Inflammation and nutritional status are increasingly recognized as key contributors to impaired wound healing in diabetes. However, the relationship between inflammation- and nutrition-based indicators and diabetic foot ulcer (DFU) has not been well established. This study investigated these associations.
The cross-sectional analysis included 1,644 participants, including 129 with DFU and 1,515 without. Several biomarkers-neutrophil-to-albumin ratio (NAR), monocyte-to-albumin ratio (MAR), red blood cell distribution width-to-albumin ratio (RAR), hemoglobin-albumin-lymphocyte-platelet (HALP) score, and prognostic nutritional index (PNI)–were significantly associated with DFU prevalence. After adjusting for covariates, individuals in the highest tertile showed increased odds of DFU for NAR (OR = 1.73; 95% CI: 1.09–2.74), MAR (OR = 1.71; 95% CI: 1.05–2.79), and RAR (OR = 4.47; 95% CI: 2.57–7.77) compared with the lowest tertile. Conversely, higher HALP (OR = 0.50; 95% CI: 0.31–0.80) and PNI (OR = 0.42; 95% CI: 0.26–0.67) were associated with lower DFU prevalence. Restricted cubic spline analysis revealed a nonlinear relationship between RAR and DFU prevalence, with an inflection point at 3.83.
Findings from the retrospective clinical study supported these results. Elevated NAR (OR = 4.71; 95% CI: 1.99–11.18), MAR (OR = 2.56; 95% CI: 1.23–5.31), and RAR (OR = 6.15; 95% CI: 2.31–16.41) were positively associated with DFU prevalence, while HALP (OR = 0.93; 95% CI: 0.90–0.97) and PNI (OR = 0.85; 95% CI: 0.78–0.93) showed protective associations.
Overall, higher NAR, MAR, and RAR were linked to increased DFU prevalence, whereas higher HALP and PNI were associated with reduced risk. Among these indicators, RAR demonstrated the strongest predictive ability.
Source: Chen H, Zhou Y, Dai J. Association of inflammation and nutrition-based indicators and diabetic foot ulcers: a cross-sectional study and a retrospective study. Front Endocrinol (Lausanne). 2025 16;16:1654831. doi: 10.3389/fendo.2025.1654831
