Comment on “Atherosclerosis index and diabetic foot ulcers: an NHANES database investigation”
Year: 2026
Type: article
Abstract: To the Editor, Ju et al leverage NHANES (1999–2018) to examine whether four composite “atherosclerosis indices” (AIP, NHHR, LAP, VAI) are associated with diabetic foot ulcers (DFU) among adults with diabetes[1]. This topic is clinically relevant because DFU remains a common, morbid complication with substantial recurrence and amputation risk, and scalable risk stratification tools are still needed[2]. A key strength is the pragmatic use of routinely available metabolic inputs (lipids and anthropometrics), which could facilitate risk enrichment in primary care and population health settings[1]. The consistent directionality across multiple indices also supports the biological plausibility that an atherogenic–visceral adiposity phenotype correlates with DFU risk – compatible with the established role of peripheral arterial disease (PAD) in impaired perfusion and ulcer non-healing[3]. However, several issues temper immediate clinical translation. First, the cross-sectional NHANES design cannot establish temporality; reverse causation is plausible if DFU-related inflammation, immobility, or nutritional change worsens lipid/adiposity profiles[1]. Second, DFU ascertainment in large surveys is often questionnaire-based and may inflate prevalence or misclassify chronic wounds – important given the notably high DFU prevalence reported[1]. Third, DFU pathogenesis is multifactorial, and residual confounding is likely without granular measures of neuropathy, objective PAD severity (ABI/toe pressures), prior ulcer history, and preventive foot-care behaviors – drivers emphasized in contemporary DFU epidemiology and guideline frameworks[3,4]. For the field, the most useful next step is to quantify incremental utility: do these indices improve prediction beyond established clinical factors and basic PAD markers, and can they identify patients who benefit from intensified foot surveillance or vascular assessment?[3] This commentary conforms to the TITAN 2025 guideline on transparency and accountable reporting[5].
Source: International Journal of Surgery
Author: Jingjing Zhong
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,450
OpenAlex ID: W7125198689