2nd Edition of Diabetes and Endocrinology World Conference 2026

Abstract

Diabetic foot (DF) is a severe and debilitating complication of diabetes mellitus, characterized by foot ulcers, infections, and potentially lower limb amputations, which profoundly impairs patients' quality of life and imposes a heavy socioeconomic burden. Non-alcoholic fatty liver disease (NAFLD), a common metabolic disorder closely associated with insulin resistance and systemic inflammation, has been increasingly linked to diabetes and its complications. However, whether NAFLD independently contributes to the development of DF remains unclear, and previous studies lack stratified analyses by sex and age.

Objective: This study aims to investigate whether NAFLD is an independent risk factor for diabetic foot and to explore the underlying metabolic and inflammatory pathways using a retrospective case-control design with stratification by gender and age.

Methods: Data were obtained from clinical records at Xiangya Third Hospital, Central South University, including 1,824 patients with DF and 6,735 control subjects without DF. Propensity score matching (PSM) was performed to balance baseline characteristics between groups. Multivariable logistic regression models were applied to assess the independent association between NAFLD and DF risk, with sequential adjustment for potential confounders. Subgroup analyses were conducted by gender and age. Mediation analyses were performed to examine the potential mediating roles of body weight, lipid profiles, and white blood cell count.

Results: NAFLD was significantly associated with an increased risk of DF, with stronger associations observed in females and individuals aged ≥60 years. Multivariable logistic regression showed that NAFLD was an independent risk factor for DF (OR = 5.002, 95% CI: 2.583–9.685, p < 0.001). Mediation analyses revealed that body weight and white blood cell count partially mediated the NAFLD-DF relationship, suggesting that obesity-related and inflammatory mechanisms may be involved. Subgroup analyses confirmed the robustness of the association across different clinical characteristics.

Conclusion: NAFLD is independently associated with the occurrence of DF, particularly among female and elderly diabetic patients. The mediating effects of body weight and systemic inflammation highlight potential mechanistic pathways. These findings suggest that controlling body weight, improving lipid metabolism, and reducing inflammation may serve as effective strategies to lower the risk of DF in patients with NAFLD.