Correlation Between Prognostic Nutritional Index, Glasgow Prognostic Score, and Different Obesity-Related Indices in People with Diabetes or Prediabetes
Authors: Ahrițculesei Roxana-Viorela , Boldeanu Lidia , Vladu Ionela Mihaela , Clenciu Diana , Mitrea Adina , Cîmpeanu Radu Cristian , Mustață Maria-Lorena , Siloși Isabela , Boldeanu Mihail Virgil , Vere Cristin Constantin 
Published: November 2024

Background/Objectives: The prognostic nutritional index (PNI) and Glasgow Prognostic Score (GPS) are associated with patients’ nutritional and immune statuses. One important factor in the pathophysiology of type 2 diabetes mellitus (T2DM) is inflammation. Being present in insulin-target tissues, chronic tissue inflammation has become recognized as a crucial aspect of obesity and type 2 diabetes. This study aimed to compare the PNI and GPS levels of the subjects with T2DM to those of prediabetes (preDM) individuals. Furthermore, the goal was to investigate how these inflammatory markers relate to different types of obesity and whether the combination of PNI, GPS, and obesity-related indices was associated with any particular prognostic variables. Methods: In this study, we enrolled one-hundred patients with newly diagnosed T2DM and one-hundred patients with preDM. Results: Four findings emerged from this observational study. As a first observation, 28% of patients with preDM and 15% of patients with T2DM had a normal weight, while up to 43% of patients with preDM and 60% of patients with T2DM were obese. The second important observation was that the PNI of the T2DM patients was significantly lower than the PNI of the patients with preDM (p < 0.0001). The PNI showed that patients with T2DM had a moderate-to-severe malnutrition status (median value of 38.00). Patients with preDM had a mild-to-moderate malnutrition status (median value of 61.00) at diagnosis. Third, observed in the current study, preDM patients with PNI < 61.00 and T2DM patients with a PNI < 38.00 were associated with significantly higher median values of the waist-to-height ratio (WHtR) (p = 0.041, and p = 0.034, respectively) and body mass index (BMI) (p = 0.016, and p = 0.041, respectively). Fourth, this study also revealed, in the T2DM group, a moderate and statistically significant negative correlation between PNI and weight (rho = −0.322, p = 0.035), waist circumference (WC) (rho = −0.308, p = 0.042), hip circumference (HC) (rho = −0.338, p = 0.039), WHtR (rho = −0.341, p = 0.022), body adiposity index (BAI) (rho = −0.312, p = 0.032), and fasting plasma glucose (FPG) (rho = −0.318, p = 0.029). Additionally, the PNI values expressed a weak negative correlation with BMI (rho = −0.279, p = 0.015), and glycated hemoglobin A1c (HbA1c) (rho = −0.245, p = 0.025). The PNI levels exhibited a single positive correlation, weak but statistically significant, with estimated glomerular filtration rate (eGFR-CKD-EPI) values (rho = 0.263, p = 0.018). Conclusions: The findings of this study regarding the correlations between PNI, GPS, and different obesity-related indices in people with diabetes or prediabetes suggest that these indices, which assess nutritional and inflammatory status, can be used as independent predictor factors associated with the four pillars of DM management (glucose, blood pressure, lipids, and weight control) recommended by the American Diabetes Association (ADA).