Nutritional Assessment of Older Female Inpatients With Hip Fracture Using Phase Angle: Calculation of Cutoff Values and Minimal Detectable Change.

BackgroundPhase angle, which is associated with cellular health, has attracted attention as a noninvasive and objective method for nutritional assessment. However, the association between malnutrition and phase angle in older inpatients with hip fractures has not been reported. Therefore, this study investigated this association in older inpatients (aged ≥65 years) with hip fractures and determined the cutoff phase angle for determining malnutrition.MethodsThis cross-sectional study retrospectively analyzed the data of 96 inpatients with hip fractures who were hospitalized in rehabilitation units after surgery (male, 29.4%; mean age, 82.4±6.2 years). Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), with malnutrition defined as a GNRI ≥98. Bioelectrical impedance analysis was used to measure phase angles.ResultsThe phase angle was associated with malnutrition (B=−1.173; odds ratio=0.310; 95% confidence interval 0.58–0.83; p=0.015). The area under the receiver operating characteristic curve was 0.71. The cutoff phase angle for malnutrition was 3.96° (sensitivity=0.85, specificity=0.63).ConclusionPhase angle could be an indicator of malnutrition in older inpatients with hip fractures. Our findings will help formulate rehabilitation strategies for these patients.

alnutrition is one of the hallmarks of frailty in elderly patients and a predictor of worse outcomes in elderly patients with severe aortic valve stenosis. 1In this context, Ishizu et al 2 present in this issue of the Journal of the American Heart Association (JAHA) their analyses on prevalence and prognostic value of the Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), and Prognostic Nutritional Index for malnutrition assessment of Japanese elderly patients at high surgical risk undergoing transcatheter aortic valve implantation (TAVI).They found that malnourishment in their population was common and associated with increased mortality after TAVI regardless of the nutrition index used and irrespective of age, sex, body mass index, frailty, kidney function, and left ventricular ejection fraction.This phenomenon had already been observed by the OCEAN-TAVI (Optimized Transcatheter Valvular Intervention-TAVI) investigators, 3 who found nutritional status as a surrogate marker for predicting worse clinical outcomes after TAVI.While one may argue that this finding might apply only to this select population (only Japanese and very old patients with a mean age >80 years) with a well-defined risk profile (only at high risk), the current evidence shows that patients with different risk profiles (not only those at high risk) and other Asian and Western populations are under the negative impact of malnutrition as well.

Usefulness of nutritional assessment using Geriatric Nutritional Risk Index as an independent predictor of 30-day mortality after hip fracture surgery

To investigate how the energy intake of institutionalized long-term-care patients through the regular nontherapeutic meals provision is associated with the nutritional status and the Geriatric Nutritional Risk Index (GNRI). A 9 month longitudinal, observational study. Long-term-care Hospital. 66 long-term-care patients with multiple medical conditions and solely oral food-intake. 47 (71 %) patients, predominantly women (n = 39/47), with a mean age of 83.04 (±9.58) years completed study time and 19 (29 %) deceased. At week 1 and week 36 of observation time energy intake was measured by means of three-days-weighing-records. Body composition was assessed with bioelectrical impedance analysis. Serum albumin, body weight and body height were taken from the medical report. Albumin content, body weight and height were used to calculate the Geriatric Nutritional Risk Index: GNRI = [1.489 × albumin (g/L)] + [41.7 × (weight/ideal body weight)]. Energy intake was significantly below 24 kcal/kg body weight per day. The GNRI of the deceased patients was significantly (p = 0.002) lower than the GNRI of the completers. During observation time energy-intake p < 0.001, body fat (p = 0.001) and phase angle (PA) of bio impedance measurement (p = 0.018) and likewise the GNRI (p = 0.021) of the completers decreased significantly. At the beginning and at the end of observation time energy intake correlated significantly with PA (p = 0.028/p < 0.001) and GNRI (p = 0.436/p = 0.004). Also GNRI and PA correlated significantly at the beginning (p = 0.001) and at the end (p < 0.001) of observation time. The energy intake through non therapeutic meals provision was too low for sustaining the nutritional status and likewise the GNRI. The malnourishment and the nutrition related clinical risk of the geriatric patients aggrevated during observation time.

