{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:14:08Z","timestamp":1786115648772,"version":"build-2736575974"},"reference-count":85,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetic retinopathy (DR) is the predominant cause of vision loss in working-age adults. The glucocentric model cannot fully account for its pathogenesis, and emerging evidence highlights the significant roles of nutritional status and inflammation. However, the precise value of composite nutritional-inflammatory-related indices in DR has yet to be systematically evaluated in diverse ethnic populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This dual-cohort study analyzed data from 3,715 adults with diabetes in NHANES (2005\u20132018) and a hospital-based clinical cohort of 252 type 2 diabetes patients from a tertiary eye center. We systematically examined associations between DR and the prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI), albumin-bilirubin (ALBI) score, and neutrophil percentage-to-albumin ratio (NPAR) using weighted multivariable logistic regression, restricted cubic splines (RCS), and subgroup analyses. Threshold effect analysis identified critical inflection points for nonlinear associations. Three sensitivity analyses were conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the NHANES cohort after multivariable adjustment, the highest versus lowest tertiles of PNI (OR = 0.57; 95% CI: 0.41\u20130.80) and GNRI (OR = 0.56; 95% CI: 0.41\u20130.76) were associated with reduced DR risk, whereas the highest tertiles of ALBI (OR = 1.58; 95% CI: 1.18\u20132.19) and NPAR (OR = 1.37; 95% CI: 1.02\u20131.83) conferred elevated risk, with all relationships demonstrating significant dose\u2013response trends. These associations were corroborated, with even stronger effect sizes, in the hospital-based clinical cohort, where PNI and GNRI declined progressively with increasing DR severity, while ALBI and NPAR rose incrementally. RCS confirmed nonlinear associations between PNI\/GNRI and DR, and threshold effect analyses identified cohort-specific inflection points (NHANES: PNI = 56.00, GNRI = 98.27; clinical cohort: PNI = 42.85, GNRI = 90.39). Subgroup analyses showed stronger protective effects of PNI among overweight\/obese individuals and stronger risk associations for ALBI in women. Sensitivity analyses confirmed the robustness of these findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This dual-cohort study provides robust and cross-ethnic evidence that PNI and GNRI are inversely linked to DR, whereas ALBI and NPAR show positive associations, and the hospital-based clinical cohort further links these indices to DR severity. These findings highlight the utility of these accessible nutritional-inflammatory-related indices as pragmatic tools for DR risk stratification and early warning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1883581","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T04:24:34Z","timestamp":1785990274000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between nutritional\u2011inflammatory status and diabetic retinopathy in adults with diabetes: insights from a US population\u2011based survey and a Chinese hospital\u2011based clinical cohort"],"prefix":"10.3389","volume":"17","author":[{"given":"Jian","family":"Deng","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Aier Eye Hospital, Jinan University","place":["Guangzhou, Guangdong, 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