Relationship between nutritional status and ulcer healing prognosis in patients with diabetic foot ulcers: a single-center retrospective study

doi:10.3877/cma.j.issn.1674-0785.2025.10.001

Abstract

Abstract:

Objective

Diabetic foot ulcer (DFU) is a serious chronic complication of diabetes with a complex healing process influenced by multiple factors. While infection control and lower limb blood supply have received considerable attention, the specific and independent role of nutritional status warrants further investigation. This study aimed to systematically analyze the relationship between the nutritional status of DFU patients and ulcer healing prognosis.

Methods

This single-center retrospective cohort study consecutively enrolled 112 hospitalized patients with Wagner grade 2~4 DFUs between March 2023 and March 2025. Nutritional and metabolic serological indicators at admission were collected, including albumin (Alb), zinc (Zn), iron (Fe), hemoglobin (Hb), and glycated hemoglobin (HbA1c). The patients were divided into a poor healing group and a good healing group based on the wound healing rate after 2 weeks of treatment (threshold: 20%). Univariate and multivariate logistic regression analyses were performed to evaluate the independent association of these indicators with healing outcome after adjusting for confounders including age, gender, ulcer location, AOFAS score, VAS score, length of hospital stay, white blood cell count (WBC), C-reactive protein (CRP) level, and ankle-brachial index (ABI).

Results

Malnutrition and metabolic disorders were common in DFU patients, manifested as hypoalbuminemia (3.35 g/dl), low hemoglobin (10.42 g/dl), low zinc (60.15 μg/dl), and high HbA1c (7.85%). Multivariate logistic regression analysis confirmed that high HbA1c (＞6%; adjusted odds ratio [aOR]=6.84, 95% confidence interval [CI]: 2.78~16.82), low albumin (＜4.25 g/dl; aOR=5.92, 95%CI: 2.42~14.47), and low zinc (＜101 μg/dl; aOR=4.75, 95%CI: 1.52~14.83) were independent risk factors for poor wound healing. A triage risk stratification model based on this "High HbA1c-Low Albumin-Low Zinc" triad showed that the high-risk group had a 28.4-fold increased risk of poor healing.

Conclusion

This study found that malnutrition is common in DFU patients. The "High HbA1c-Low Albumin-Low Zinc" triad is a strong independent predictor of poor wound healing, and its effect is not confounded by key factors such as blood supply and inflammation. The results indicate that in the comprehensive management of DFU, in addition to controlling infection and improving blood supply, active blood glucose control and focused attention on correcting nutritional deficiencies are crucial for promoting wound healing and improving patient prognosis.

Key words: Diabetic foot ulcer, Nutritional status, Wound healing, Retrospective analysis

Zihao Cui, Jian Gao, Yue Yang, Guang Feng, Xiaoye Tuo. Relationship between nutritional status and ulcer healing prognosis in patients with diabetic foot ulcers: a single-center retrospective study[J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(10): 725-732.

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Figures/Tables 9

项目	创面愈合率低于20%（n=56）	创面愈合率高于20%（n=56）	P值
平均年龄（岁， $x ¯$ ±s）	61.12±8.47	60.85±7.91	0.862
性别[例（%）]			0.831
男性	41（73.2）	39（69.6）
女性	15（26.8）	17（30.4）
位置[例（%）]			0.427
左足	20（35.7）	22（39.3）
右足	27（48.2）	29（51.8）
双足	9（16.1）	5（8.9）
平均AOFAS评分（分， $x ¯$ ±s）	71.35±14.12	72.64±14.03	0.538
平均VAS评分（分， $x ¯$ ±s）	3.24±1.21	3.38±1.32	0.589
住院时间（d， $x ¯$ ±s）	14.87±11.15	16.42±12.07	0.501