Background and Aims Malnutrition is a prevalent condition in patients with chronic kidney disease (CKD) receiving replacement therapy by peritoneal dialysis (PD). Geriatric nutritional risk index (GNRI) is an effective tool for screening nutritional status in maintenance hemodialysis patients. The purpose of this study was to determine the information content of GNRI for the diagnosis of protein-energy malnutrition in patients with CKD receiving replacement therapy with PD when compared to malnutrition inflammation score (MIS) and 7-point subjective global assessment (7p-SGA). Method A prospective cohort study included 222 adults PD-patients (man 100, female 112, age 44±14). All patients received continuous ambulatory peritoneal dialysis. Median duration PD before inclusion in the study was 12 months, the observation period of patients was 36 months. Nutritional status assessment included anthropometric (body mass index, triceps skinfold thickness, midupper arm muscular area) and biochemical (albumin, C-reactive protein, total iron-binding capacity, total cholesterol, hemoglobin and others) examinations as well as bioelectrical impedance analysis (BIA – fat mass). GNRI calculated according to the formula GNRI = 1.489 × albumin (g/dL)] + [41.7 × (body wt/ideal body wt)], where the ideal body weight for women is: height (cm)–100–[(height–152) × 0.2], ideal body weight for men is equal to: height (cm) -100 - [(height - 152) × 0.4]. We used MIS and 7p-SGA as a reference standard, a score ≥6 and ≤5, respectively, defined malnutrition. The cutoff of GNRI the diagnosis of malnutrition were derived from these ROC-analysis. Results Most of the individual nutritional indexes, including the anthropometric, biochemical and BIA indexes, were significantly (P&amp;lt;0.001) lower in the patients with MIS score ≥6 and 7p-SGA score ≤5, thus both nutritional screening tools were considered reasonable as a reference standard to determine the information content GNRI in PD-patients. The GNRI fluctuated in the range 66–126 (median 99), MIS score – 2–24 (median 7) and 7p-SGA score – 2–7 (median 5). The GNRI showed a significantly negative correlation with MIS (r = -0,708, p&amp;lt;0.0001) and a significantly positive correlation with 7p-SGA (r = 0.636, p&amp;lt;0.0001) (Fig. 1). The most accurate GNRI cutoff to identify a malnourished patient according to the MIS was ≤99 (Fig. 2). The frequency of malnutrition among the observed patients was 52.3% when using GNRI≤99, 55.9% when using MIS≥6 and 51.4% when using 7p-SGA≤5 (n.s.). The values for sensitivity and specificity with a GNRI of ≤99 in predicting malnutrition based on the MIS were 77.4% (95%CI 69.0-84.4%) and 79.6% (95%CI 70.3-87.1%) respectively. Positive predictive value and negative predictive value also had high scores respectively 73.7% (95%CI 64.9-80.9%) and 72.2 (95%CI 63.1-79.8%). The application of the GNRI to the PD-patients found significant (p&amp;lt;0.001) differences in the various nutrition-related indexes (anthropometric, biochemical and BIA) between the group with a GNRI≤99 and that with GNRI&amp;gt;99. Mortality from all causes among patients with GNRI&amp;gt;99 was one case per 54.9 patient-years, among patients with GNRI≤99 was one case per 29.7 patient-years. Conclusion In PD-patients GNRI closely correlates with MIS and 7p-SGA, characterized by high sensitivity and specificity. GNRI can be used to determine the nutritional status of PD patients.

