Correlation Analysis Between the Geriatric Nutritional Risk Index Hip Fracture in Male: Based on the National Health and Nutrition Examination Survey Database

Abstract

Objectives

Hip fractures (HFs) are common in elderly patients and are associated with high mortality rates and functional impairment. Malnutrition has been shown to negatively impact postoperative survival rates in HF patients. However, the relationship between the Geriatric Nutrition Risk Index (GNRI) and the risk of HF remains unclear. This study aims to evaluate the association between GNRI and HF risk, with a particular focus on the elderly male population.

Methods

We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) for the periods 2007–2010, 2013–2014, and 2017–2018. Through multivariate regression analysis, we assessed the association between GNRI and HF and performed stratified and subgroup analyses to further explore this relationship. Additionally, we utilized restricted cubic splines (RCSs) to investigate the potential nonlinear relationship between GNRI and HF risk.

Results

The study found that gender significantly influenced the relationship between GNRI and HF (p for interaction = 0.002). In males, GNRI was significantly negatively associated with the risk of HF (OR < 1, p < 0.05). RCS analysis showed that the relationship between GNRI and HF risk in elderly males might be linearly negative. The critical threshold for GNRI was identified as 104.14, beyond which the risk of HF significantly decreased.

Conclusion

This study demonstrates a linear negative correlation between GNRI and the risk of HF in elderly males, with a GNRI of 104.14 identified as the critical threshold for predicting the risk of hip fractures.

Zusammenfassung

Zielsetzung

Hüftfrakturen (HF) treten oft bei älteren Patienten auf; die Folgen solcher Frakturen reichen von eingeschränkter Beweglichkeit bis hin zur erhöhten Sterblichkeit. Durch Ernährungsmängel werden postoperative Überlebensraten bei HF-Patienten erwiesenermaßen negativ beeinflusst. Der Zusammenhang zwischen dem Geriatric Nutrition Risk Index (GNRI) und dem HF-Risiko bleibt allerdings unklar. Ziel dieser Studie ist es, die Korrelation zwischen dem GNRI und HF zu analysieren, wobei der Schwerpunkt insbesondere auf ältere männliche Patienten gelegt wurde.

Methoden

Es wurde eine Querschnittsstudie anhand von Daten aus der NHANES-Erhebung (National Health and Nutrition Examination Survey) aus den Zeiträumen 2007–2010, 2013–2014, und 2017–2018 durchgeführt. Mittels einer multivariaten Regressionsanalyse konnte der Zusammenhang zwischen GNRI und HF untersucht werden, wobei eine stratifizierte sowie eine untergruppenbezogene Analyse diesen Zusammenhang näher erläutern sollten. Eine mögliche nichtlineare Beziehung zwischen dem GNRI und dem HF-Risiko sollte außerdem mittels restriktiver kubischer Splines (RCS) untersucht werden.

Ergebnisse

Als Ergebnis dieser Studie wurde gezeigt, dass das Geschlecht den Zusammenhang zwischen GNRI und HF signifikant beeinflusst (P für Interaktion = 0,002). Bei männlichen Patienten ergab sich eine signifikante Assoziation zwischen GNRI und HF-Risiko (OR < 1; P < 0,05). Durch die RCS-Analyse zeigte sich, dass bei älteren männlichen Patienten der Zusammenhang zwischen dem GNRI und dem HF-Risiko möglicherweise linear-negativ verläuft. Es wurde ein Grenzwert von 104,14 für den GNRI ermittelt, oberhalb dessen sich das HF-Risiko deutlich verringert.

Schlussfolgerung

Im Ergebnis dieser Studie zeigte sich eine linear-negative Korrelation zwischen dem GNRI und dem HF-Risiko bei älteren Männern, wobei ein GNRI von 104,14 als kritischer Schwellenwert zur Vorhersage des Hüftfrakturrisikos gilt.

Keywords

Geriatric Nutritional Risk Index - cross-sectional study - gender - hip fracture - National Health and Nutrition Examination Survey - HF

Schlüsselwörter

Geriatrischer Ernährungs-Risiko-Index - Querschnittsstudie - Geschlecht - Hüftfraktur

