Geriatric nutritional risk index as a predictor for fragility fracture risk in elderly with type 2 diabetes mellitus: A 9-year ambispective longitudinal cohort study
The elderly are prone to fragility fractures, especially those suffering from type 2 diabetes mellitus (T2DM) combined with osteoporosis. Although studies have confirmed the association between GNRI and the prevalence of osteoporosis, the relationship between GNRI and fragility fracture risk and the...
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| creator | Pan, Jiangmei Xu, Guoling Zhai, Zhenwei Sun, Jingxia Wang, Qiu Huang, Xiuxian Guo, Yanli Lu, Quan Mo, Jianming Nong, Yuechou Huang, Jianhao Lu, Wensheng |
| description | The elderly are prone to fragility fractures, especially those suffering from type 2 diabetes mellitus (T2DM) combined with osteoporosis. Although studies have confirmed the association between GNRI and the prevalence of osteoporosis, the relationship between GNRI and fragility fracture risk and the individualized 10-year probability of osteoporotic fragility fractures estimated by FRAX remains unclear. This study aims to delve into the association between the GNRI and a fragility fracture and the 10-year probability of hip fracture (HF) and major osteoporotic fracture (MOF) evaluated by FRAX in elderly with T2DM.
A total of 580 patients with T2DM aged ≥60 were recruited in the study from 2014 to 2023. This research is an ambispective longitudinal cohort study. All participants were followed up every 6 months for 9 years with a median of 3.8 years through outpatient services, medical records, and home fixed-line telephone interviews. According to the tertiles of GNRI, all subjects were divided into three groups: low-level (59.72–94.56, n = 194), moderate-level (94.56–100.22, n = 193), and high-level (100.22–116.45, n = 193). The relationship between GNRI and a fragility fracture and the 10-year probability of HF and MOF calculated by FRAX was assessed by receiver operating characteristic (ROC) analysis, Spearman correlation analyses, restricted cubic spline (RCS) analyses, multivariable Cox regression analyses, stratified analyses, and Kaplan–Meier survival analysis.
Of 580 participants, 102 experienced fragile fracture events (17.59%). ROC analysis demonstrated that the optimal GNRI cut-off value was 98.58 with a sensitivity of 75.49% and a specificity of 47.49%, respectively. Spearman partial correlation analyses revealed that GNRI was positively related to 25-hydroxy vitamin D [25-(OH) D] (r = 0.165, P |
| doi_str_mv | 10.1016/j.clnu.2024.03.032 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3153762155</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0261561424001067</els_id><sourcerecordid>3034778336</sourcerecordid><originalsourceid>FETCH-LOGICAL-c433t-3cebf370b6cbdfe8859c092112644708e81d12fc19acc54747078847578fc8453</originalsourceid><addsrcrecordid>eNqNUctuFDEQtBCILAk_wAH5yGUWP8cexCWKICBFyoWcLY_dk3iZF7YnYT6I_8SjTTiiSG11264qtaoQekfJnhJafzzsXT8ue0aY2BNeir1AOyo5q2ij-Uu0I6ymlaypOEFvUjoQQiRX-jU64VpqzqXYoT-XEIPNMTg8LqXlMI22xzGknziMHn5jm7DFcwQfXJ4i7rYT7W3oQ163yeUlwhMBQ-8h9it-CPkO53UGzLAPtoUMCQ_QF9aSPuFz3FQr2Ijt0IY0g8vhHnA_jbfl34dtBTfdTTHjVO7rGXrV2T7B28d-im6-fvlx8a26ur78fnF-VTnBea64g7bjirS1a30HWsvGkYZRymohFNGgqaesc7SxzkmhypvSWiipdOe0kPwUfTjqznH6tUDKZgjJla3tCNOSDC_uqppR-Qwo4UKp4nJdoOwIdXFKKUJn5hgGG1dDidmSNAezJWm2JA3hpVghvX_UX9oB_D_KU3QF8PkIgGLIfYBokgswuhJULH4aP4X_6f8Fesax5Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3034778336</pqid></control><display><type>article</type><title>Geriatric nutritional risk index as a predictor for fragility fracture risk in elderly with type 2 diabetes mellitus: A 9-year ambispective longitudinal