项目	创面愈合率低于20%（n=56）	创面愈合率高于20%（n=56）	P值
平均年龄（岁， $x ¯$ ±s）	61.12±8.47	60.85±7.91	0.862
性别[例（%）]			0.831
男性	41（73.2）	39（69.6）
女性	15（26.8）	17（30.4）
位置[例（%）]			0.427
左足	20（35.7）	22（39.3）
右足	27（48.2）	29（51.8）
双足	9（16.1）	5（8.9）
平均AOFAS评分（分， $x ¯$ ±s）	71.35±14.12	72.64±14.03	0.538
平均VAS评分（分， $x ¯$ ±s）	3.24±1.21	3.38±1.32	0.589
住院时间（d， $x ¯$ ±s）	14.87±11.15	16.42±12.07	0.501

项目	65岁以下（n=49）	65岁以上（n=63）	P值
HbA1C（%）	8.05±1.49	7.78±1.42	0.341
Hb（g/dl）	11.08±1.83	9.65±2.31	0.018
总蛋白（g/dl）	7.02±0.52	6.91±0.64	0.372
白蛋白（g/dl）	3.51±0.46	3.27±0.57	0.081
Fe（g/dl）	39.87±20.97	32.15±14.08	0.142
Mg（g/dl）	2.11±0.36	2.16±0.27	0.423
Zn（g/dl）	59.74±12.89	60.32±16.84	0.902
VitaminB12（pg/ml）	638.45±568.34	803.72±554.18	0.358
HDL-C（mg/dl）	37.15±12.87	33.52±10.61	0.297
LDL-C（mg/dl）	69.12±35.84	68.05±25.07	0.937
住院时间（d）	11.25±4.71	18.95±14.75	0.019

项目	2周以下	2周以上	P值
HbA1C（%）	8.01±1.71	8.01±1.71	0.423
Hb（g/dl）	10.96±2.27	9.50±1.73	0.018
总蛋白（g/dl）	7.09±0.52	6.78±0.69	0.059
白蛋白（g/dl）	3.54±0.49	3.17±0.53	0.016
Fe（μg/dl）	36.52±18.35	34.28±17.82	0.538
Mg（μg/dl）	2.15±0.33	2.11±0.31	0.497
Zn（μg/dl）	57.20±12.45	63.82±17.88	0.032
VitaminB12（pg/ml）	652.30±515.40	836.90±624.70	0.194
HDL-C（mg/dl）	35.75±8.52	34.72±15.48	0.689
LDL-C（mg/dl）	73.58±32.35	61.30±26.55	0.042
年龄（岁）	58.95±7.92	63.72±8.18	0.048

项目	正常范围	升高	正常	降低	患者数量
HbA1C（%）	4~6	105	7	0	112
Hb（g/dl）	13~17	0	10	102	112
总蛋白（g/dl）	6.6~8.3	0	50	62	112
白蛋白（g/dl）	3.3~5.2	0	41	71	112
Fe（μg/dl）	50~130	0	2	110	112
Mg（μg/dl）	1.5~2.5	7	93	12	112
Zn（μg/dl）	81~121	2	5	105	112
VitaminB12（pg/ml）	200~950	33	75	0	108
HDL-C（mg/dl）	45~75	2	51	59	112
LDL-C（mg/dl）	0~130	105	7	0	112

项目	DFU患者的OR值（95% CI）	正常值
HbA1C（%）	7.85（7.40，8.30）	6
Hb（g/dl）	10.42（9.80，11.04）	15
总蛋白（g/dl）	6.95（6.76，7.14）	7.45
白蛋白（g/dl）	3.35（3.19，3.51）	4.25
Fe（μg/dl）	34.92（29.60，40.24）	125
Mg（μg/dl）	2.12（2.02，2.22）	2.15
Zn（μg/dl）	60.15（55.50，64.80）	101
VitaminB12（pg/ml）	715.30（550.00，880.60）	567
HDL（mg/dl）	35.10（31.60，38.60）	47.5
LDL（mg/dl）	72.50（65.80，79.20）	65

