Search Results (178)

Background: Nutritional indices are increasingly studied as prognostic tools in sepsis, but their comparative value remains uncertain. We conducted a systematic review and meta-analysis to evaluate associations between major nutritional indices and mortality in adult sepsis. Methods: PubMed, Embase, and Web of Science were searched for eligible studies. Pooled odds ratios (ORs), hazard ratios (HRs), and diagnostic accuracy measures were synthesized using random-effects models. Subgroup and sensitivity analyses explored heterogeneity and tested robustness. Results: Twenty-two studies comprising 51,769 patients were included. Higher modified Nutrition Risk in the Critically Ill (mNUTRIC) and Nutrition Risk in the Critically Ill (NUTRIC) scores were associated with increased mortality (OR 3.10, 95% CI 1.39–6.89; OR 4.54, 95% CI 2.13–9.66, respectively). In contrast, a higher Prognostic Nutritional Index (PNI) was consistently associated with lower mortality (OR 0.64, 95% CI 0.50–0.83; HR 0.66, 95% CI 0.54–0.81), and a higher Geriatric Nutritional Risk Index (GNRI) was associated with improved survival (HR 0.66, 95% CI 0.44–0.98). Controlling Nutritional Status (CONUT) showed a non-significant trend toward higher mortality (OR 1.83, 95% CI 0.94–3.54). In diagnostic analyses, mNUTRIC demonstrated better discrimination than PNI (AUC 0.84 vs. 0.74). Heterogeneity in mNUTRIC analyses decreased markedly after stratification by mortality endpoint. Conclusions: Nutritional indices are prognostically informative in sepsis, but performance is context-dependent. mNUTRIC/NUTRIC show stronger short-term signals in ICU cohorts, likely reflecting illness-severity components, and cross-index comparisons remain indirect due to heterogeneous thresholds and endpoints. Full article

Background/Objectives: Sarcopenia—the progressive loss of skeletal muscle mass and function—is a growing public health challenge in ageing populations. Island territories face compounded vulnerabilities due to distinct epidemiological and socio-economic profiles. This study examines sarcopenia risk prevalence among community-dwelling older adults in Tenerife (Canary Islands, Spain) and estimates the economic burden alongside the cost-effectiveness of evidence-based interventions. Methods: A cross-sectional study was conducted among 374 community-dwelling older adults (mean age 80.4 years, SD 4.8; 51.1% female) recruited from primary care health centres across three health zones in Tenerife. Participants were stratified into a control group without established chronic disease-related functional decline (Group 1; n = 274) and a case group with multimorbidity and functional limitations (Group 3; n = 100). Sarcopenia risk was assessed using the SARC-F questionnaire (threshold ≥ 4). A comprehensive geriatric battery—including the Barthel Index, FRAIL scale, MNA-SF, Pfeiffer test, SPPB, handgrip dynamometry, and IPAQ—characterised multidimensional vulnerability. Annual direct and indirect costs were estimated using unit costs from Spanish national health accounts, and intervention cost-effectiveness was modelled using published meta-analytic data. Results: Overall sarcopenia risk prevalence was 36.4% (n = 136; SARC-F ≥ 4), rising to 83.0% in the case group versus 19.3% in controls (OR ≈ 21.5, p < 0.001). Prevalence was 42.1% in males and 30.9% in females. Diabetes was independently associated with elevated risk (44.8% vs. 29.9%; OR 1.90, 95% CI 1.23–2.92; p = 0.003). Health Zone 1 exhibited the highest prevalence (63.0%) versus Zones 2 (23.5%) and 3 (32.8%). Multidimensional vulnerability was pervasive: 28.6% of participants were frail, 75.7% had nutritional compromise, 11.5% showed moderate cognitive impairment, and 89.8% reported low or no physical activity. The estimated annual socio-economic cost of sarcopenia in Tenerife is approximately EUR 88.9 million (Spain nationally: EUR 12.1 billion). Combined exercise–nutrition interventions yield cost-per-QALY ratios of EUR 3800–7000, far below Spain’s EUR 25,000/QALY threshold. Conclusions: Sarcopenia constitutes a major, multidimensionally compounded health burden in Tenerife’s older population, concentrated among frail, diabetic, nutritionally compromised, and physically inactive individuals. The economic case for universal SARC-F screening and multicomponent intervention is compelling, exceeding cost-effectiveness thresholds by a wide margin. Territorial disparities in burden call for equity-oriented, place-based resource allocation within the Canarian health system. Full article