cohort study</title><source>Elsevier ScienceDirect Journals</source><creator>Pan, Jiangmei ; Xu, Guoling ; Zhai, Zhenwei ; Sun, Jingxia ; Wang, Qiu ; Huang, Xiuxian ; Guo, Yanli ; Lu, Quan ; Mo, Jianming ; Nong, Yuechou ; Huang, Jianhao ; Lu, Wensheng</creator><creatorcontrib>Pan, Jiangmei ; Xu, Guoling ; Zhai, Zhenwei ; Sun, Jingxia ; Wang, Qiu ; Huang, Xiuxian ; Guo, Yanli ; Lu, Quan ; Mo, Jianming ; Nong, Yuechou ; Huang, Jianhao ; Lu, Wensheng</creatorcontrib><description><![CDATA[The elderly are prone to fragility fractures, especially those suffering from type 2 diabetes mellitus (T2DM) combined with osteoporosis. Although studies have confirmed the association between GNRI and the prevalence of osteoporosis, the relationship between GNRI and fragility fracture risk and the individualized 10-year probability of osteoporotic fragility fractures estimated by FRAX remains unclear. This study aims to delve into the association between the GNRI and a fragility fracture and the 10-year probability of hip fracture (HF) and major osteoporotic fracture (MOF) evaluated by FRAX in elderly with T2DM.
A total of 580 patients with T2DM aged ≥60 were recruited in the study from 2014 to 2023. This research is an ambispective longitudinal cohort study. All participants were followed up every 6 months for 9 years with a median of 3.8 years through outpatient services, medical records, and home fixed-line telephone interviews. According to the tertiles of GNRI, all subjects were divided into three groups: low-level (59.72–94.56, n = 194), moderate-level (94.56–100.22, n = 193), and high-level (100.22–116.45, n = 193). The relationship between GNRI and a fragility fracture and the 10-year probability of HF and MOF calculated by FRAX was assessed by receiver operating characteristic (ROC) analysis, Spearman correlation analyses, restricted cubic spline (RCS) analyses, multivariable Cox regression analyses, stratified analyses, and Kaplan–Meier survival analysis.
Of 580 participants, 102 experienced fragile fracture events (17.59%). ROC analysis demonstrated that the optimal GNRI cut-off value was 98.58 with a sensitivity of 75.49% and a specificity of 47.49%, respectively. Spearman partial correlation analyses revealed that GNRI was positively related to 25-hydroxy vitamin D [25-(OH) D] (r = 0.165, P < 0.001) and bone mineral density (BMD) [lumbar spine (LS), r = 0.088, P = 0.034; femoral neck (FN), r = 0.167, P < 0.001; total hip (TH), r = 0.171, P < 0.001]; negatively correlated with MOF (r = −0.105, P = 0.012) and HF (r = −0.154, P < 0.001). RCS analyses showed that GNRI was inversely S-shaped dose-dependent with a fragility fracture event (P < 0.001) and was Z-shaped with the 10-year MOF (P = 0.03) and HF (P = 0.01) risk assessed by FRAX, respectively. Multivariate Cox regression analysis demonstrated that compared with high-level GNRI, moderate-level [hazard ratio (HR) = 1.950; 95% confidence interval (CI) = 1.076–3.535; P = 0.028] and low-level (HR = 2.538; 95% CI = 1.378–4.672; P = 0.003) had an increased risk of fragility fracture. Stratified analysis exhibited that GNRI was negatively correlated with the risk of fragility fracture, which the stratification factors presented in the forest plot were not confounding factors and did not affect the prediction effect of GNRI on the fragility fracture events in this overall cohort population (P for interaction > 0.05), despite elderly females aged ≥70, with body mass index (BMI) ≥24, hypertension, and with or without anemia (all P < 0.05). Kaplan–Meier survival analysis identified that the lower-level GNRI group had a higher cumulative incidence of fragility fractures (log-rank, all P < 0.001).