项目	创面愈合率低于20%（n=56）	创面愈合率高于20%（n=56）	P值	OR（95%CI）
HbA1C（＞6%）	46（82.1）	18（32.1）	＜0.001	9.5（4.1，22.3）
Hb（＜15 g/dl）	50（89.3）	27（48.2）	＜0.001	9.3（3.5，24.7）
总蛋白（＜7.45 g/dl）	22（39.3）	9（16.1）	0.006	3.4（1.4，8.3）
白蛋白（＜4.25 g/dl）	39（69.6）	12（21.4）	＜0.001	8.2（3.5，19.2）
Fe（＜125 μg/dl）	54（96.4）	42（75.0）	0.001	8.6（1.8，40.2）
Mg（＜2.15 μg/dl）	4（7.1）	3（5.4）	0.695	1.4（0.3，6.5）
Zn（＜101 μg/dl）	51（91.1）	34（60.7）	＜0.001	6.8（2.0，19.8）
VitaminB12（＞567 pg/ml）	14（25.0）	15（26.8）	0.829	0.9（0.4，2.1）
HDL-C（＜47.5 mg/dl）	48（85.7）	45（80.4）	0.456	1.5（0.5，4.1）
LDL-C（＞130 mg/dl）	4（7.1）	5（8.9）	0.732	0.8（0.2，3.1）

风险等级	例数	愈合不良比例（＜20%）	平均愈合率（%， $x ¯$ ±s）	12周完全愈合率	OR（95%CI）	P值
高风险	43	39（90.7）	15.2±4.8	8（18.6）	28.4（9.6，84.2）	＜0.001
中风险	38	17（44.7）	38.5±10.3	21（55.3）	3.2（1.3，7.8）	0.012
低风险	31	0（0）	64.7±12.1	27（87.1）	1.0	-

风险等级	例数	愈合不良比例（＜20%）	平均愈合率（%， $x ¯$ ±s）	12周完全愈合率	OR（95%CI）	P值
高风险	43	39（90.7）	15.2±4.8	8（18.6）	28.4（9.6，84.2）	＜0.001
中风险	38	17（44.7）	38.5±10.3	21（55.3）	3.2（1.3，7.8）	0.012
低风险	31	0（0）	64.7±12.1	27（87.1）	1.0	-

预测指标	AUC	敏感度（%）	特异度（%）	PPV（%）	NPV（%）	准确率（%）
风险分层模型	0.91	90.7	96.8	90.7	96.8	94.6
单一HbA1C＞6%	0.75	82.1	67.9	71.9	79.2	75.0
单一白蛋白＜4.25 g/dl	0.74	69.6	78.6	76.5	72.0	74.1
单一Zn＜101 μg/dl	0.76	91.1	39.3	60.0	81.5	65.2

变量	调整后比值比（aOR）	95%置信区间	P值
营养与代谢指标
HbA1c（＞6%）	6.84	2.78，16.82	＜0.001
白蛋白（＜4.25 g/dl）	5.92	2.42，14.47	＜0.001
Zn（＜101 μg/dl）	4.75	1.52，14.83	0.007
Hb（＜15 g/dl）	1.95	0.63，6.02	0.248
总蛋白（＜7.45 g/dl）	1.62	0.60，4.36	0.343
铁（＜125 μg/dl）	4.12	0.66，25.68	0.130
临床协变量
年龄（每增加1岁）	1.01	0.96，1.06	0.734
性别（男性vs女性）	1.20	0.50，2.86	0.686
溃疡位置（以左足为参考）
右足	0.89	0.39，2.03	0.782
双足	1.82	0.52，6.34	0.347
AOFAS评分（每增加1分）	0.99	0.96，1.02	0.471
VAS评分（每增加1分）	0.91	0.65，1.27	0.569
住院时间（每增加1 d）	1.02	0.98，1.06	0.365
WBC（每增加1×109/L）	0.08	0.95，1.27	0.346
CRP（每增加1 mg/L）	1.03	1.00，1.06	0.048
ABI（每增加0.1）	0.85	0.62，1.05	0.116

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