Background: Albania has undergone a rapid demographic transition characterized by pronounced population aging. Comprehensive geriatric assessment—functional performance, validated nutritional screening tools, and systematic evaluation of morbidities—is essential for accurately characterizing frailty and identifying the risk of malnutrition in its early stages. The objective of the present study was to improve the assessment of the health status of Albanian older adults, both community-dwelling and residing in long-term care facilities, by addressing both functional and nutritional components. Methods: This observational study included Albanian older adults aged ≥ 65 years, both institutionalized and community-dwelling. Frailty and nutritional status were assessed using validated questionnaires (Grauer Geriatric Functional Evaluation and Mini Nutritional Assessment—MNA), alongside body composition analysis performed by bioelectrical impedance analysis (BIA). Results: Data for 123 older adults were analyzed (56.9% female; mean age 71.3 ± 7.4 years; 54.5% institutionalized vs. 45.5% community-dwelling). A high prevalence of frailty and multimorbidity was observed, particularly among institutionalized older adults. With regard to nutritional status, marked age-related differences were identified among females, with a pronounced deterioration in those aged over 75 years. Body-composition-derived parameters identified a substantially higher proportion of individuals at risk of malnutrition compared with other conventional anthropometric measures. Low body cell mass index (BCMI) and institutionalization were the factors with the strongest independent associations with frailty (AOR 5.02, 95% CI 1.69–14.87, p = 0.004, and AOR 5.71, 95% CI 1.76–18.54, p = 0.004, respectively), while low BCMI was the only variable associated with an increased risk of malnutrition (AOR 4.88, 95% CI 1.78–13.40, p = 0.002). Conclusions: These exploratory findings suggest that incorporating body composition parameters into geriatric assessment may provide complementary information alongside traditional screening tools to support the development of targeted preventive and therapeutic strategies. Full article

Background: We investigated the prognostic value of nutritional indices in patients with atrial fibrillation (AF) undergoing percutaneous left atrial appendage occlusion (LAAO). Methods: This two-center retrospective study enrolled 151 patients (median age 75, IQR: 69–80) undergoing LAAO. The Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), and Prognostic Nutritional Index (PNI) were calculated preoperatively. Endpoints included all-cause mortality (primary), postoperative bleeding, and stroke. Associations with mortality were analyzed using multivariable Cox regression models. Results: Over a median follow-up of 8 months (IQR: 5–13), 28 patients (18.5%) died. In multivariable analyses (adjusted for age, sex, diabetes, and chronic kidney disease), each 1-point increase in the CONUT score was associated with a higher risk of all-cause mortality (HR 1.196, 95% CI 1.029–1.390; p = 0.020), whereas higher GNRI values were associated with a lower mortality risk (HR 0.956, 95% CI 0.915–0.998; p = 0.042). In contrast, PNI was not associated with mortality (p = 0.993). Nutritional indices did not significantly predict secondary outcomes like bleeding or stroke. Conclusions: These findings suggest that malnutrition is strongly and independently associated with mortality in high-risk AF patients receiving LAAO. The CONUT score demonstrates the most robust association in this population, highlighting the importance of metabolic reserves. Full article

Background: Frailty is a common finding in elderly subjects with severe aortic stenosis (AoS) and a strong predictor of mortality and disability after aortic valve surgery. The atherogenic index of plasma (AIP) is related to different cardiovascular (CV) risk factors, which in turn are correlated to the progression of frailty as well as of AoS. Aim: to analyze the association of AIP with different CV risk factors and frailty scores and its value as a determinant of mortality in older adults with severe AoS. Methods: The association of AIP with a multidimensional assessment of frailty by using Fried criteria and the following indices; timed up-and-go test (TUG) for gait function; Charlson Index (CI), basic activities of daily living (BADL) and instrumental activities of daily living (IADL) for disability; mini–mental state examination for cognitive function evaluation (MMSE); Geriatric Depression Score for mood disorder (GDS); Mini Nutritional Assessment (MNA) for nutritional status was assessed in 102 elderly AoS patients (33 males; mean age 83 ± 6 yrs). Moreover, the relationship between AIP and demographic, lifestyle, traditional CV risk factors and CV mortality was also evaluated. Results: Significant relationships between AIP and glycemia and inflammatory parameters (CRP, ESR and fibrinogen) as well as with troponin I were found. Moreover, AIP significantly correlates with CI, BADL, IADL and MNA. However, the Kaplan–Meier analysis did not show any significant difference for survival rates according to AIP intervals of risk, whereas ejection fraction remained the only significant determinant after multivariate adjustment for mortality at the Cox proportional hazard models analysis in this patient population. Conclusions: Higher AIP is significantly associated with cardiometabolic risk and increased physical dysfunction risk and frailty in AoS pts, evidencing its potential use as a simple biomarker in this clinical setting, although it did not represent a significant determinant for mortality in this population. Full article