This study confirms for the first time that GNRI is negatively related to a fragility fracture and the 10-year probability of osteoporotic fragility fractures assessed by FRAX in an inverse S-shaped and Z-shaped dose-dependent pattern in elderly with T2DM, respectively. GNRI may serve as a valuable predictor for fragility fracture risk in elderly with T2DM. Therefore, in routine clinical practice, paying attention to the nutritional status of the elderly with T2DM and giving appropriate dietary guidance may help prevent a fragility fracture event.]]></description><identifier>ISSN: 0261-5614</identifier><identifier>EISSN: 1532-1983</identifier><identifier>DOI: 10.1016/j.clnu.2024.03.032</identifier><identifier>PMID: 38583354</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>anemia ; body mass index ; bone density ; clinical nutrition ; cohort studies ; confidence interval ; dietary recommendations ; dose response ; elderly ; femur ; Fracture risk assessment tool ; Fragile fracture ; Geriatric nutritional risk index ; hazard ratio ; hip fractures ; hips ; hypertension ; lumbar spine ; meta-analysis ; noninsulin-dependent diabetes mellitus ; nutrition risk assessment ; nutritional status ; Osteoporosis ; prediction ; regression analysis ; risk ; telephones ; Type 2 diabetes mellitus</subject><ispartof>Clinical nutrition (Edinburgh, Scotland), 2024-05, Vol.43 (5), p.1125-1135</ispartof><rights>2024 The Author(s)</rights><rights>Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c433t-3cebf370b6cbdfe8859c092112644708e81d12fc19acc54747078847578fc8453</citedby><cites>FETCH-LOGICAL-c433t-3cebf370b6cbdfe8859c092112644708e81d12fc19acc54747078847578fc8453</cites><orcidid>0000-0002-0212-3624</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0261561424001067$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38583354$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pan, Jiangmei</creatorcontrib><creatorcontrib>Xu, Guoling</creatorcontrib><creatorcontrib>Zhai, Zhenwei</creatorcontrib><creatorcontrib>Sun, Jingxia</creatorcontrib><creatorcontrib>Wang, Qiu</creatorcontrib><creatorcontrib>Huang, Xiuxian</creatorcontrib><creatorcontrib>Guo, Yanli</creatorcontrib><creatorcontrib>Lu, Quan</creatorcontrib><creatorcontrib>Mo, Jianming</creatorcontrib><creatorcontrib>Nong, Yuechou</creatorcontrib><creatorcontrib>Huang, Jianhao</creatorcontrib><creatorcontrib>Lu, Wensheng</creatorcontrib><title>Geriatric nutritional risk index as a predictor for fragility fracture risk in elderly with type 2 diabetes mellitus: A 9-year ambispective longitudinal cohort study</title><title>Clinical nutrition (Edinburgh, Scotland)</title><addtitle>Clin Nutr</addtitle><description><![CDATA[The elderly are prone to fragility fractures, especially those suffering from type 2 diabetes mellitus (T2DM) combined with osteoporosis. Although studies have confirmed the association between GNRI and the prevalence of osteoporosis, the relationship between GNRI and fragility fracture risk and the individualized 10-year probability of osteoporotic fragility fractures estimated by FRAX remains unclear. This study aims to delve into the association between the GNRI and a fragility fracture and the 10-year probability of hip fracture (HF) and major osteoporotic fracture (MOF) evaluated by FRAX in elderly with T2DM.
A total of 580 patients with T2DM aged ≥60 were recruited in the study from 2014 to 2023. This research is an ambispective longitudinal cohort study. All participants were followed up every 6 months for 9 years with a median of 3.8 years through outpatient services, medical records, and home fixed-line telephone interviews. According to the tertiles of GNRI, all subjects were divided into three groups: low-level (59.72–94.56, n = 194), moderate-level (94.56–100.22, n = 193), and high-level (100.22–116.45, n = 193). The relationship between GNRI and a fragility fracture and the 10-year probability of HF and MOF calculated by FRAX was assessed by receiver operating characteristic (ROC) analysis, Spearman correlation analyses, restricted cubic spline (RCS) analyses, multivariable Cox regression analyses, stratified analyses, and Kaplan–Meier survival analysis.