Publication History

Received: 08 May 2024

Accepted after revision: 13 December 2024

Article published online:
28 January 2025

• References

• 1 Henderson CY, Shanahan E, Butler A. et al. Dedicated orthogeriatric service reduces hip fracture mortality. Ir J Med Sci 2017; 186: 179-184
• 2 Haddad BI, Abu Ali M, Alashkar O. et al. Quality of Life After Hip Fracture Surgery in the Elderly: A Cross-Sectional Study. Cureus 2024; 16: e52631
• 3 Hong S, Han K. The incidence of hip fracture and mortality rate after hip fracture in Korea: A nationwide population-based cohort study. Osteoporos Sarcopenia 2019; 5: 38-43
• 4 Hong S, Han K. Corrigendum to "The incidence of hip fracture and mortality rate after hip fracture in Korea: A nationwide population-based cohort study" [Osteoporos Sarcopenia 5 (2019) 38–43]. Osteoporos Sarcopenia 2019; 5: 102
• 5 Pabich S, Binkley N. Trends in Hip Fracture Mortality in Wisconsin and the United States, 1999–2017. WMJ 2020; 119: 48-51
• 6 Dong Y, Zhang Y, Song K. et al. What was the Epidemiology and Global Burden of Disease of Hip Fractures From 1990 to 2019? Results From and Additional Analysis of the Global Burden of Disease Study 2019. Clin Orthop Relat Res 2023; 481: 1209-1220
• 7 Sing CW, Lin TC, Bartholomew S. et al. Global Epidemiology of Hip Fractures: Secular Trends in Incidence Rate, Post-Fracture Treatment, and All-Cause Mortality. J Bone Miner Res 2023; 38: 1064-1075
• 8 Lewiecki EM, Ortendahl JD, Vanderpuye-Orgle J. et al. Healthcare Policy Changes in Osteoporosis Can Improve Outcomes and Reduce Costs in the United States. JBMR Plus 2019; 3: e10192
• 9 Yao X, Li P, Deng Y. et al. Role of p53 in promoting BMP9‑induced osteogenic differentiation of mesenchymal stem cells through TGF‑beta1. Exp Ther Med 2023; 25: 248
• 10 Meyer AC, Eklund H, Hedstrom M. et al. The ASA score predicts infections, cardiovascular complications, and hospital readmissions after hip fracture – A nationwide cohort study. Osteoporos Int 2021; 32: 2185-2192
• 11 Resnick B, Hebel JR, Gruber-Baldini AL. et al. The impact of body composition, pain and resilience on physical activity, physical function and physical performance at 2 months post hip fracture. Arch Gerontol Geriatr 2018; 76: 34-40
• 12 Oh ES, Sieber FE, Leoutsakos JM. et al. Sex Differences in Hip Fracture Surgery: Preoperative Risk Factors for Delirium and Postoperative Outcomes. J Am Geriatr Soc 2016; 64: 1616-1621
• 13 Han S, Zhao D, Ping P. et al. Prevalence and correlates of malnutrition risk among Chinese centenarians and oldest-old adults. iScience 2023; 26: 107076
• 14 Marshall S, Young A, Bauer J. et al. Malnutrition in Geriatric Rehabilitation: Prevalence, Patient Outcomes, and Criterion Validity of the Scored Patient-Generated Subjective Global Assessment and the Mini Nutritional Assessment. J Acad Nutr Diet 2016; 116: 785-794
• 15 Malafarina V, Reginster JY, Cabrerizo S. et al. Nutritional Status and Nutritional Treatment Are Related to Outcomes and Mortality in Older Adults with Hip Fracture. Nutrients 2018; 10: 555
• 16 Wong AM, Xu BY, Low LL. et al. Impact of malnutrition in surgically repaired hip fracture patients admitted for rehabilitation in a community hospital: A cohort prospective study. Clin Nutr ESPEN 2021; 44: 188-193
• 17 Millrose M, Schmidt W, Krickl J. et al. Influence of Malnutrition on Outcome after Hip Fractures in Older Patients. J Pers Med 2023; 13: 109
• 18 Liao D, Deng Y, Li X. et al. The prognostic effects of the geriatric nutritional risk index on elderly acute kidney injury patients in intensive care units. Front Med (Lausanne) 2023; 10: 1165428
• 19 Hao X, Li D, Zhang N. Geriatric Nutritional Risk Index as a predictor for mortality: a meta-analysis of observational studies. Nutr Res 2019; 71: 8-20
• 20 Polonen S, Tiihonen M, Hartikainen S. et al. Individually Tailored Dietary Counseling among Old Home Care Clients – Effects on Nutritional Status. J Nutr Health Aging 2017; 21: 567-572
• 21 Cabre M, Ferreiro C, Arus M. et al. Evaluation of CONUT for Clinical Malnutrition Detection and Short-Term Prognostic Assessment in Hospitalized Elderly People. J Nutr Health Aging 2015; 19: 729-733
