with diabetes. The primary outcome was a DXA-defined low-lean-mass obesity phenotype, defined as low appendicular lean mass adjusted for body mass index combined with BMI-defined obesity. The Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) score were analyzed as standardized continuous variables and quartiles using survey-weighted logistic regression.</p> Results <p>Among 1,130 participants, 97 met the phenotype definition. Because poverty-income ratio was missing in 81 participants, 1,049 participants with 87 events contributed to the fully adjusted model. Each 1-standard deviation increase in GNRI was associated with lower odds of the phenotype (OR 0.74, 95% CI 0.57–0.96; <i>P</i> = 0.026), whereas PNI and CONUT were not significantly associated and showed no consistent quartile dose-response patterns. The GNRI association remained inverse when obesity was defined by waist circumference or DXA body-fat percentage, but was attenuated to the null after adjustment for BMI or waist circumference.</p> Conclusions <p>GNRI was more consistently associated with the phenotype than PNI or CONUT. However, attenuation after body-size adjustment and component analyses suggest body-size-related construct overlap. GNRI should be interpreted as a composite albumin/body-size marker rather than an independent nutritional indicator.</p>

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Comparative associations of nutritional risk scores with a DXA-defined low-lean-mass obesity phenotype among U.S. adults aged 20–59 years with diabetes: NHANES 2011–2018

  • 期刊论文

  • 发表日期：

    2026年7月27日

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  • Miao Bai,
  • Tongyuge Yan

摘要

Background

Low muscle reserve combined with excess adiposity is clinically relevant in diabetes, but whether laboratory-based nutritional risk scores differ in their associations with this phenotype remains unclear.

Methods

This cross-sectional NHANES 2011–2018 analysis included U.S. adults aged 20–59 years with diabetes. The primary outcome was a DXA-defined low-lean-mass obesity phenotype, defined as low appendicular lean mass adjusted for body mass index combined with BMI-defined obesity. The Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) score were analyzed as standardized continuous variables and quartiles using survey-weighted logistic regression.

Results

Among 1,130 participants, 97 met the phenotype definition. Because poverty-income ratio was missing in 81 participants, 1,049 participants with 87 events contributed to the fully adjusted model. Each 1-standard deviation increase in GNRI was associated with lower odds of the phenotype (OR 0.74, 95% CI 0.57–0.96; P = 0.026), whereas PNI and CONUT were not significantly associated and showed no consistent quartile dose-response patterns. The GNRI association remained inverse when obesity was defined by waist circumference or DXA body-fat percentage, but was attenuated to the null after adjustment for BMI or waist circumference.

Conclusions

GNRI was more consistently associated with the phenotype than PNI or CONUT. However, attenuation after body-size adjustment and component analyses suggest body-size-related construct overlap. GNRI should be interpreted as a composite albumin/body-size marker rather than an independent nutritional indicator.