Of 580 participants, 102 experienced fragile fracture events (17.59%). ROC analysis demonstrated that the optimal GNRI cut-off value was 98.58 with a sensitivity of 75.49% and a specificity of 47.49%, respectively. Spearman partial correlation analyses revealed that GNRI was positively related to 25-hydroxy vitamin D [25-(OH) D] (r = 0.165, P < 0.001) and bone mineral density (BMD) [lumbar spine (LS), r = 0.088, P = 0.034; femoral neck (FN), r = 0.167, P < 0.001; total hip (TH), r = 0.171, P < 0.001]; negatively correlated with MOF (r = −0.105, P = 0.012) and HF (r = −0.154, P < 0.001). RCS analyses showed that GNRI was inversely S-shaped dose-dependent with a fragility fracture event (P < 0.001) and was Z-shaped with the 10-year MOF (P = 0.03) and HF (P = 0.01) risk assessed by FRAX, respectively. Multivariate Cox regression analysis demonstrated that compared with high-level GNRI, moderate-level [hazard ratio (HR) = 1.950; 95% confidence interval (CI) = 1.076–3.535; P = 0.028] and low-level (HR = 2.538; 95% CI = 1.378–4.672; P = 0.003) had an increased risk of fragility fracture. Stratified analysis exhibited that GNRI was negatively correlated with the risk of fragility fracture, which the stratification factors presented in the forest plot were not confounding factors and did not affect the prediction effect of GNRI on the fragility fracture events in this overall cohort population (P for interaction > 0.05), despite elderly females aged ≥70, with body mass index (BMI) ≥24, hypertension, and with or without anemia (all P < 0.05). Kaplan–Meier survival analysis identified that the lower-level GNRI group had a higher cumulative incidence of fragility fractures (log-rank, all P < 0.001).
This study confirms for the first time that GNRI is negatively related to a fragility fracture and the 10-year probability of osteoporotic fragility fractures assessed by FRAX in an inverse S-shaped and Z-shaped dose-dependent pattern in elderly with T2DM, respectively. GNRI may serve as a valuable predictor for fragility fracture risk in elderly with T2DM. Therefore, in routine clinical practice, paying attention to the nutritional status of the elderly with T2DM and giving appropriate dietary guidance may help prevent a fragility fracture event.]]></description><subject>anemia</subject><subject>body mass index</subject><subject>bone density</subject><subject>clinical nutrition</subject><subject>cohort studies</subject><subject>confidence interval</subject><subject>dietary recommendations</subject><subject>dose response</subject><subject>elderly</subject><subject>femur</subject><subject>Fracture risk assessment tool</subject><subject>Fragile fracture</subject><subject>Geriatric nutritional risk index</subject><subject>hazard ratio</subject><subject>hip fractures</subject><subject>hips</subject><subject>hypertension</subject><subject>lumbar spine</subject><subject>meta-analysis</subject><subject>noninsulin-dependent diabetes mellitus</subject><subject>nutrition risk assessment</subject><subject>nutritional status</subject><subject>Osteoporosis</subject><subject>prediction</subject><subject>regression analysis</subject><subject>risk</subject><subject>telephones</subject><subject>Type 2 diabetes mellitus</subject><issn>0261-5614</issn><issn>1532-1983</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqNUctuFDEQtBCILAk_wAH5yGUWP8cexCWKICBFyoWcLY_dk3iZF7YnYT6I_8SjTTiiSG11264qtaoQekfJnhJafzzsXT8ue0aY2BNeir1AOyo5q2ij-Uu0I6ymlaypOEFvUjoQQiRX-jU64VpqzqXYoT-XEIPNMTg8LqXlMI22xzGknziMHn5jm7DFcwQfXJ4i7rYT7W3oQ163yeUlwhMBQ-8h9it-CPkO53UGzLAPtoUMCQ_QF9aSPuFz3FQr2Ijt0IY0g8vhHnA_jbfl34dtBTfdTTHjVO7rGXrV2T7B28d-im6-fvlx8a26ur78fnF-VTnBea64g7bjirS1a30HWsvGkYZRymohFNGgqaesc7SxzkmhypvSWiipdOe0kPwUfTjqznH6tUDKZgjJla3tCNOSDC_uqppR-Qwo4UKp4nJdoOwIdXFKKUJn5hgGG1dDidmSNAezJWm2JA3hpVghvX_UX9oB_D_KU3QF8PkIgGLIfYBokgswuhJULH4aP4X_6f8Fesax5Q</recordid><startdate>20240501</startdate><enddate>20240501</enddate><creator>Pan, Jiangmei</creator><creator>Xu, Guoling</creator><creator>Zhai, Zhenwei</creator><creator>Sun, Jingxia</creator><creator>Wang, Qiu</creator><creator>Huang, Xiuxian</creator><creator>Guo, Yanli</creator><creator>Lu, Quan</creator><creator>Mo, Jianming</creator><creator>Nong, Yuechou</creator><creator>Huang, Jianhao</creator><creator>Lu, Wensheng</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7S9</scope><scope>L.6</scope><orcidid>https://orcid.org/0000-0002-0212-3624</orcidid></search><sort><creationdate>20240501</creationdate><title>Geriatric