The relationship between geriatric nutritional risk index and cardiovascular disease and all-cause mortality in patients with osteoporosis and osteopenia

Abstract

Background: The correlation between geriatric nutritional risk index (GNRI) and the prognosis of patients with osteoporosis or osteopenia has not been studied. This study aims to explore the relationship between GNRI and the cardiovascular disease (CVD) and all-cause mortality rates in elderly patients with osteoporosis or osteopenia.

Methods: This study included 4756 patients with osteoporosis and osteopenia from five cycles of the National Health and Nutrition Examination Survey (NHANES). We used multivariable Cox regression and subgroup analyses to investigate the correlation between GNRI and mortality rates. The restricted cubic spline analysis was used to assess the dose-response relationship between GNRI and mortality risk. Mediation analysis was conducted to examine the mediating effect of chronic kidney disease on the relationship between nutritional risk and mortality.

Results: During a median follow-up period of 114 months, a total of 1241 deaths (26.09%) occurred, including 300 deaths due to CVD (6.31%). In the fully adjusted Model 3, compared to the no-risk group, the risk group showed significantly increased all-cause mortality risk (HR = 2.05, 95% CI: 1.74-2.40) and CVD mortality risk (HR = 1.88, 95% CI: 1.30-2.71). The restricted cubic spline analysis indicated a non-linear association between GNRI and all-cause mortality risk as well as CVD mortality risk. The mediation analysis results indicated that chronic kidney disease mediates 16.9% of the effect of nutritional risk on all-cause mortality and 25.3% on CVD mortality risk.

Conclusions: GNRI can serve as a predictive factor for all-cause and CVD mortality rates in elderly patients with osteoporosis or osteopenia.

Figure 1

Flow chart of the survey participants. GNRI: geriatric nutritional risk index.

Figure 2

Weighted cumulative hazards of cardiovascular disease mortality (A) and all-cause mortality (B). GNRI: geriatric nutritional risk index.

Figure 3

Restricted cubic spline model. Multivariable adjusted hazard ratios (red solid line) with 95% CI (pink shaded area) for the associations of GNRI with CVD mortality (A) and all-cause mortality (B). Adjusted for age, sex, race, marital status, education level, total cholesterol, high-density lipoprotein cholesterol, smoking status, alcohol consumption, body mass index level, hypertension, diabetes mellitus, chronic kidney disease, congestive heart failure, and coronary heart disease. CVD: cardiovascular disease; GNRI: geriatric nutritional risk index.

Figure 4

Cumulative risk curves for CVD death and competing events. The blue line represents CVD mortality in individuals without nutritional risk, the red line represents CVD mortality in individuals with nutritional risk, the green line represents non-CVD cause mortality in individuals without nutritional risk, and the purple line represents non-CVD cause mortality in individuals with nutritional risk. CVD: cardiovascular disease.

Figure 5

Association of GNRI (category) with risk of all-cause mortality in subgroups. All hazard ratios were adjusted for age, sex, race, marital status, education level, total cholesterol, high-density lipoprotein cholesterol, smoking status, alcohol consumption, body mass index level, hypertension, diabetes mellitus, chronic kidney disease, congestive heart failure, and coronary heart disease, except the stratification factor itself. GNRI: geriatric nutritional risk index.

Figure 6

Association of GNRI (category) with risk of CVD mortality in subgroups. All hazard ratios were adjusted for age, sex, race, marital status, education level, total cholesterol, high-density lipoprotein cholesterol, smoking status, alcohol consumption, body mass index level, hypertension, diabetes mellitus, chronic kidney disease, congestive heart failure, and coronary heart disease, except the stratification factor itself. CVD: cardiovascular disease; GNRI: geriatric nutritional risk index.

Figure 7

The mediating effect of CKD on the relationship between GNRI (category) and all-cause mortality (brown rectangle) or CVD mortality (pink rectangle). Adjusted for age, sex, race, marital status, education level, total cholesterol, high-density lipoprotein cholesterol, smoking status, alcohol consumption, body mass index level, hypertension, diabetes mellitus, CKD, congestive heart failure, and coronary heart disease. CKD: chronic kidney disease; CVD: cardiovascular disease; GNRI: geriatric nutritional risk index.