Background/Objectives: Autonomy and the ability to live independently are priority goals for older adults and are closely linked to healthy aging and quality of life (QoL). However, nutrition, although a crucial and modifiable determinant, remains undervalued. Cardiovascular diseases are highly prevalent in middle-aged and older adults and increase the risk of functional impairment, burdening the economy and limiting the patient’s autonomy. This study aimed to analyse the quality of life in older adults and its relationship with functional impairment and nutritional status. Methods: This was a cross-sectional study that included 359 patients with a mean age of 71.52 years who were admitted to the National Institute of Gerontology and Geriatrics “Ana Aslan”, between January 2024 and April 2025. Data were collected through interviews, medical records, and standardized instruments, including the Up and Go Test, Tinetti Test, Downton Fall Risk Index, and handgrip strength assessment. Quality of life was assessed using the EQ-5D-5L and the visual analog scale (VAS). Results: Nutritional status assessed using MNA showed significant moderate-to-strong correlations with EQ-5D-5L mobility (r = −0.326, p = 0.007 in the ≥80 years’ group), anxiety/depression (r = −0.544, p < 0.001 in the ≥80 years’ group), self-care (r = −0.271 to −0.311, p < 0.05 in patients over 65), and usual activities (r = −0.294, p = 0.016 in the ≥80 years’ group). In contrast, BMI showed moderate positive correlations with EQ-5D-5L pain/discomfort across all age groups (r = 0.365 to 0.524, p < 0.002). Functional assessment revealed strong negative correlations between EQ-5D-5L mobility and the Tinetti Test (r = −0.583 to −0.728, p < 0.001), with weaker correlations for pain/discomfort and anxiety/depression dimensions. While BMI-EQ-5D-5L pain/discomfort correlations were consistent across age groups, a stronger correlation was observed in the ≥80 years’ group for MNA-EQ-5D-5L anxiety/depression. Conclusions: In this exploratory cross-sectional study, MNA and BMI were associated with different quality of life domains. Lower MNA scores were more frequently associated with anxiety/depression and certain functional domains, particularly in the ≥80 years’ group, whereas higher BMI was more consistently associated with pain/discomfort across age groups. Full article

Background/Objectives: The aim of this study was to identify which pre-radiotherapy (RT) immunonutritional indices best predict mortality and overall survival in geriatric patients with lung cancer (LC). Methods: This retrospective single-center study included LC patients aged ≥ 65 years who underwent RT between August 2020 and December 2024. Clinical records and laboratory data obtained within 14 days before RT were used to calculate immunonutritional indices. Survival and subgroup analyses evaluated prognostic significance. Results: Among the 174 patients included in the study, the median age was 69 years, and the median follow-up after RT was 8 months. Inflammatory indices were higher among non-survivors, whereas nutritional indices were lower (all p < 0.05). The ROC curve analyses identified the Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), and CALLY (CRP–Albumin–Lymphocyte Index) as the strongest predictors of mortality (AUCs > 0.700). In adjusted Cox models, CALLY (HR = 0.652), PNI (HR = 0.939), and GNRI (HR = 0.950) were independently associated with reduced mortality risk. Conclusions: In older adults with LC undergoing RT, pre-treatment immunonutritional indices were independently associated with overall survival. Lower inflammatory burden and higher nutritional scores were linked to improved outcomes. These indices were associated with mortality before RT across LC types, independent of disease stage. Among them, CALLY, PNI, and GNRI showed the strongest associations with mortality, suggesting that these markers may be promising candidates for pre-RT risk assessment. However, further validation in prospective cohorts is required before routine clinical implementation. Full article

