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Pan J, Wu T, Ma JD, Jia PW, Zou YW, Ouyang ZM, Zheng HW, Lin JZ, Zhang Q, Lu Y, Chen LF, Yang ZH, Zhu YY, Song QY, Su Y, Su LW, Dai W, Dai J, Dai L. Geriatric nutrition risk index: a more powerful index identifying muscle mass loss in patients with rheumatoid arthritis. Clin Rheumatol 2024; 43:1299-1310. [PMID: 38433147 DOI: 10.1007/s10067-024-06918-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 11/29/2023] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To explore the association of geriatric nutrition risk index (GNRI), a traditional albumin-body weight calculation, with myopenia in patients with rheumatoid arthritis (RA) and compare its ability to identify myopenia with protein indicators. METHODS This cross-sectional study was carried out based on a Chinese RA cohort. Clinical data and protein indicators (including albumin, globulin, albumin to globulin ratio, prealbumin, hemoglobin) were collected. GNRI was estimated by serum albumin and body weight. Myopenia was indicated as muscle mass loss measured by bioelectric impedance analysis. RESULTS There were 789 RA patients included with mean age 52.6 ± 12.6 years and 77.6% female. There were 41.3%, 18.0%, 27.5%, 13.2% patients with no (GNRI > 98), low (GNRI 92 to ≤ 98), moderate (GNRI 82 to < 92), and major nutrition-related risk (GNRI < 82). There were 406 (51.5%) RA patients with myopenia, RA patients with major nutrition-related risk had the highest prevalence of myopenia (87.5% vs. 73.3% vs. 50.0% vs. 26.1%). Multivariate logistic analysis showed that compared with no risk, RA patients with low (OR = 3.23, 95% CI: 1.86-5.61), moderate (OR = 9.56, 95% CI: 5.70-16.01), and major nutrition-related risk (OR = 28.91, 95% CI: 13.54-61.71) were associated with higher prevalence of myopenia. Receiver operating characteristic curves showed that GNRI (AUC = 0.79) performed a better identifiable ability toward myopenia than serum albumin (AUC = 0.66) or others indicators (AUC range 0.59 to 0.65), respectively. CONCLUSION GNRI, an objective and convenient albumin-weight index, may be preferable for identifying myopenia in RA patients. Key Points • We firstly elucidated the association of GNRI with muscle mass loss among RA patients, and compared its ability to identify muscle mass loss with serum albumin or other protein indicators. • Major nutrition-related risk identified by GNRI showed the highest risk of muscle mass loss, GNRI demonstrated a greater ability to identify myopenia in RA patients. which indicated GNRI was an objective and convenient albumin-weight index to identify myopenia in RA patients.
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Affiliation(s)
- Jie Pan
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, People's Republic of China
| | - Tao Wu
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, People's Republic of China
| | - Jian-Da Ma
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, People's Republic of China
| | - Pei-Wen Jia
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, People's Republic of China
| | - Yao-Wei Zou
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, People's Republic of China
| | - Zhi-Ming Ouyang
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, People's Republic of China
| | - Hu-Wei Zheng
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, People's Republic of China
| | | | - Qian Zhang
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, People's Republic of China
| | - Ye Lu
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, People's Republic of China
| | - Le-Feng Chen
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, People's Republic of China
| | - Ze-Hong Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, People's Republic of China
| | - Ying-Ying Zhu
- Division of Clinical Research Design, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, People's Republic of China
| | - Qing-Yang Song
- Zhongshan School of Medicine, Sun Yat-Sen University, 74 Zhongshan Road II, Guangzhou, Guangdong, People's Republic of China
| | - Yun Su
- Zhongshan School of Medicine, Sun Yat-Sen University, 74 Zhongshan Road II, Guangzhou, Guangdong, People's Republic of China
| | - Lin-Wang Su
- Zhongshan School of Medicine, Sun Yat-Sen University, 74 Zhongshan Road II, Guangzhou, Guangdong, People's Republic of China
| | - Wei Dai
- Department of Biostatistics, School of Public Health, Yale University, College Street, P.O. Box 20803460, New Haven, CT, 06520-0834, USA
| | - Jun Dai
- Department of Public Health, College of Health Sciences, Des Moines University, 8025 Grand Avenue, West Des Moines, IA, 50266, USA.
| | - Lie Dai
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, People's Republic of China.
