{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T03:01:19Z","timestamp":1792119679664,"version":"4.4.0"},"reference-count":54,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Shanghai new three-year action plan for public health","award":["GWVl-11.1-23"],"award-info":[{"award-number":["GWVl-11.1-23"]}]},{"name":"Fudan School of Public Health-Jiading CDC key disciplines and key special projects for the high-quality development of public health","award":["GWGZLXK-2023-02"],"award-info":[{"award-number":["GWGZLXK-2023-02"]}]},{"name":"local high-level discipline construction project of Shanghai and National Key Research and Development Program of China","award":["2017YFC0907000"],"award-info":[{"award-number":["2017YFC0907000"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Both adiposity and nutritional\u2013inflammatory status influence glucose metabolism; however, their longitudinal associations with glycemic changes in non-diabetic populations remain unclear. We examined the independent, interactive, and joint associations of body mass index (BMI) and prognostic nutritional index (PNI) with the 3-year change in HbA1c (\u0394HbA1c). PNI, a composite marker of serum albumin and peripheral lymphocyte count, reflects both protein nutritional status and systemic immune competence. We hypothesized that BMI and PNI would each independently predict \u0394HbA1c and that their joint profiling would identify higher-risk subgroups. Methods: A total of 9414 non-diabetic adults from the Shanghai Suburban Adult Cohort were included. Participants with diabetes at baseline (defined as fasting plasma glucose \u2265 7.0 mmol\/L, 2-h post-load glucose \u2265 11.1 mmol\/L, HbA1c \u2265 6.5%, or self-reported physician diagnosis of diabetes or use of glucose-lowering medications) were excluded. BMI was measured, and PNI was calculated as serum albumin + 5 \u00d7 lymphocyte count. \u0394HbA1c was assessed over a 3-year period. Multivariable linear regression, interaction testing, and joint stratification were performed. Covariate selection was guided by prior biological plausibility, and model adequacy was evaluated using the Akaike Information Criterion (AIC). Results: Both BMI (\u03b2 = 0.013% per kg\/m2, 95% CI: 0.011\u20130.016, p &lt; 0.001) and PNI (\u03b2 = 0.002% per unit, 95% CI: 0.000\u20130.004, p = 0.019) were independently and positively associated with \u0394HbA1c. No significant interaction was observed (p = 0.431). High BMI (\u226524 kg\/m2) was associated with glycemic worsening irrespective of PNI level (\u03b2 \u2248 0.075%, p &lt; 0.001). Among normal-weight individuals, higher PNI was associated with a modest increase in \u0394HbA1c (\u03b2 = 0.031%, p = 0.007). Conclusions: Although the absolute effect sizes were modest at the individual level, BMI was consistently and independently associated with glycemic deterioration therefore, even small per-unit increases may translate into meaningful risk at the population level given the high prevalence of overweight and obesity. PNI showed a small positive association, suggesting that in relatively healthy populations a higher PNI may partly capture subtle pro-glycemic factors\u2014such as low-grade inflammation or higher protein intake\u2014rather than representing unambiguous nutritional benefit. The absence of interaction suggests that BMI and PNI act through largely independent pathways. These findings extend prior evidence by demonstrating that PNI provides modest additional glycemic information beyond BMI in non-diabetic community-dwelling adults, particularly among those of normal weight.<\/jats:p>","DOI":"10.3390\/nu18091459","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T16:54:07Z","timestamp":1777654447000},"page":"1459","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["BMI and Prognostic Nutritional Index Are Independently and Positively Associated with Three Year Glycemic Change in Non-Diabetic Adults: A Community-Based Cohort Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8113-1851","authenticated-orcid":false,"given":"Yuting","family":"Yu","sequence":"first","affiliation":[{"name":"Songjiang District Center for Disease Control and Prevention and Health Inspection, Shanghai 201600, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Chen","sequence":"additional","affiliation":[{"name":"Zhongshan Community Health Center, Shanghai 201613, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Zhongshan Community Health Center, Shanghai 201613, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihua","family":"Jiang","sequence":"additional","affiliation":[{"name":"Sheshan Community Health Center, Shanghai 201602, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunmin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Xinqiao Community Health Center, Shanghai 201612, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoying","family":"Ni","sequence":"additional","affiliation":[{"name":"Maogang Community Health Center, Shanghai 201607, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianguo","family":"Yu","sequence":"additional","affiliation":[{"name":"Zhongshan Community Health Center, Shanghai 201613, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonggen","family":"Jiang","sequence":"additional","affiliation":[{"name":"Songjiang District Center for Disease Control and Prevention and Health Inspection, Shanghai 201600, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.cmet.2023.02.003","article-title":"The Global Burden of Metabolic Disease: Data from 2000 to 2019","volume":"35","author":"Chew","year":"2023","journal-title":"Cell Metab."},{"key":"ref_2","unstructured":"NCD Risk Factor Collaboration (NCD-RisC) (2024). 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