Background: Age- and cancer-related sarcopenia and malnutrition are common in older patients with colorectal cancer (CRC) and may negatively influence treatment tolerance and prognosis. However, the comparative prognostic value of post-chemotherapy changes in CT-based body composition parameters at the third lumbar vertebra (L3) and the twelfth thoracic vertebra (T12) levels, and their associations with nutritional indices, remain unclear. This study aimed to examine and compare the prognostic relevance of post-chemotherapy body composition changes at L3 and T12 and to assess their relationship with nutritional indices in older patients with metastatic CRC (mCRC). Methods: This retrospective study included 87 older patients with mCRC. Baseline and ~3-month follow-up CT scans were analyzed at L3 and T12 using 3D Slicer to quantify skeletal muscle index (SMI), subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), visceral-to-subcutaneous fat ratio (VSR), and intramuscular adipose tissue index (IMATI). Changes (Δ) in CT-derived body composition after chemotherapy were calculated as percentage change using ((follow-up − baseline)/baseline) × 100. Prognostic Nutritional Index (PNI) and Geriatric Nutritional Index (GNRI), which are established nutritional assessment tools, were calculated from baseline laboratory/anthropometric data. Agreement between T12 and L3 was assessed, and associations with grade ≥ 3 toxicity, progression-free survival (PFS), and overall survival (OS) were evaluated using multivariable models and ROC analyses. Results: Mean age was 69.0 ± 4.5 years (59 male/28 female), and 26.4% developed grade ≥ 3 adverse events. Over 3 months, mean SMI declined significantly at both L3 (46.7 ± 8.8 → 42.8 ± 9.8 cm²/m²) and T12 (34.6 ± 8.2 → 31.6 ± 8.1 cm²/m²) (p < 0.001 for both), accompanied by decreases in VATI and VSR; T12-IMATI increased significantly. Baseline PNI showed a weak positive correlation with L3-SMI (r = 0.302, p = 0.033), whereas GNRI showed moderate correlations with SMI at L3 (r = 0.502, p < 0.001) and T12 (r = 0.317, p = 0.025) and was associated with longitudinal changes in muscle metrics. T12-SMI consistently yielded lower values than L3-SMI, and agreement varied by compartment (best for SATI; weakest for VSR). Lower GNRI and greater L3-SMI loss were independently associated with grade ≥ 3 toxicity; ΔL3-SMI showed the highest discrimination (AUC = 0.79, 95% CI = 0.69–0.87, p < 0.001; cut-off >5.1% loss). All patients progressed (median PFS 7.6 months); mortality was 82.8% (median follow-up: 25 months). In multivariable analysis, PFS, CRP, GNRI, and ΔL3-SMI remained independently associated with OS. ΔL3-SMI provided the strongest mortality discrimination (AUC = 0.85, 95% CI = 0.74–0.94, p < 0.001; cut-off >10.4% loss), while ΔIMATI was also informative (AUC = 0.71, 95% CI = 0.59–0.82, p = 0.023). Conclusions: In older patients with mCRC, early post-chemotherapy skeletal muscle loss—particularly at the L3 level—showed the strongest prognostic association with severe toxicity and mortality. GNRI provided complementary prognostic information as a marker of baseline immunonutritional reserve. Although T12-derived measurements were correlated with L3-derived values, systematic bias suggests that they should not be interpreted interchangeably for longitudinal risk stratification. Full article