nutritional risk index as a predictor for fragility fracture risk in elderly with type 2 diabetes mellitus: A 9-year ambispective longitudinal cohort study</title><author>Pan, Jiangmei ; Xu, Guoling ; Zhai, Zhenwei ; Sun, Jingxia ; Wang, Qiu ; Huang, Xiuxian ; Guo, Yanli ; Lu, Quan ; Mo, Jianming ; Nong, Yuechou ; Huang, Jianhao ; Lu, Wensheng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c433t-3cebf370b6cbdfe8859c092112644708e81d12fc19acc54747078847578fc8453</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>anemia</topic><topic>body mass index</topic><topic>bone density</topic><topic>clinical nutrition</topic><topic>cohort studies</topic><topic>confidence interval</topic><topic>dietary recommendations</topic><topic>dose response</topic><topic>elderly</topic><topic>femur</topic><topic>Fracture risk assessment tool</topic><topic>Fragile fracture</topic><topic>Geriatric nutritional risk index</topic><topic>hazard ratio</topic><topic>hip fractures</topic><topic>hips</topic><topic>hypertension</topic><topic>lumbar spine</topic><topic>meta-analysis</topic><topic>noninsulin-dependent diabetes mellitus</topic><topic>nutrition risk assessment</topic><topic>nutritional status</topic><topic>Osteoporosis</topic><topic>prediction</topic><topic>regression analysis</topic><topic>risk</topic><topic>telephones</topic><topic>Type 2 diabetes mellitus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pan, Jiangmei</creatorcontrib><creatorcontrib>Xu, Guoling</creatorcontrib><creatorcontrib>Zhai, Zhenwei</creatorcontrib><creatorcontrib>Sun, Jingxia</creatorcontrib><creatorcontrib>Wang, Qiu</creatorcontrib><creatorcontrib>Huang, Xiuxian</creatorcontrib><creatorcontrib>Guo, Yanli</creatorcontrib><creatorcontrib>Lu, Quan</creatorcontrib><creatorcontrib>Mo, Jianming</creatorcontrib><creatorcontrib>Nong, Yuechou</creatorcontrib><creatorcontrib>Huang, Jianhao</creatorcontrib><creatorcontrib>Lu, Wensheng</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>AGRICOLA</collection><collection>AGRICOLA - Academic</collection><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pan, Jiangmei</au><au>Xu, Guoling</au><au>Zhai, Zhenwei</au><au>Sun, Jingxia</au><au>Wang, Qiu</au><au>Huang, Xiuxian</au><au>Guo, Yanli</au><au>Lu, Quan</au><au>Mo, Jianming</au><au>Nong, Yuechou</au><au>Huang, Jianhao</au><au>Lu, Wensheng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Geriatric nutritional risk index as a predictor for fragility fracture risk in elderly with type 2 diabetes mellitus: A 9-year ambispective longitudinal cohort study</atitle><jtitle>Clinical nutrition (Edinburgh, Scotland)</jtitle><addtitle>Clin Nutr</addtitle><date>2024-05-01</date><risdate>2024</risdate><volume>43</volume><issue>5</issue><spage>1125</spage><epage>1135</epage><pages>1125-1135</pages><issn>0261-5614</issn><eissn>1532-1983</eissn><abstract><![CDATA[The elderly are prone to fragility fractures, especially those suffering from type 2 diabetes mellitus (T2DM) combined with osteoporosis. Although studies have confirmed the association between GNRI and the prevalence of osteoporosis, the relationship between GNRI and fragility fracture risk and the individualized 10-year probability of osteoporotic fragility fractures estimated by FRAX remains unclear. This study aims to delve into the association between the GNRI and a fragility fracture and the 10-year probability of hip fracture (HF) and major osteoporotic fracture (MOF) evaluated by FRAX in elderly with T2DM.
