ArticleAnnals of geriatric medicine and research2026
Comparative Prognostic Performance of Nutritional, Immuneinflammatory, and Anthropometric Indices for Cardiovascular and All-cause Mortality in Older Adults with Cardiovascular Disease (NHANES 2009-2018).
Article in Annals of geriatric medicine and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCardiovascular disease (CVD) in older adults is compounded by malnutrition and chronic inflammation. We compared the long-term prognostic performance of three categories of routinely available indices: nutritional (Prognostic Nutritional Index [PNI], Geriatric Nutritional Risk Index [GNRI], Controlling Nutritional Status [CONUT]); immune-inflammatory (Systemic Immune- Inflammation Index [SII]); and anthropometric (Weight-Adjusted Waist Index [WWI]).
methodsWe analyzed 1,804 National Health and Nutrition Examintion Survey 2009-2018 participants aged ≥60 years with established CVD, linked to the National Death Index. Survey- weighted Cox models with restricted cubic splines estimated associations with cardiovascular and all-cause mortality, adjusted for demographic, socioeconomic, behavioral, and comorbid covariates. Sensitivity analyses included landmark exclusion of early deaths (6, 12, 24 months), a complete-case analysis, and additional adjustment for total energy and protein intake.
resultsPNI and GNRI showed L-shaped associations with cardiovascular mortality, whereas CONUT showed a monotonic positive association. Each 1-point increase in PNI corresponded to an adjusted hazard ratio of 0.91 (95% confidence interval 0.87-0.95) for cardiovascular mortality; moderate-to-severe malnutrition by PNI carried a 4.61-fold higher hazard. PNI yielded the best model fit for cardiovascular mortality (lowest Akaike and Bayesian information criteria [AIC and BIC]); CONUT had the highest discrimination. The SII association attenuated when deaths within 24 months were excluded. The WWI predicted all-cause but not cardiovascular mortality.
conclusionThe nutritional indices (PNI, GNRI, CONUT) showed durable associations with cardiovascular mortality, whereas the SII signal was acute and the WWI predicted only all-cause mortality. These findings are hypothesis-generating; prospective external validation is required before routine clinical use.
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