Association Between Controlling Nutritional Status (CONUT) Score and Retinopathy in Adults With Diabetes Mellitus: An NHANES Analysis

<b>Background:</b> Diabetes mellitus (DM) is a growing global health issue, with diabetic retinopathy (DR) being a significant complication causing vision loss. Whether the Controlling Nutritional Status (CONUT) score is predictive of DR has yet to be understood. <b>Objective:</b> This study is aimed at exploring the relationship between CONUT scores and DR using national health data. <b>Methods:</b> Data from adults aged ≥ 20 years diagnosed with DM were extracted from the National Health and Nutrition Examination Survey (NHANES) database from 2005 to 2016 and analyzed retrospectively. DR was identified based on participants' self-reported physician diagnosis. The CONUT score was calculated from serum albumin, lymphocyte count, and cholesterol levels, obtained from the NHANES lab profiles. Logistic regression analysis was used to determine the relationship between CONUT scores and the presence of DR. All data were analyzed in 2024. <b>Results:</b> Data from 3494 NHANES participants (representing 17,619,250 people in the United States after weighting) were analyzed. After adjusting for relevant confounders, multivariable analysis revealed that each one-point increase in CONUT score was significantly associated with increased odds of DR by 11% (adjusted odds ratio [aOR] = 1.11, confidence interval: 1.02-1.22). Stratified analyses revealed significant associations between CONUT score and DR among patients with a DM duration of ≥ 10 years (aOR = 1.14, 95% CI: 1.03-1.26) and those younger than 60 years (continuous: aOR = 1.19, 95% CI: 1.03-1.37; high vs. low: aOR = 1.57, 95% CI: 1.05-2.35). <b>Conclusions:</b> Poor nutritional status, indicated by higher CONUT scores, is associated with an increased likelihood of DR in adults with DM. The relationship was particularly evident among those with a DM duration of ≥ 10 years and younger than 60 years. These findings highlight the potential of CONUT score assessments as part of comprehensive diabetes care.