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Neutrophil-to-lymphocyte ratio and lymphocyte count as an alternative to body mass index for screening malnutrition in older adults living in the community

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Abstract

Purpose

Accurate height and weight measurement can be challenging in older adults and complicates nutritional status assessment. Other parameters like the neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte count (LC) could be an option to these measurements. We aimed to test these variables as subrogates of body mass index (BMI) or calf-circumference (CC) for malnutrition screening in community-dwelling older adults.

Methods

This is a secondary analysis from the Salud, Bienestar y Envejecimiento (SABE) survey from Ecuador (2009). Includes data on demographics, health-related factors, physical assessments, and complete blood count, allowing to calculate NLR and LC to be used as part of the Mini Nutritional Assessment (MNA), instead of the BMI. Consequently, 4 models were included: standard MNA, MNA-CC, MNA-NLR and MNA-LC. Finally, age, sex, and comorbidities were considered as confounding variables.

Results

In our analysis of 1,663 subjects, 50.81% were women. Positive correlations with standard MNA were found for MNA-NLR (Estimate = 0.654, p < 0.001) MNA-CC (Estimate = 0.875, p value < 0.001) and MNA-LC (Estimate = 0.679, p < 0.001). Bland-Altman plots showed the smallest bias in MNA-CC. Linear association models revealed varying associations between MNA variants and different parameters, being MNA-NLR strongly associated with all of them (e.g. Estimate = 0.014, p = 0.001 for albumin), except BMI.

Conclusion

The newly proposed model classified a greater number of subjects at risk of malnutrition and fewer with normal nutrition compared to the standard MNA. Additionally, it demonstrated a strong correlation and concordance with the standard MNA. This suggests that hematological parameters may offer an accurate alternative and important insights into malnutrition.

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Acknowledgements

We want to thank the people, researchers, and technical staff that made the SABE Ecuador study possible.

Funding

This paper represents independent research supported by the Norwegian government, through hospital owner Helse Vest (Western Norway Regional Health Authority). Also, funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London.

Author information

Author notes

  1. Miguel Germán Borda and Salomón Salazar-Londoño Shared first authorship.

Authors and Affiliations

  1. Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, PB, 8100, N-4068, Norway

    Miguel Germán Borda, Jonathan Patricio Baldera & Dag Aarsland

  2. Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia

    Miguel Germán Borda & Salomón Salazar-Londoño

  3. Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden

    Miguel Germán Borda

  4. Unidad de Hospitalizacion Domiciliaria, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, Alzira, 46600, Spain

    Pablo Lafuente-Sanchis & Antonio Martín-Marco

  5. Escuela de Estadística de la Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana

    Jonathan Patricio Baldera

  6. Hospital Universitario Mayor-Méderi, Universidad del Rosario, Bogotá, Colombia

    Luis Carlos Venegas

  7. Geriatric Medicine Department, Hospital Universitario de la Ribera, Carretera de Corbera km. 1, Alzira, 46600, Spain

    Miguel Germán Borda & Francisco José Tarazona-Santabalbina

  8. Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, 28029, Spain

    Francisco José Tarazona-Santabalbina

  9. Medical School, Universidad Católica de Valencia San Vicente Mártir, Valencia, 46001, Spain

    Francisco José Tarazona-Santabalbina

  10. Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK

    Dag Aarsland

  11. Instituto Nacional de Geriatría, Ciudad de México, México

    Mario Ulises Pérez-Zepeda

  12. Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México, Huixquilucan Edo, México

    Mario Ulises Pérez-Zepeda

Authors
  1. Miguel Germán Borda
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  2. Salomón Salazar-Londoño
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Contributions

Conceptualization: M.G.B. and S.S.L.; Methodology: M.G.B. and M.U.P.Z.; Formal analysis: J.P.B.; Writing - original draft preparation: M.G.B. and S.S.L.; Validation: M.G.B., S.S.L., P.L.S., J.P.B., L.C.V., F.J.T.S., D.A., A.M.M., M.U.P.Z.; Writing - review and editing: P.L.S., J.P.B., L.C.V., F.J.T.S., D.A., A.M.M., M.U.P.Z.; Funding acquisition: D.A.; Resources: D.A.; Supervision: D.A., A.M.M., M.U.P.Z. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Miguel Germán Borda.

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Ethical approval

This study received ethical approval from the ethics and scientific committee of the Ageing Institute at Hospital Universitario San Ignacio and the Pontificia Universidad Javeriana ethics committee. SABE Ecuador was authorized by the Ecuadoran ministry of health authorities. All research procedures were conducted in accordance with the ethical standards outlined in the 1964 Declaration of Helsinki and its subsequent amendments. Measures were taken to protect the identity of the study subjects.

Conflict of interest

The authors declare that they have no conflict of interest.

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Borda, M.G., Salazar-Londoño, S., Lafuente-Sanchis, P. et al. Neutrophil-to-lymphocyte ratio and lymphocyte count as an alternative to body mass index for screening malnutrition in older adults living in the community. Eur J Nutr (2024). https://doi.org/10.1007/s00394-024-03392-0

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