A total of 580 patients with T2DM aged ≥60 were recruited in the study from 2014 to 2023. This research is an ambispective longitudinal cohort study. All participants were followed up every 6 months for 9 years with a median of 3.8 years through outpatient services, medical records, and home fixed-line telephone interviews. According to the tertiles of GNRI, all subjects were divided into three groups: low-level (59.72–94.56, n = 194), moderate-level (94.56–100.22, n = 193), and high-level (100.22–116.45, n = 193). The relationship between GNRI and a fragility fracture and the 10-year probability of HF and MOF calculated by FRAX was assessed by receiver operating characteristic (ROC) analysis, Spearman correlation analyses, restricted cubic spline (RCS) analyses, multivariable Cox regression analyses, stratified analyses, and Kaplan–Meier survival analysis.
Of 580 participants, 102 experienced fragile fracture events (17.59%). ROC analysis demonstrated that the optimal GNRI cut-off value was 98.58 with a sensitivity of 75.49% and a specificity of 47.49%, respectively. Spearman partial correlation analyses revealed that GNRI was positively related to 25-hydroxy vitamin D [25-(OH) D] (r = 0.165, P < 0.001) and bone mineral density (BMD) [lumbar spine (LS), r = 0.088, P = 0.034; femoral neck (FN), r = 0.167, P < 0.001; total hip (TH), r = 0.171, P < 0.001]; negatively correlated with MOF (r = −0.105, P = 0.012) and HF (r = −0.154, P < 0.001). RCS analyses showed that GNRI was inversely S-shaped dose-dependent with a fragility fracture event (P < 0.001) and was Z-shaped with the 10-year MOF (P = 0.03) and HF (P = 0.01) risk assessed by FRAX, respectively. Multivariate Cox regression analysis demonstrated that compared with high-level GNRI, moderate-level [hazard ratio (HR) = 1.950; 95% confidence interval (CI) = 1.076–3.535; P = 0.028] and low-level (HR = 2.538; 95% CI = 1.378–4.672; P = 0.003) had an increased risk of fragility fracture. Stratified analysis exhibited that GNRI was negatively correlated with the risk of fragility fracture, which the stratification factors presented in the forest plot were not confounding factors and did not affect the prediction effect of GNRI on the fragility fracture events in this overall cohort population (P for interaction > 0.05), despite elderly females aged ≥70, with body mass index (BMI) ≥24, hypertension, and with or without anemia (all P < 0.05). Kaplan–Meier survival analysis identified that the lower-level GNRI group had a higher cumulative incidence of fragility fractures (log-rank, all P < 0.001).
This study confirms for the first time that GNRI is negatively related to a fragility fracture and the 10-year probability of osteoporotic fragility fractures assessed by FRAX in an inverse S-shaped and Z-shaped dose-dependent pattern in elderly with T2DM, respectively. GNRI may serve as a valuable predictor for fragility fracture risk in elderly with T2DM. Therefore, in routine clinical practice, paying attention to the nutritional status of the elderly with T2DM and giving appropriate dietary guidance may help prevent a fragility fracture event.]]></abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>38583354</pmid><doi>10.1016/j.clnu.2024.03.032</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-0212-3624</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical nutrition (Edinburgh, Scotland), 2024-05, Vol.43 (5), p.1125-1135 |
| issn | 0261-5614 1532-1983 |
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| source | Elsevier ScienceDirect Journals |
| subjects | anemia body mass index bone density clinical nutrition cohort studies confidence interval dietary recommendations dose response elderly femur Fracture risk assessment tool Fragile fracture Geriatric nutritional risk index hazard ratio hip fractures hips hypertension lumbar spine meta-analysis noninsulin-dependent diabetes mellitus nutrition risk assessment nutritional status Osteoporosis prediction regression analysis risk telephones Type 2 diabetes mellitus |
| title | Geriatric nutritional risk index as a predictor for fragility fracture risk in elderly with type 2 diabetes mellitus: A 9-year ambispective longitudinal cohort study |
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