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Ikenouchi H, Nozue K, Yamaguchi S, Miyamoto T, Yamamoto N, Endo K. Geriatric nutrition risk index predicts prolonged post-stroke dysphagia in acute ischemic stroke. J Stroke Cerebrovasc Dis 2023; 32:107207. [PMID: 37295174 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Post-stroke dysphagia (PSD) is a common complication after stroke. Malnutrition inhibits stroke recovery and is associated with stroke mortality. However, no studies have investigated the effects of nutritional state at admission on prolonged PSD. METHODS We retrospectively analyzed ischemic stroke patients in our institute from January 2018 to December 2020. Swallowing function was assessed using the Food Oral Intake Scale; prolonged PSD was defined as levels 1-3 at 14 days after admission. The Geriatric Nutritional Risk Index (GNRI) was used to assess nutritional risks, which were classified as follows: >98, no nutritional risk; 92-98, mild nutritional risk; 82-92, moderate nutritional risk; and <82, severe nutritional risk. The association between GNRI and prolonged PSD was assessed. RESULTS Of 580 patients (median age, 81 years; male, 53%), prolonged PSD was detected in 117 patients. Patients with severe dysphagia had older age, higher pre-stroke modified Rankin Scale score, lower GNRI, and higher National Institutes of Health Stroke Scale score. Logistic regression analysis revealed that lower GNRI was independently associated with prolonged PSD (continuous value; adjusted odds ratio [OR] 1.03, 95% confidence interval [CI] 1.00-1.05). In addition, when "severe" and "moderate" nutritional risk was analyzed as a single class, moderate or severe nutritional risk (GNRI < 92) was independently associated with prolonged PSD (adjusted OR 2.50, 95% CI 1.29-4.87), compared with no nutritional risk patients (GNRI > 98). CONCLUSIONS In acute ischemic stroke, lower GNRI at admission was independently associated with prolonged PSD, suggesting that GNRI at admission might identify patients at risk of prolonged PSD.
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Affiliation(s)
- Hajime Ikenouchi
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-nagamachi, Taihaku-ku, Sendai, Miyagi 982-8502, Japan.
| | - Kei Nozue
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-nagamachi, Taihaku-ku, Sendai, Miyagi 982-8502, Japan
| | - Satoru Yamaguchi
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-nagamachi, Taihaku-ku, Sendai, Miyagi 982-8502, Japan
| | - Tatsuo Miyamoto
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-nagamachi, Taihaku-ku, Sendai, Miyagi 982-8502, Japan
| | - Naoki Yamamoto
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-nagamachi, Taihaku-ku, Sendai, Miyagi 982-8502, Japan
| | - Kaoru Endo
- Division of Neurology, Sendai City Hospital, 1-1-1 Asuto-nagamachi, Taihaku-ku, Sendai, Miyagi 982-8502, Japan
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Ji Y, Geng N, Niu Y, Zhao H, Fei W, Chen S, Ren LP. Relationship between geriatric nutritional risk index and osteoporosis in type 2 diabetes in Northern China. BMC Endocr Disord 2022; 22:308. [PMID: 36494810 PMCID: PMC9733244 DOI: 10.1186/s12902-022-01215-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Osteoporosis is a very common bone disease in the elderly population and can lead to fractures and disability. Malnutrition can lead to osteoporosis. The geriatric nutritional risk index (GNRI) is a tool used to assess the risk of malnutrition and complications associated with nutritional status in older patients and is a crucial predictor of many diseases. Hence, this study investigated the association between the GNRI and the presence of osteoporosis and assessed the value of this index for predicting osteoporosis in patients with type 2 diabetes mellitus (T2DM). METHODS This cross-sectional study enrolled 610 elderly patients with T2DM. General and laboratory data of the patients were collected, along with their measurements of bone mineral density (BMD). The GNRI was calculated based on ideal body weight and serum albumin (ABL) levels. Correlation analysis was performed to determine the relationship between the GNRI and BMD and bone metabolism indices. The GNRI predictive value for osteoporosis development was analyzed through logistic regression analysis and by creating a receiver operating characteristic curve (ROC), calculating the area under the curve (AUC). RESULTS All patients were divided into the no-nutritional risk and nutritional risk groups. Compared with the no-nutritional risk group, the nutritional risk group had a longer diabetes course, older age, higher HbA1c levels, higher prevalence of osteoporosis; lower BMI, ABL,triglyceride (TG),Calcium (Ca),25-hydroxy-vitamin-D(25(OH)D),and parathyroid hormone(PTH) and lower femoral neck BMD,total hip BMD (P < 0.05). All patients were also assigned to the non-osteoporosis and osteoporosis groups. The non-osteoporosis group had higher GNRI values than the osteoporosis group (P < 0.05). Correlation analysis revealed a positive correlation between the GNRI and lumbar BMD, femoral neck BMD, and total hip BMD (P < 0.05). After the adjustment for confounding factors, Spearman's correlation analysis revealed that the GNRI was positively correlated with Ca, 25(OH)D, and PTH and negatively correlated with alkaline phosphatase (ALP) and procollagen of type-1 N-propeptide (P1NP). Regression analysis exhibited that the GNRI was significantly associated with osteoporosis. The ROC curve analysis was performed using the GNRI as the test variable and the presence of osteoporosis as the status variable. This analysis yielded an AUC for the GNRI of 0.695 and was statistically significant (P < 0.05). CONCLUSIONS A lower GNRI among T2DM patients in northern China is associated with a higher prevalence of osteoporosis.
