Altern Ther Health Med. 2023 Jan;29(1):85-89.
Type 2 diabetes (T2D) and osteoporosis are both diseases with a high clinical incidence. Among the population with diabetes, T2D accounts for approximately 90%. With the change in people's eating habits and lifestyles, the incidence rate is gradually increasing.
We aimed to explore the relationship between the change in the Geriatric Nutritional Risk Index (GNRI) and the change in bone metabolism index parameters in elderly male patients with T2D and the occurrence of osteoporosis.
A total of 290 elderly male patients with type 2 diabetes (T2D) diagnosed in North China University of Science and Technology Affiliated Hospital from October 2019 to February 2022 were selected for GNRI evaluation. Of these patients, 148 with a GNRI > 98 (the normal group) and 142 with a GNRI ≤ 98 (the risk group) were selected for the study. The levels of 1,25-hydroxyvitamin D3 [1,25 (OH) 2D3], type 1 collagen N-terminal propeptide (P1NP), serum type 1 collagen C-terminal peptide hinge (S-CTX), osteocalcin (OC) and serum bone alkaline phosphatase (BALP) in the 2 groups were detected and compared. A dual-energy bone mineral density instrument was used to detect the bone mineral density (BMD) in the 2 groups. The logistic regression model was used to analyze the relationship between the occurrence of osteoporosis and indicators such as GNRI, and the receiver operating characteristic (ROC) curve was drawn to analyze the value of GNRI in predicting osteoporosis in elderly patients with T2D.
The 1,25(OH)2D3 and P1NP levels in the risk group were lower than in the normal group, and the serum S-CTX and BALP levels in the risk group were higher than in the normal group; the differences were statistically significant (P <.05). The average BMD values of femoral neck, femur trochanter, Ward triangle and lumbar spine in the risk group were lower than in the normal group; the differences were statistically significant (P < .05). There were 70 patients with osteoporosis in the risk group and 9 patients with osteoporosis in the normal group. The difference in the detection rate of osteoporosis between the 2 groups was statistically significant (χ2 = 68.281; P = .000 < .05). The area under the curve (AUC) value under the ROC curve predicted by the GNRI for osteoporosis in elderly patients with T2D was 0.719, the sensitivity was 51.43% and the specificity was 97.26%. The logistic regression model showed that duration of diabetes, glycated hemoglobin A1c (HbA1c), S-CTX and BALP were independent risk factors for osteoporosis in elderly male patients with T2D (P < .05). Increased 1,25(OH)2D3, ALB and GNRI can reduce the risk for osteoporosis in elderly male patients with T2D (P < .05).
GNRI can reflect the nutritional status of elderly male patients with T2D, which is related to some extent to osteoporosis caused by loss of bone mass.
2 型糖尿病（T2D）和骨质疏松症都是临床发病率较高的疾病。在糖尿病患者中，T2D 约占 90%。随着人们饮食习惯和生活方式的改变，发病率逐渐上升。
探讨老年男性 2 型糖尿病（T2D）患者老年营养风险指数（GNRI）的变化与骨代谢指标参数的变化及骨质疏松症的发生的关系。
选取 2019 年 10 月至 2022 年 2 月在华北理工大学附属医院确诊的 290 例老年男性 2 型糖尿病（T2D）患者进行 GNRI 评估。其中，GNRI>98 者 148 例（正常组），GNRI≤98 者 142 例（风险组）。检测并比较两组患者 1,25-二羟维生素 D3[1,25（OH）2D3]、I 型胶原 N 端前肽（P1NP）、血清 I 型胶原 C 端肽铰链（S-CTX）、骨钙素（OC）和血清骨碱性磷酸酶（BALP）水平。使用双能骨密度仪检测两组患者的骨密度（BMD）。采用 logistic 回归模型分析 GNRI 与骨质疏松发生的关系，并绘制受试者工作特征（ROC）曲线分析 GNRI 对老年 T2D 患者骨质疏松的预测价值。
风险组的 1,25（OH）2D3 和 P1NP 水平低于正常组，S-CTX 和 BALP 水平高于正常组；差异有统计学意义（P<.05）。风险组的股骨颈、股骨转子间、Ward 三角和腰椎 BMD 平均值均低于正常组；差异有统计学意义（P<.05）。风险组中骨质疏松症患者 70 例，正常组中骨质疏松症患者 9 例。两组骨质疏松症检出率比较，差异有统计学意义（χ2=68.281；P=0.000<.05）。ROC 曲线预测老年 T2D 患者骨质疏松的 GNRI 曲线下面积（AUC）值为 0.719，灵敏度为 51.43%，特异度为 97.26%。logistic 回归模型显示，糖尿病病程、糖化血红蛋白 A1c（HbA1c）、S-CTX 和 BALP 是老年男性 T2D 患者骨质疏松的独立危险因素（P<.05）。升高 1,25（OH）2D3、ALB 和 GNRI 可降低老年男性 T2D 患者骨质疏松的风险（P<.05）。
GNRI 可反映老年男性 T2D 患者的营养状况，与一定程度上因骨量丢失引起的骨质疏松症有关。