Background: Changes in body composition, such as decreased muscle mass and increased adipose tissue, are significant in older adults, impacting health, functional capacity, and increasing the risk of metabolic diseases, functional decline, and frailty. Bioelectrical Impedance Analysis (BIA) is a non-invasive tool for assessing body composition, including fat-free mass (FFM), skeletal muscle mass (SMM), and fluid distribution (e.g., ECW/TBW ratio). Complementing BIA, the Mini Nutritional Assessment (MNA) serves as a validated tool for identifying malnutrition risk in the elderly. This study aimed to understand the correlation between BIA-derived parameters, MNA scores and clinical outcomes. Methods: This cross-sectional study involved 195 older adults (mean age 72.8 ± 5.4 years), divided into two groups based on body composition profiles determined by cluster analysis. Data collected included demographics, comprehensive BIA parameters (BMI, fat mass, FFM, SMM, ECW/TBW, phase angle), MNA scores, self-assessed health, chronic disease prevalence, frailty index (TFI), and functional limitations (EQ-5D). Statistical analyses included descriptive statistics, t-tests/ANOVA, chi-square tests, Pearson’s/Spearman’s correlations, point-biserial correlations, regression analyses, and ROC curve analysis to compare groups, explore variable relationships, and assess predictive abilities for malnutrition risk. Results: The first group had significantly higher BMI, AFM (AFM), FFM, and SMM, but a lower ECW/TBW ratio compared to Group 2 (N = 115), which was predominantly female and had higher frailty scores. MNA scores showed significant positive correlations with FFM (rho = 0.165, p = 0.021) and SMM (rho = 0.182, p = 0.011), and a negative correlation with ECW/TBW (rho = −0.188, p = 0.008). Higher adiposity (BMI, fat mass) correlated positively with arterial hypertension and obesity. Lower FFM and SMM were negatively correlated with gastroesophageal reflux disease. Skeletal muscle mass (AUC = 0.634, cut-off ≤ 17.3 kg) and ECW/TBW ratio (AUC = 0.626, cut-off ≥ 49.7%) showed modest discriminatory capacity to identify malnutrition risk. Individuals at risk of malnutrition reported greater functional limitations and lower self-assessed health. Numerous BIA parameters, including segmental muscle mass, total body water, phase angle, and impedance values, significantly correlated with MNA scores. Conclusions: The study highlights the importance of body composition analysis, particularly BIA, in correlation with MNA, for assessing nutritional status, functional limitations, and chronic disease associations in older adults. Integrating BIA and MNA into geriatric assessments provides a complementary profile of nutritional and functional vulnerability. Full article

The objective was to evaluate the impact of a 3-month comprehensive rehabilitation program on functional outcomes and caregiver burden in a 73-year-old male with end-stage Parkinson’s disease (PD) following pallidotomy. Baseline evaluation included cardiorespiratory, digestive, and neuromusculoskeletal assessments, complemented by a multidomain geriatric assessment: activities of daily living (Barthel Index), cognition (MoCA), nutrition (MNA), mental health (GDS, UCLA Loneliness Scale), sarcopenia (AWGS criteria), frailty (Clinical Frailty Scale), fatigue (FSS), mobility (De Morton Mobility Index), fall risk (Morse Fall Scale), and caregiver burden (Zarit Burden Interview). The patient then underwent a structured 3-month rehabilitation program consisting of strengthening and flexibility training, cardiopulmonary endurance exercise, functional task practice, and psychological and nutritional counseling, with monthly evaluations. At baseline, the patient presented with generalized rigidity, fatigue, low cardiorespiratory endurance, total ADL dependence, malnutrition, sarcopenia, frailty, loneliness, and high caregiver burden, but intact cognition and mood. After rehabilitation, he achieved short distance walking, improved appetite and weight gain, and reduced scores in Zarit Burden, Fatigue Severity Scale, and MNA. Functional independence (Barthel Index) and respiratory capacity (single-breath count) improved, while frailty and sarcopenia remained stable without progression. In advanced PD, comprehensive rehabilitation can yield meaningful gains in mobility, nutrition, and functional independence while alleviating caregiver burden. Frailty and sarcopenia remain strongly associated with disease progression and highlight the need for sustained multidisciplinary care for both patients and caregivers. Full article

Background: The Index of Cardiac Electrophysiological Balance (ICEB) has emerged as a electrocardiographic marker reflecting the equilibrium between ventricular depolarization and repolarization. Although obesity is known to alter cardiac electrophysiology, the combined influence of body mass index (BMI) and objective nutritional status on ICEB and its heart rate-corrected form (ICEBc) remains insufficiently defined. This study aimed to investigate the associations between BMI categories, nutritional status, and cardiac electrophysiological balance. Methods: This cross-sectional study included 591 adult patients classified as normal-weight, overweight, or obese according to BMI. Electrophysiological assessment of ICEB (QT/QRS) and ICEBc (QTc/QRS) values was calculated from standard 12-lead electrocardiogram recordings. Participants’ nutritional status was analyzed using validated clinical indices such as the Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT), Geriatric Nutritional Risk Index (GNRI) and Hemoglobin–Albumin–Lymphocyte–Platelet (HALP) score. Results: According to the results, both ICEB and ICEBc showed significant differences among BMI categories (p < 0.001). ICEB/ICEBc exhibited a non-linear distribution. The ICEB/ICEBc values were found to be minimum in the normal weight group at 4.22 ± 0.54/4.87 ± 0.66 and maximum in the obese group at 4.27 ± 0.51/4.99 ± 0.59. The ICEB/ICEBc value closest to the optimal physiological limits was found in the overweight group at 4.04 ± 0.53/4.59 ± 0.58. Higher ICEBc quartiles were accompanied by increased GNRI (120.9 ± 13.7, 129 ± 15.1, 130.5 ± 16.3, 131.8 ± 17.6, p < 0.001)and decreased HALP scores (59.7 ± 24.4, 56.1 ± 25.3, 55.2 ± 25.9, 51.1 ± 19.4, p: 0.025). Conclusion: The association between BMI and cardiac electrophysiological balance is non-linear and appears to be modulated by nutritional and inflammatory status. ICEBc may represent a more sensitive marker than ICEB for detecting subtle electrophysiological alterations related to obesity. Full article