Utilité de l’évaluation de l’état nutritionnel à l’aide de l’indice de risque nutritionnel gériatrique comme facteur prédictif indépendant de la mortalité à 30 jours après un traitement opératoire d’une fracture de hanche

Background: Hip fractures are a prevalent and serious health issue, particularly among the elderly population aged >65 years. These injuries are associated with elevated rates of postoperative complications and mortality, significantly diminishing patients’ quality of life in both the short- and long-term. The prognosis for recovery is further exacerbated in individuals with signs of malnutrition. The primary objective of this study was to evaluate the predictive value of four distinct nutritional assessment scores in relation to postoperative mortality in patients undergoing surgical intervention for hip fractures at 1, 3, 6, 12, and 24 months. Methods: This observational study included patients admitted to the Department of Traumatology at the Medical University for the surgical management of hip fractures between January 2019 and November 2021. Nutritional assessment scores were derived from a retrospective analysis of clinical data. The statistical correlation between nutritional scores and postoperative mortality outcomes was rigorously evaluated. Results: Logistic regression analysis revealed a statistically significant correlation (p < 0.01) between all four nutritional scores and postoperative mortality risk. The malnourished cohorts demonstrated a markedly higher risk of mortality compared to those with adequate nutritional status, as indicated by the following risk ratios: Graz Malnutrition Screening (risk ratio = 2.53–1.68), Prognostic Nutritional Index (risk ratio = 2.44–1.74), Geriatric Nutritional Risk Index (risk ratio = 2.05–1.58), and Controlling Nutritional Status (risk ratio = 2.34–1.46). Despite these findings, the receiver operating characteristic analysis yielded area under the curve (AUC) values ranging from 0.64 to 0.68, indicating limited predictive power. Conclusions: Although a significant correlation existed between the evaluated nutritional scores and postoperative mortality, the predictive value of these scores was quantitatively low. No single nutritional assessment tool has emerged as a strong predictor of postoperative outcomes in this patient population. Consequently, implementation of any specific nutritional screening tool for standard assessment in patients with hip fractures is not recommended at this time. Nevertheless, given the established association between malnutrition and postoperative mortality, a comprehensive evaluation of nutritional status is advisable and further research is needed.

Objective: This study investigates how malnutrition, assessed by Mini Nutritional Assessment (MNA), Controlling Nutritional Status (CONUT), and Geriatric Nutritional Risk Index (GNRI), affects bone mineral density (BMD) in older women. Materials and Methods: A retrospective analysis was conducted on 196 women aged 65 years and older who underwent comprehensive geriatric assessment and dual-energy X-ray absorptiometry. Nutritional status was evaluated using the MNA, CONUT, and GNRI tools. BMD was measured at the lumbar spine and femoral neck, while body mass index and body fat percentage (BF%) were assessed via bioelectrical impedance analysis. Results: Among the participants, 14.43% were newly diagnosed with osteoporosis and 40.72% with osteopenia. The prevalence of malnutrition varied depending on the assessment tool used: 50.32% according to the MNA, 15.64% based on the CONUT score, and 10.31% using the GNRI. Lower femoral neck T-scores and femoral BMD were significantly associated with undernutrition as determined by the CONUT score. In univariate analysis, MNA, GNRI, hemoglobin, albumin, handgrip strength, BF%, and obesity were all significantly and inversely associated with low BMD (osteopenia and osteoporosis) (p=0.007, p=0.018, p=0.004, p=0.004, p&lt;0.001, p &lt;0.001, p=0.011, respectively). After adjustment for related variables, only the MNA remained significantly associated with low BMD (OR: 0.78, 95% CI: 0.64–0.96), whereas no significant associations were observed for the GNRI or CONUT scores. Conclusion: Our findings underscore the significance of the MNA as a comprehensive indicator that not only evaluates nutritional status but also incorporates functional and psychological components, thereby providing a more holistic perspective on bone health. Additionally, serum albumin, handgrip strength, and hemoglobin levels may further serve as valuable indicators in assessing bone health. A multidimensional evaluation of nutritional status is essential to accurately assess osteoporosis risk in older adults.

