Frontiers in nutrition · 2026
Association of prognostic nutritional index with fecal incontinence and fecal incontinence severity index in individuals with osteoporosis: mediating roles of C-reactive protein and gamma-glutamyl transferase.
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Li Feng, Chen Jianbin, Zhou Longxin, Yang Chaoran, Zhu Zhenxing
Аннотация
BACKGROUND: Malnutrition is increasingly recognized as a contributor to both osteoporosis and gastrointestinal dysfunction. The prognostic nutritional index, derived from serum albumin and lymphocyte counts, reflects nutritional and immune status. However, its association with fecal incontinence in osteoporotic patients remains unexplored.
METHODS: This cross-sectional study included osteoporotic patients from one Chinese tertiary hospital between 2021 and 2025. FI was assessed using the bowel health questionnaire, and severity was quantified by the fecal incontinence severity index (FISI). Multivariable logistic and linear regression models examined associations between PNI, FI, and FISI in osteoporotic patients. Restricted cubic splines assessed dose-response relationships. ROC curves assessed the predictive effect of PNI on fecal incontinence in individuals with osteoporosis. Mediation analyses evaluated the roles of C-reactive protein (CRP) and gamma-glutamyl transferase (GGT).
RESULTS: Among 10,906 osteoporotic patients, FI prevalence was 8.78%. PNI was independently and negatively associated with FI (OR = 0.85; 95% CI: 0.76-0.93) and FISI (β = -0.46; 95% CI: -0.57 to -0.38), with linear dose-response relationships (P for nonlinear > 0.05). PNI demonstrated moderate predictive performance for FI (AUC = 0.723, 95% CI: 0.707-0.739), outperforming alternative malnutrition indices, and it also increased the discriminative predictive capacity (NRI = 0.13, 95% CI: 0.06-0.22; IDI = 0.08, 95% CI: 0.03-0.14). In cross-sectional exploratory mediation analysis, CRP and GGT were associated with these relationships, accounting for 24.2-29.0% and 11.6-17.5% of the total statistical associations, respectively. In addition, the association also remained consistent across subgroups and sensitivity analyses.
CONCLUSION: The PNI is independently and linearly associated with FI and its severity in osteoporotic patients, partially mediated by inflammation and oxidative stress. PNI may serve as a useful nutritional indicator to identify at-risk individuals for targeted intervention.
METHODS: This cross-sectional study included osteoporotic patients from one Chinese tertiary hospital between 2021 and 2025. FI was assessed using the bowel health questionnaire, and severity was quantified by the fecal incontinence severity index (FISI). Multivariable logistic and linear regression models examined associations between PNI, FI, and FISI in osteoporotic patients. Restricted cubic splines assessed dose-response relationships. ROC curves assessed the predictive effect of PNI on fecal incontinence in individuals with osteoporosis. Mediation analyses evaluated the roles of C-reactive protein (CRP) and gamma-glutamyl transferase (GGT).
RESULTS: Among 10,906 osteoporotic patients, FI prevalence was 8.78%. PNI was independently and negatively associated with FI (OR = 0.85; 95% CI: 0.76-0.93) and FISI (β = -0.46; 95% CI: -0.57 to -0.38), with linear dose-response relationships (P for nonlinear > 0.05). PNI demonstrated moderate predictive performance for FI (AUC = 0.723, 95% CI: 0.707-0.739), outperforming alternative malnutrition indices, and it also increased the discriminative predictive capacity (NRI = 0.13, 95% CI: 0.06-0.22; IDI = 0.08, 95% CI: 0.03-0.14). In cross-sectional exploratory mediation analysis, CRP and GGT were associated with these relationships, accounting for 24.2-29.0% and 11.6-17.5% of the total statistical associations, respectively. In addition, the association also remained consistent across subgroups and sensitivity analyses.
CONCLUSION: The PNI is independently and linearly associated with FI and its severity in osteoporotic patients, partially mediated by inflammation and oxidative stress. PNI may serve as a useful nutritional indicator to identify at-risk individuals for targeted intervention.