Backgrounds/Objectives: Advances in prevention and medical care in the field of cardiology have led to an increase in the number of older patients with heart failure. In this population, assessment of nutritional status is particularly important. However, the prognostic impact of severity-based nutritional assessment at admission remains unclear. We conducted a study to elucidate the impact of malnutrition severity at admission on the prognosis of older patients hospitalized for acute heart failure (AHF). Methods: This study investigated the relationship between the Geriatric Nutritional Risk Index (GNRI) at admission and prognosis in 214 older patients aged ≥65 years who were hospitalized for AHF (mean age, 85 ± 8 years; male, 49%) between 2019 and 2023. GNRI was assessed by dividing patients into four groups: GNRI > 98 as normal (n = 64), 92 ≤ GNRI < 98 as mild risk (n = 54), 82 ≤ GNRI < 92 as moderate risk (n = 66), and GNRI < 82 as severe risk (n = 30). The discriminative performance of GNRI for 1-year all-cause mortality was compared with that of the Controlling Nutritional Status (CONUT) score and the Prognostic Nutritional Index (PNI). Results: During a median follow-up of 356 days, 76 deaths were observed. Worse GNRI categories were associated with older age, underweight, frailty, and anemia. Multivariable Cox proportional hazards models revealed that moderate GNRI risk (hazard ratio (HR), 2.69; 95% confidence interval (CI), 1.34–5.40) and severe GNRI risk (HR, 9.75; 95% CI, 4.30–22.10) were associated with higher all-cause mortality when compared with normal GNRI, along with age (HR per 1-year increase, 1.07; 95% CI, 1.03–1.11). Sensitivity analysis using GNRI as a continuous variable demonstrated similar results; GNRI was inversely associated with all-cause mortality (HR per 1 GNRI increase, 0.92; 95% CI, 0.90–0.95). In a subgroup analysis of age ≥85 years, the inverse association between GNRI and all-cause mortality was consistent. For 1-year all-cause mortality, GNRI showed moderate discrimination (area under the curve (AUC), 0.71; 95% CI, 0.63–0.80). Although the AUC of GNRI was not significantly different from that of the CONUT score or the PNI, GNRI demonstrated significantly better risk reclassification (net reclassification improvement, 0.47 vs. CONUT, p = 0.05; 0.43 vs. PNI, p = 0.02). Conclusions: In older patients with AHF including the oldest-old, nutritional status assessed by the GNRI at admission was predictive of prognosis. The importance of evaluating nutritional status at admission in clinical settings is reaffirmed. Full article

Background/Objectives: To examine the importance of a composite measure incorporating the Geriatric Nutritional Risk Index (GNRI) and total cholesterol (TC), termed TC-GNRI, in predicting pneumonia mortality in community-dwelling aged individuals. Methods: A longitudinal analysis of the Tsurugaya cohort in Japan, including 1124 participants aged 70 years or older, was used for tracking pneumonia-related deaths for an 11-year period. Total cholesterol thresholds were set at 171 mg/dL (males) and 192 mg/dL (females), classified into higher- and lower-groups. GNRI was divided into higher (≥100.64) and lower (<100.64) groups. A combined index (TC-GNRI) was then created by integrating these indices into three levels: high (both values at or above the thresholds), intermediate (one value above and one below), and low (both below). Cox proportional hazards models estimated hazard ratios (HRs) for pneumonia mortality, adjusting for age, gender, smoking, the Timed Up and Go test, %FVC, and tuberculosis, using high groups as references. Results: Kaplan–Meier curves showed that lower total cholesterol and lower GNRI were associated with higher pneumonia mortality than in the respective higher groups. The intermediate- and low-TC-GNRI groups had poorer survival rates than the high group. After adjustment, lower total cholesterol (HR = 3.03, 95% CI 1.41–6.52) and lower GNRI (HR = 2.69, 95% CI 1.21–5.99) were each associated with greater pneumonia mortality than the higher groups. The intermediate- (HR = 2.81, 95% CI 1.18–6.70) and low-TC-GNRI (HR = 6.17, 95% CI 2.15–17.74) groups showed greater pneumonia mortality than the high group. Conclusions: TC-GNRI may provide additional value in indicating pneumonia mortality risk than total cholesterol or GNRI alone. TC-GNRI may be a valuable tool for identifying older adults at particularly high risk of pneumonia mortality. Full article

