Association between Controlling Nutritional Status and Allostatic Load with Heart Failure across Different Depressive States: A Cross-Sectional Study Using NHANES Data

Both the controlling nutritional status (CONUT) and allostatic load (AL) have been established as significant correlations of heart failure (HF). Given that depressive status associated with metabolic dysregulation may modulate these associations, the study aims to investigate the relationships between CONUT, AL, and HF across different depressive states.
This study analyzed data from 4632 participants in the National Health and Nutrition Examination Survey (NHANES) 2005–2018. The predictive performance of CONUT and AL, two clinical indices for HF stratified by depressive status, was assessed across multiple models.
In Model 1/2, both CONUT and AL positively correlated with HF (model1: CONUT: OR [95% CI], 1.434 [1.258–1.634], p < 0.001, AL: 1.226 [1.140–1.318], p < 0.001; model2: CONUT: OR [95% CI], 1.286 [1.119–1.478], p < 0.001, AL: 1.141 [1.048–1.241], p=0.002). Depressive status moderated the association between CONUT and HF (p for interaction = 0.035). The result revealed that AL was significantly associated with HF in the depressive subgroup (AUC, 0.6048 [95% CI, 0.5162–0.6934]). Model 4 showed no significant difference between CONUT, AL, and HF across different depressive states (depression: NRI: –0.0982 [95% CI, –0.1267-0.0794], p=0.0585, IDI: –0.0025 [95% CI, –0.0105-0.0054], p=0.5308; non-depression: NRI: 0.0625 [95% CI, –0.1713-0.2601], p=0.5610, IDI: –0.0030 [95% CI, –0.0217-0.0158], p=0.7569).
CONUT and AL demonstrated positive associations with HF, and the associations could be attenuated by depressive status. It’s necessary to integrate nutritional-metabolic, socio-environmental, and psychiatric factors to optimize the predictive accuracy of HF.