• 22 Bauer JM, Kaiser MJ, Sieber CC. Evaluation of nutritional status in older persons: nutritional screening and assessment. Curr Opin Clin Nutr Metab Care 2010; 13: 8-13
• 23 Zhao H, Xu L, Tang P. et al. Geriatric Nutritional Risk Index and Survival of Patients With Colorectal Cancer: A Meta-Analysis. Front Oncol 2022; 12: 906711
• 24 Kamioka H, Saeki C, Kinoshita A. et al. Low geriatric nutritional risk index predicts poor prognosis in patients with cirrhosis: a retrospective study. Front Nutr 2023; 10: 1269399
• 25 Kotera A. Geriatric Nutritional Risk Index and Controlling Nutritional Status Score can predict postoperative 180-day mortality in hip fracture surgeries. JA Clin Rep 2019; 5: 62
• 26 Funahashi H, Morita D, Iwase T. et al. Usefulness of nutritional assessment using Geriatric Nutritional Risk Index as an independent predictor of 30-day mortality after hip fracture surgery. Orthop Traumatol Surg Res 2022; 108: 103327
• 27 Wu J, Liu X, Qin C. et al. Effect of maternal serum albumin level on birthweight and gestational age: an analysis of 39200 singleton newborns. Front Endocrinol (Lausanne) 2024; 15: 1266669
• 28 Wang L, Zhang D, Xu J. Association between the Geriatric Nutritional Risk Index, bone mineral density and osteoporosis in type 2 diabetes patients. J Diabetes Investig 2020; 11: 956-963
• 29 Dai H, Xu J. Preoperative geriatric nutritional risk index is an independent prognostic factor for postoperative survival after gallbladder cancer radical surgery. BMC Surg 2022; 22: 133
• 30 Huang W, Xiao Y, Wang H. et al. Association of geriatric nutritional risk index with the risk of osteoporosis in the elderly population in the NHANES. Front Endocrinol (Lausanne) 2022; 13: 965487
• 31 Yu YH, Cheung WS, Miller DR. et al. Number of teeth is associated with hip fracture and femoral neck bone mineral density in the NHANES. Arch Osteoporos 2021; 16: 105
• 32 Zhang Y, Liu W, Zhang W. et al. Association between blood lead levels and hyperlipidemiais: Results from the NHANES (1999–2018). Front Public Health 2022; 10: 981749
• 33 Wang X, Mukherjee B, Park SK. Associations of cumulative exposure to heavy metal mixtures with obesity and its comorbidities among U.S. adults in NHANES 2003–2014. Environ Int 2018; 121: 683-694
• 34 Zhao Y, Li H. Association of serum vitamin C with liver fibrosis in adults with nonalcoholic fatty liver disease. Scand J Gastroenterol 2022; 57: 872-877
• 35 Li C, Shang S. Relationship between Sleep and Hypertension: Findings from the NHANES (2007–2014). Int J Environ Res Public Health 2021; 18: 7867
• 36 Miao H, Liu Y, Tsai TC. et al. Association Between Blood Lead Level and Uncontrolled Hypertension in the US Population (NHANES 1999–2016). J Am Heart Assoc 2020; 9: e015533
• 37 Zheng XY, Zhou Z, Gao Y. et al. Racial differences and factors associated with low femoral neck bone mineral density: an analysis of NHANES 2005–2014 data. Arch Osteoporos 2021; 16: 9
• 38 Cross MB, Yi PH, Thomas CF. et al. Evaluation of malnutrition in orthopaedic surgery. J Am Acad Orthop Surg 2014; 22: 193-199
• 39 Yu YT, Liu J, Hu B. et al. Expert consensus on the use of human serum albumin in critically ill patients. Chin Med J (Engl) 2021; 134: 1639-1654
• 40 Seidu S, Kunutsor SK, Khunti K. Serum albumin, cardiometabolic and other adverse outcomes: systematic review and meta-analyses of 48 published observational cohort studies involving 1,492,237 participants. Scand Cardiovasc J 2020; 54: 280-293
• 41 Song P, Yang D, Li J. et al. Dynamic serum albumin and outcome of peritoneal dialysis patients: A retrospective study in China. Front Med (Lausanne) 2022; 9: 917603
• 42 Zhang Y, Kong FF, Zhu ZQ. et al. Controlling Nutritional Status (CONUT) score is a prognostic marker in III-IV NSCLC patients receiving first-line chemotherapy. BMC Cancer 2023; 23: 225
• 43 Ignacio de Ulíbarri J, González-Madroño A, de Villar NG. et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp 2005; 20: 38-45
• 44 Phodhichai T, Satheannoppakao W, Tipayamongkholgul M. et al. Development of a protein energy malnutrition screening tool for older Thais in public residential homes. Public Health Nutr 2022; 25: 565-577
• 45 Leij-Halfwerk S, Verwijs MH, van Houdt S. et al. Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults ≥ 65 years: A systematic review and meta-analysis. Maturitas 2019; 126: 80-89
