Low geriatric nutritional risk index is associated with osteoporosis and fracture risk in patients with chronic liver disease: a cross-sectional study

Abstract

Background: Patients with chronic liver disease (CLD) frequently suffer from malnutrition and bone diseases, both of which heighten the risk of poor clinical outcomes. This study investigated the relationship between geriatric nutritional risk index (GNRI) and osteoporosis or fracture risk using the fracture risk assessment tool (FRAX) in patients with CLD.

Methods: This cross-sectional study included 209 consecutive patients with CLD. The participants were divided into two groups: the all-risk group (GNRI ≤ 98.0) with nutrition-related risk and the no-risk group (GNRI > 98.0) without nutrition-related risk. Osteoporosis was diagnosed according to the World Health Organization criteria. The FRAX was used to estimate the 10-year probabilities of hip fracture (FRAX-HF) and major osteoporotic fracture (FRAX-MOF).

Results: Of the 209 patients, 72 (34.4%) had osteoporosis. The all-risk group had a significantly higher prevalence of osteoporosis than the no-risk group (p < 0.001). Conversely, patients with osteoporosis had significantly lower GNRI than those without osteoporosis (p < 0.001). Multivariate analysis found lower GNRI to be a significant and independent risk factor for osteoporosis (odds ratio [OR], 0.927; p < 0.001) and high fracture risk derived from FRAX (without BMD) (OR, 0.904; p = 0.009). GNRI had a positive correlation with bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip, but a negative correlation with FRAX-HF and FRAX-MOF in the FRAX with and without BMD (p < 0.001 for all). The cutoff value of GNRI for predicting osteoporosis was 104.9, with sensitivity of 0.667 and specificity of 0.657.

Conclusions: The GNRI was significantly associated with osteoporosis and FRAX-derived fracture risk in patients with CLD, suggesting that it could be a simple and useful indicator for the management of bone diseases.

Keywords: Chronic liver disease; Fracture risk; Geriatric nutritional risk index; Osteoporosis.

Fig. 1

Correlations between geriatric nutritional risk index (GNRI) and bone mineral density (BMD). GNRI was significantly correlated with BMD at the (A) lumbar spine (r = 0.268), (B) femoral neck (r = 0.350), and (C) total hip (r = 0.410) (p < 0.001 for all)

Fig. 2

The receiver operating characteristic curve analysis of age and geriatric nutritional risk index (GNRI) for predicting osteoporosis. (A) The cutoff value for age was 72.5 years, with an area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.76, 0.667, 0.723, 0.558, and 0.805, respectively. (B) The cutoff value for GNRI was 104.9, with an AUC, sensitivity, specificity, PPV, and NPV of 0.70, 0.667, 0.657, 0.505, and 0.789, respectively

Fig. 3

Correlations between geriatric nutritional risk index (GNRI) and 10-year probabilities of hip fracture (FRAX-HF) and major osteoporotic fracture (FRAX-MOF). (A) (B) In the FRAX with mineral density (BMD), GNRI was significantly correlated with FRAX-HF (r = − 0.347) and FRAX-MOF (r = − 0.277) (p < 0.001 for both). (C) (D) In the FRAX without BMD, GNRI was significantly correlated with FRAX-HF (r = − 0.436) and FRAX-MOF (r = − 0.345) (p < 0.001 for both). FRAX, fracture risk assessment tool