Background: Osteoporosis is a major complication in older adults with type 2 diabetes mellitus (T2DM). Malnutrition contributes to bone loss, and the Geriatric Nutritional Risk Index (GNRI) has emerged as a simple tool for assessing nutritional status. Evidence on the predictive value of the GNRI for osteoporosis in elderly patients with T2DM remains limited. Objective: To evaluate the association between GNRI scores and osteoporosis and determine its predictive performance in elderly patients with T2DM. Methods: A cross-sectional study was conducted on 200 elderly patients with T2DM attending the internal medicine outpatient clinics at Zagazig university hospitals between January and October 2025. Clinical data, biochemical parameters, and bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip were assessed. GNRI scores were calculated using standard formulas. Participants were classified into osteoporosis and non-osteoporosis groups according to WHO criteria. Correlations and ROC curve analysis were performed to assess the predictive ability of the GNRI in comparison with age, BMI, and serum albumin. Results: Osteoporosis was present in 15% of the cohort. Patients with osteoporosis had significantly lower GNRI scores and lower BMD values at all measured sites (p < 0.05). The GNRI showed significant positive correlations with BMD parameters in both sexes. ROC analysis demonstrated that the GNRI had the highest predictive performance for osteoporosis (AUC = 0.80 for all patients; AUC = 0.85 in males; AUC = 0.77 in females). Optimal GNRI cutoff values were <100.03 for the total sample, <99.10 for males, and <100.3 for females. Conclusions: The GNRI is a valuable and simple clinical tool for predicting osteoporosis in elderly patients with T2DM. Lower GNRI scores are significantly associated with reduced BMD. Incorporating the GNRI into routine assessment may help identify high-risk patients who require early screening and intervention. Full article

Background: Probable sarcopenia, indicated by low handgrip strength, is a prevalent condition among hospitalized older adults and may reflect broader functional and nutritional decline. Methods: We examined differences in nutritional, functional, and cognitive status between Alzheimer’s clinical syndrome (ACS) patients with probable sarcopenia and those without sarcopenia. A cross-sectional analysis was conducted on 194 hospitalized older adults with ACS. Probable sarcopenia was defined using European Working Group on Sarcopenia in Older People (EWGSOP2) handgrip strength thresholds. Results: Patients with probable sarcopenia (n = 137) had significantly lower Mini-Mental State Examination (MMSE) scores, Geriatric Nutritional Risk Index (GNRI), albumin, hemoglobin, and gait speed compared to those without. After age and sex adjustment, MMSE (p = 0.023), GNRI (p = 0.002), hemoglobin (p = 0.022), albumin (p = 0.003), and gait speed (p < 0.001) remained significantly different. In the sex- and age-adjusted multivariable model (adjusted R² = 0.442), higher nutritional risk (β = 0.26, p = < 0.001), lower MMSE scores (β = 0.17, p = 0.029), polypharmacy (β = −4.20, p = 0.002), and slower gait speed (β = 4.12, p = 0.010) were associated with reduced handgrip strength. In the multivariable binary logistic regression model (adjusted for age and sex), moderate or high nutritional risk and slow gait speed emerged as independent predictors of probable sarcopenia, with OR 5.14 (95% CI 1.34–19.75; p = 0.017) and OR 3.13 (95% CI 1.30–7.52; p = 0.011), respectively. Conclusions: Probable sarcopenia in hospitalized older adults with ACS is highly prevalent and is associated with higher nutritional risk, poorer cognitive and physical function, and polypharmacy; its early recognition may help to guide more targeted nutritional and functional interventions. Full article