• 46 Marshall S, Craven D, Kelly J. et al. A systematic review and meta-analysis of the criterion validity of nutrition assessment tools for diagnosing protein-energy malnutrition in the older community setting (the MACRo study). Clin Nutr 2018; 37: 1902-1912
• 47 Markson F, Akuna E, Asemota I. et al. Protein-Energy Malnutrition Is Associated with Worse Outcomes in Patients with Atrial Fibrillation: A Nationwide Analysis. J Innov Card Rhythm Manag 2023; 14: 5538-5545
• 48 Eminovic S, Vincze G, Eglseer D. et al. Malnutrition as predictor of poor outcome after total hip arthroplasty. Int Orthop 2021; 45: 51-56
• 49 Kim JG, Hong JY, Park J. et al. Risk of fracture according to temporal changes of low body weight changes in adults over 40 years: a nationwide population-based cohort study. BMC Public Health 2023; 23: 948
• 50 Rinonapoli G, Pace V, Ruggiero C. et al. Obesity and Bone: A Complex Relationship. Int J Mol Sci 2021; 22: 13662
• 51 Bouillanne O, Morineau G, Dupont C. et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 2005; 82: 777-783
• 52 Ruan GT, Zhang Q, Zhang X. et al. Geriatric Nutrition Risk Index: Prognostic factor related to inflammation in elderly patients with cancer cachexia. J Cachexia Sarcopenia Muscle 2021; 12: 1969-1982
• 53 Cho A, Hong YS, Park HC. et al. Geriatric nutritional risk index is associated with retinopathy in patients with type 2 diabetes. Sci Rep 2022; 12: 11746
• 54 Li Y, Shen J, Hou X. et al. Geriatric nutritional risk index predicts all-cause mortality in the oldest-old patients with acute coronary syndrome: A 10-year cohort study. Front Nutr 2023; 10: 1129978
• 55 Abraham AG, Sun J, Sharma A. et al. The combined effects of age and HIV on the anatomic distribution of cortical and cancellous bone in the femoral neck among men and women. AIDS 2021; 35: 2513-2522
• 56 Meyer I, Morgan SL, Markland AD. et al. Pelvic floor disorder symptoms and bone strength in postmenopausal women. Int Urogynecol J 2020; 31: 1777-1784
• 57 Chun N, Chae H. Problems with Bone Health and the Influencing Factors of Bone Mineral Density in Women across the Life Cycle. Korean J Women Health Nurs 2015; 21: 43-54
• 58 Jackson RD, Wright NC, Beck TJ. et al. Calcium plus vitamin D supplementation has limited effects on femoral geometric strength in older postmenopausal women: the Women’s Health Initiative. Calcif Tissue Int 2011; 88: 198-208
• 59 Fiechtner JJ. Hip fracture prevention. Drug therapies and lifestyle modifications that can reduce risk. Postgrad Med 2003; 114: 22-28
• 60 Sumsion RM, June HM, Cope MR. Measuring Food Insecurity: The Problem with Semantics. Foods 2023; 12: 1816
• 61 Beyene SD. The impact of food insecurity on health outcomes: empirical evidence from sub-Saharan African countries. BMC Public Health 2023; 23: 338
• 62 Kandapan B, Pradhan I, Pradhan J. Food Insecurity and Malnutrition among Indian Older Adults: Findings from Longitudinal Ageing Study in India, 2017–18. J Popul Ageing 2022;
• 63 Grammatikopoulou MG, Gkiouras K, Theodoridis X. et al. Food insecurity increases the risk of malnutrition among community-dwelling older adults. Maturitas 2019; 119: 8-13
• 64 Gkiouras K, Cheristanidis S, Papailia TD. et al. Malnutrition and Food Insecurity Might Pose a Double Burden for Older Adults. Nutrients 2020; 12: 2407
• 65 Cin P, Tanriover O, Yavuzer H. et al. Evaluation of malnutrition status and related risk factors in geriatric outpatient clinic. Nutr Res Pract 2021; 15: 504-515
• 66 Oliphant SS, Ghetti C, McGough 3rd RL. et al. Inpatient procedures in elderly women: an analysis over time. Maturitas 2013; 75: 349-354
• 67 Amarilla-Donoso FJ, Lopez-Espuela F, Roncero-Martin R. et al. Quality of life in elderly people after a hip fracture: a prospective study. Health Qual Life Outcomes 2020; 18: 71
• 68 Modi A, Sajjan S, Gandhi S. Challenges in implementing and maintaining osteoporosis therapy. Int J Womens Health 2014; 6: 759-769
• 69 Romme EA, Geusens P, Lems WF. et al. Fracture prevention in COPD patients; a clinical 5-step approach. Respir Res 2015; 16: 32
• 70 De Nijs RN. Glucocorticoid-induced osteoporosis: a review on pathophysiology and treatment options. Minerva Med 2008; 99: 23-43