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. 2025 Jul 15:12:1625281.
doi: 10.3389/fnut.2025.1625281. eCollection 2025.

Geriatric Nutritional Risk Index and mortality in individuals with prediabetes and diabetes: a longitudinal cohort study

Luyao Qiao  1 , Te Li  2 , Jiaxing Peng  1 , Qing Xie  1 , Mengqian Wu  1 , Yanping Li  1 , Zhenyu Tang  1
Affiliations

Geriatric Nutritional Risk Index and mortality in individuals with prediabetes and diabetes: a longitudinal cohort study

Luyao Qiao et al. Front Nutr. .

Abstract

Background: This study examines the relationship between Geriatric Nutrition Risk Index (GNRI) and all-cause and cardiovascular mortality in individuals with prediabetes and diabetes, aiming to guide clinical nutrition management and extend life expectancy.

Methods: We analyzed a weighted sample of 7,640 individuals with prediabetes and diabetes from the NHANES 2005-2018 and the NCI database. Nutritional status was assessed using the GNRI. Survival outcomes, including all-cause and cardiovascular mortality, were analyzed using Cox proportional hazards regression models and Kaplan-Meier survival curves. Subgroup analyses and restricted cubic spline (RCS) regressions were further conducted to evaluate the robustness and potential nonlinear relationships between GNRI and mortality outcomes.

Results: Over a median follow-up of 8.00 years, 1,210 participants died, including 319 from cardiovascular diseases. Kaplan-Meier curves revealed significantly lower survival rates for both mortalities in participants with low GNRI. Fully adjusted COX regression models revealed a 2.50-fold (95% CI: 2.14-2.92, p < 0.001) increased risk of all-cause mortality and a 2.78-fold (95% CI: 2.04-3.77, p < 0.001) increased risk of cardiovascular mortality in the low GNRI group. These associations remained robust across subgroup analyses. RCS analyses presented nonlinear associations between GNRI and both mortalities (both p-non-linear <0.05, p-overall <0.05).

Conclusion: GNRI demonstrated a significant, negative, and nonlinear association with all-cause and cardiovascular mortality in US individuals with prediabetes and diabetes, highlighting its utility in improving survival outcomes through nutritional assessment.

Keywords: Geriatric Nutritional Risk Index; all-cause mortality; cardiovascular mortality; diabetes; nutritional status; prediabetes.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart for the selection of participants.
Figure 2
Figure 2
Kaplan–Meier analyses for all-cause (A) and cardiovascular mortality (B) among participants with prediabetes and diabetes.
Figure 3
Figure 3
Dose–response relationships of GNRI and all-cause (A) and cardiovascular mortality (B). Adjusted for gender, age, race, education level, PIR, BMI, marital status, drinking status, and smoking status. HR, hazard ratio; CI, confidence interval; GNRI, Geriatric Nutritional Risk Index; PIR, income-to-poverty ratio; BMI, body mass index.
Figure 4
Figure 4
Subgroup analysis of the associations between GNRI and all-cause and cardiovascular mortality.
See this image and copyright information in PMC

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