Association Between Geriatric Nutritional Risk Index and Frailty in Older Hospitalized Patients

Abstract

Objective

Previous studies have explored the association between malnutrition and frailty, but no study has investigated whether the Geriatric Nutritional Risk Index (GNRI), a simple and objective nutritional risk screening tool, is associated with the frailty of older adults. The study aimed to examine the relationship between nutrition-related risk, as assessed by the GNRI, and frailty among older hospitalized patients.

Methods

A cross-sectional study was conducted in the West China Hospital of Sichuan University with 740 patients aged ≥70 years between March 2016 and Jan 2017. Nutritional and frailty status was evaluated with the GNRI and FRAIL scale, respectively. The adjusted and unadjusted ordinal logistic regression analyses were used to examine the relationship between nutritional risk and frailty. The ability of GNRI in detecting frailty was assessed by receiver operating characteristic (ROC) curve analysis.

Results

The prevalence of low, moderate, and severe nutritional risk among frail patients were 30.1%, 27.6%, and 12.5%, respectively. Ordinal logistic regression analysis showed that malnutrition assessed by the GNRI had a significant association with frailty after adjustment of age, sex, polypharmacy, comorbidity, vision impairment, hearing impairment, cognitive impairment, and depression. In the ROC analysis, the area under the curve for GNRI identifying frailty was 0.698 (95% CI: 0.66–0.74; P<0.001), and the optimal cut-point value was 97.16 (sensitivity: 64.3%; specificity: 66.9%).

Conclusion

Nutrition-related risk screened by the GNRI was independently associated with frailty. The GNRI could be used as a simple tool in detecting nutritional risk and frailty status of older patients.

Keywords:

• frailty
• malnutrition
• Geriatric Nutritional Risk Index
• older people

Acknowledgments

We would like to thank the staff of the Department of Geriatrics Medicine, West China Hospital and all participants for their great contribution. Thanks to Dr Hui Wang (Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, China) for the statistical analyses.

Abbreviations

GNRI, geriatric nutritional risk index; MNA-SF, Mini Nutritional Assessment-Short Form; SPMSQ, Short Portable Mental Status Questionnaire; CCI, Charlson Comorbidity Index; GDS-15, 15-item Geriatric Depression Scale; ROC, receiver operating characteristic; AUC, area under the curve; PPV, positive prediction value; NPV, negative prediction value.

Data Sharing Statement

There are no linked research data sets for this paper. Data will be made available on reasonable request to the corresponding author.

Ethical Approval and Informed Consent

Ethical approval was obtained from the Institutional Review Boards of West China Hospital, Sichuan University (West China Hospital #201440). All participants provided written informed consent prior to the interview.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no conflicts of interest.