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Affiliation(s)
- Yuanyuan Ji
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Nan Geng
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yingchun Niu
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Hang Zhao
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Wenjie Fei
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Shuchun Chen
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Lu Ping Ren
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, Hebei, China.
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Kouzu K, Tsujimoto H, Sugasawa H, Ishibashi Y, Hase K, Kishi Y, Ueno H. Modified geriatric nutrition risk index as a prognostic predictor of esophageal cancer. Esophagus 2021; 18:278-87. [PMID: 33170460 DOI: 10.1007/s10388-020-00795-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/23/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study aimed to establish a simple and useful prognostic indicator for elderly esophageal cancer patients. We designed the modified geriatric nutrition risk index (mGNRI) using the inverse of C-reactive protein (CRP) instead of albumin and compared its prognostic value with those of the GNRI and other indices. METHODS We included 128 patients aged > 65 years who underwent esophagectomy for esophageal cancer. We defined mGNRI as (1.489/CRP in mg/dL) + (41.7 × present/ideal body weight) and divided patients into two groups: the low-mGNRI (mGNRI < 70, n = 50) and high-mGNRI (mGNRI ≥ 70, n = 78) groups. We retrospectively examined the relationship between mGNRI and long-term prognosis. RESULTS The low-mGNRI group had more advanced cancer by stage, higher rates of recurrence, and earlier recurrence than the high-mGNRI group. Univariate analysis identified the following factors as significantly associated with poor overall survival (OS): a lower American society of anesthesiologist performance status (ASA-PS), male gender, CRP-albumin ratio ≥ 0.1, CRP ≥ 1.0, low-mGNRI, tumor depth ≥ T3, Charlson comorbidity index ≥ 2, tumor size ≥ 40 mm, and age > 75 years. A low-mGNRI, ASA-PS 3, age > 75 years, and tumor depth ≥ T3 were independent unfavorable prognostic factors for OS. A low-mGNRI was an independent poor prognostic factor for relapse-free survival. We performed model selection analysis to identify the most clinically useful indices; mGNRI was the best predictive model. CONCLUSION mGNRI in patients with esophageal cancer correlated with early recurrence and was a useful independent prognostic factor.
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Qing B, Wang N, Wang L, Li P, Li L, Chen H. Association between geriatric nutrition risk index and bone mineral density in elderly Chinese people. Arch Osteoporos 2021; 16:55. [PMID: 33709189 DOI: 10.1007/s11657-020-00862-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/23/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Malnutrition contributes to the occurrence of osteoporosis. This study showed that participants with higher GNRI values had higher levels of BMD. GNRIs were positively correlated with BMD and independently associated with total hip T-score. GNRIs may be a good indicator for identifying elderly who need further bone health nutritional support. PURPOSE To evaluate the relationship between geriatric nutrition risk index (GNRI) and bone mineral density (BMD) in elderly Chinese people. METHODS We recruited 1130 older adults (60-89 years old) between May 2018 and December 2019. Participants underwent clinical, laboratory, and densitometry examinations. Dual-energy x-ray absorptiometry densitometers and corresponding software were used to assess the BMD and T-scores of participants. Differences between study groups were assessed using one-way analysis of variance (ANOVA) for continuous variables and the chi-square test for categorical variables. Pearson's correlation coefficient was used to assess the correlation between two variables. Multivariate linear regressions with or without adjustments were constructed to explore the possible confounding variables. RESULTS Individuals with higher GNRI values had higher total hip and lumbar spine T-scores (P < 0.001, P = 0.029, respectively). Pearson's correlation demonstrated that GNRIs were positively correlated with BMD at different anatomical sites, in both sexes but especially in women. A multiple regression demonstrated that GNRIs were independently associated with total hip T-score in both sexes (β = 0.111 for men and 0.174 for women; P = 0.034 and 0.008, respectively). CONCLUSIONS Elderly people with higher GNRI values had higher total hip and lumbar spine T-scores, which suggested that GNRI is closely related to BMD. This relationship is maintained at the total hip, even after fully adjusting for possible confounding variables, and consequently, it may be a good indicator for identifying older people who need further bone health nutritional support.
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