Nutritional and inflammatory disorders are factors that increase the risk of adverse clinical outcomes and mortality in elderly hemodialysis (HD) patients. This study aimed to examine nutritional and inflammation status as well as body composition in older adults on HD compared to matched controls. A case–control study was conducted on 168 older participants (84 HD patients (cases) and 84 controls) age- and sex-matched. Demographic, clinical, anthropometric, and laboratory parameters were collected from medical records. The primary outcome was nutritional status assessment using a combination of nutritional and inflammatory markers along with the geriatric nutritional risk index (GNRI). Sarcopenic obesity (SO) was studied by the combined application of anthropometric measures. Body composition and hydration status were assessed by bioelectrical impedance analysis (BIA). Univariate and multivariate regression analyses were performed to identify nutritional and inflammatory independent risk indicators in elderly HD patients and controls. A significantly high prevalence of nutritional risk measured by the GNRI was found in HD patients (32.1%) compared to controls (6.0%) (p < 0.001). Elderly HD patients were overweight and had lower percent arm muscle circumference, phase angle (PA), serum albumin (s-albumin), as well as higher percent extracellular body water (ECW%) and serum C-reactive protein (s-CRP) than controls (all at least, p < 0.01). SO was higher in HD patients (15.50%) than in controls (14.30%). By multi-regression analyses, age < 75 years (OR: 0.119; 95%CI: 0.036 to 0.388), ECW% (OR: 1.162; 95%CI: 1.061 to 1.273), PA (OR: 0.099; 95%CI: 0.036 to 0.271), as well as BMI, s-albumin ≥ 3.8 g/dL, and lower s-CRP were independently related between cases and controls (all at least, p < 0.05). Elderly HD patients had increased nutritional risk, SO, inflammation, overhydration, and metabolic derangements compared to controls. This study highlights the importance of identifying nutritional risk along with inflammation profile and associated body composition disorders in the nutritional care of elderly HD patients. Further studies are needed to prevent nutritional disorders in elderly HD patients.

Geriatric Nutrition Risk Index is Associated with LVAD Recipient Survival with Cutoff Value of 92.68

Six-month trajectory of phase angle after cardiovascular surgery and associated factors of the recovery during cardiac rehabilitation: A retrospective cohort study

Comparison of anemia, renal function, and nutritional status in older women with femoral neck fracture and older women with osteoarthritis of the hip joint

Nutritional screening and mortality in newly institutionalised elderly: A comparison between the Geriatric Nutritional Risk Index and the Mini Nutritional Assessment

Background and Objectives: Malnutrition is one of the most common complications in patients undergoing hemodialysis (HD) and is closely linked to increased morbidity and mortality. This study aimed to investigate the nutritional status of HD patients and the clinical relevance of bioelectrical impedance analysis (BIA) parameters such as the percent body fat (PBF), skeletal muscle mass index (SMI), extracellular water-to-total body water ratio (ECW/TBW), and phase angle (PhA) in assessing malnutrition in Vietnamese HD patients. Materials and Methods: This cross-sectional study was conducted among 184 patients undergoing hemodialysis in Hanoi, Vietnam. The BIA parameters were measured by the InBody S10 body composition analyzer, while malnutrition was assessed by the geriatric nutritional risk index (GNRI), with a GNRI <92 classified as a high risk of malnutrition. The independent BIA variables for predicting malnutrition and its cut-off values were explored using logistic regression models and a receiver operating characteristic (ROC) curve analysis, respectively. Results: Among the study population, 42.9% (79/184) of patients were identified as being at a high risk of malnutrition. The multivariate logistic regression analysis revealed that a higher ECW/TBW was independently associated with an increased risk of malnutrition, while the PBF, SMI, and PhA expressed significant and inverse associations with the malnutrition risk after adjusting for multiple confounders. The cut-off values for predicting the high risk of malnutrition in overall HD patients were determined to be 20.45%, 7.75 kg/m2, 5.45°, and 38.03% for the PBF, the SMI, the PhA, and the ECW/TBW ratio, respectively. Conclusions: BIA parameters, including the PBF, SMI, PhA, and ECW/TBW ratio, could serve as indicators of malnutrition in general Vietnamese patients with HD.

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.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.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.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.