Associations Between Controlling Nutritional Status and Allostatic Load With Heart Failure Across Different...

The controlling nutritional status (CONUT) and allostatic load (AL) indices indicate significant correlations with heart failure (HF). Given that depressive status associated with metabolic dysregulation may influence these associations, this research aimed to explore whether depressive status modulates the associations between these two indices and HF.

Data were analyzed from 4632 participants aged ≥20 years in the National Health and Nutrition Examination Survey (NHANES), 2005-2018. After applying weighting (WTINT2YR) to the included data, samples with missing data and those without weighted processing were excluded. Binary logistic regression analysis was then employed to investigate the relationships between CONUT, AL, and HF. Subgroup analysis was performed with depressive status as a stratifying factor, and a restricted cubic spline (RCS) model was used to investigate the presence of linear or non-linear relationships between the two clinical indices and HF. Receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were employed to evaluate the predictive performance of the different models for HF.

Both CONUT and AL were positively correlated with HF in Model 1 (CONUT: odds ratio (OR) = 1.43, 95% confidence interval (CI): 1.25-1.63, p < 0.001; AL: OR = 1.23, 95% CI: 1.14-1.32, p < 0.001) and Model 2 (CONUT: OR = 1.29, 95% CI: 1.12-1.48, p < 0.001; AL: OR = 1.14, 95% CI: 1.05-1.24, p = 0.002). Depressive status was shown to moderate the positive association between CONUT and HF (p for interaction = 0.035). AL was associated with HF in the depressive subgroup (area under the curve (AUC) = 0.6048, 95% CI: 0.5162-0.6934), indicating limited predictive performance of the model. The NRI and IDI values revealed no significant difference in the predictive performance of CONUT and AL in Model 4.

The CONUT and AL indices demonstrated positive associations with HF in the general population. Depressive status is a moderating factor that attenuates the association between CONUT and HF. Meanwhile, CONUT and AL are not effective predictors of HF risk under conditions of depressive status. Therefore, screening for depressive status in individuals with high CONUT and AL indices is important for predicting HF.