Skip to main content

Advertisement

SpringerLink
Log in

Prognostic value of geriatric nutritional risk index in elderly patients with heart failure: a meta-analysis

  • Review
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

Geriatric Nutritional Risk Index (GNRI) is a promising tool for predicting nutrition-related complications. This meta-analysis sought to determine the prognostic utility of GNRI in elderly patients with heart failure.

Methods

We comprehensively searched the PubMed and Embase databases from their inception to July 2019. Original studies investigating the prognostic value of GNRI in patients with heart failure were included. Outcome of interests were all-cause mortality and major cardiovascular events. The prognostic value of GNRI was expressed as risk ratios (RR) with 95% confidence intervals (CI) for the lowest versus the highest GNRI category or continuous GNRI analysis.

Results

Eleven articles (10 studies) involving 10,589 elderly heart failure patients were included. Meta-analysis indicated that heart failure patients with the lowest GNRI had an increased risk of all-cause mortality (RR 2.11; 95% CI 1.72–2.58) and major cardiovascular events (RR 2.00; 95% CI 1.24–3.22) after adjustment for confounding. In addition, each unit reduction in GNRI significantly increased 6% risk of all-cause mortality.

Conclusion

Lower GNRI independently predicts all-cause mortality and major cardiovascular events in elderly patients with heart failure. Determination of nutritional status using GNRI may improve risk stratification in elderly patients with heart failure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Butrous H, Hummel SL (2016) Heart failure in older adults. Can J Cardiol 32:1140–1147

    Article  Google Scholar 

  2. Kinugawa S, Fukushima A (2018) Malnutrition in heart failure: important but undervalued issue. JACC Heart failure 6:487–488

    Article  Google Scholar 

  3. Rahman A, Jafry S, Jeejeebhoy K, Nagpal AD, Pisani B, Agarwala R (2016) Malnutrition and cachexia in heart failure. JPEN J Parenter Enteral Nutr 40:475–486

    Article  CAS  Google Scholar 

  4. Bouillanne O, Morineau G, Dupont C, et al (2005) Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr 82:777–783

    Article  CAS  Google Scholar 

  5. Cereda E, Pedrolli C (2009) The geriatric nutritional risk index. Curr Opin Clin Nutr Metab Care 12:1–7

    Article  Google Scholar 

  6. Kinugasa Y, Kato M, Sugihara S, et al (2013) Geriatric nutritional risk index predicts functional dependency and mortality in patients with heart failure with preserved ejection fraction. Circulation 77:705–711

    Article  CAS  Google Scholar 

  7. Narumi T, Arimoto T, Funayama A, et al (2013) Prognosticimportance of objective nutritional indexes in patients with chronic heart failure. J Cardiol 62:307–313

    Article  Google Scholar 

  8. Kaneko H, Suzuki S, Goto M, et al  (2015) Geriatric nutritional risk index in hospitalized heart failure patients. Int J Cardiol 181:213–215

    Article  Google Scholar 

  9. Sargento L, Vicente Simoes A, Rodrigues J, Longo S, Lousada N, Palma Dos Reis R (2017) Geriatric nutritional risk index as a nutritional and survival risk assessment tool in stable outpatients with systolic heart failure. Nutr Metabol Cardiovasc Dis 27:430–437

    Article  CAS  Google Scholar 

  10. Sze S, Pellicori P, Kazmi S, et al  (2018) Prevalence and prognostic significance of malnutrition using 3 scoring systems among outpatients with heart failure: a comparison with body mass index. JACC Heart Fail 6:476–486

    Article  Google Scholar 

  11. Sze S, Pellicori P, Zhang J, Clark AL (2019) Malnutrition, congestion and mortality in ambulatory patients with heart failure. Heart 105:297–306

    Article  CAS  Google Scholar 

  12. Yoshihisa A, Kanno Y, Watanabe S, et al  (2018) Impact of nutritional indices on mortality in patients with heart failure. Open Heart 5:e000730

    Article  Google Scholar 

  13. Minamisawa M, Miura T, Motoki H, et al  (2018) Geriatric nutritional risk index predicts cardiovascular events in patients at risk for heart failure. Circulation 82:1614–1622

    Article  CAS  Google Scholar 

  14. Nishi I, Seo Y, Hamada-Harimura Y, et al  (2019) Geriatric nutritional risk index predicts all-cause deaths in heart failure with preserved ejection fraction. ESC Heart Fail 6:396–405

    Article  Google Scholar 

  15. Lin H, Zhang H, Lin Z, Li X, Kong X, Sun G (2016) Review of nutritional screening and assessment tools and clinical outcomes in heart failure. Heart Fail Rev 21:549–565

    Article  CAS  Google Scholar 

  16. Liberati A, Altman DG, Tetzlaff J, et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–34

    Article  Google Scholar 

  17. Wells G, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P (2020) The Newcastle–Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp 10 May 2020

  18. Higgins J, Green Se (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011) The Cochrane Collaboration, 2011. www.cochrane-handbook.org.

  19. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101

    Article  CAS  Google Scholar 

  20. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  CAS  Google Scholar 

  21. Nakamura T, Matsumoto M, Haraguchi Y, Ishida T, Momomura SI (2019) Prognostic impact of malnutrition assessed using geriatric nutritional risk index in patients aged 80 years with heart failure. Eur Soc Cardiol 19:172–177

    Google Scholar 

  22. Minamisawa M, Seidelmann SB, Claggett B, et al (2019) Impact of malnutrition using geriatric nutritional risk index in heart failure with preserved ejection fraction. JACC Heart failure 7:664–675

    Article  Google Scholar 

  23. Lau J, Ioannidis JP, Terrin N, Schmid CH, Olkin I (2006) The case of the misleading funnel plot. BMJ 333:597–600

    Article  Google Scholar 

  24. Xiong J, Wang M, Zhang Y, et al (2018) Association of geriatric nutritional risk index with mortality in hemodialysis patients: A meta-analysis of cohort studies. Kidney Blood Pressure Res 43:1878–1889

    Article  Google Scholar 

  25. Hao XY, Li DY, Zhang N (2019) Geriatric nutritional risk index as a predictor for mortality: A meta-analysis of observational studies. Nutr Res 71:8–20

    Article  CAS  Google Scholar 

  26. Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL (1999) The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 15:116–122

    Article  CAS  Google Scholar 

  27. Sargento L, Longo S, Lousada N, dos Reis RP (2014) The importance of assessing nutritional status in elderly patients with heart failure. Curr Heart Fail Rep 11:220–226

    CAS  PubMed  Google Scholar 

  28. Gopal DM, Kalogeropoulos AP, Georgiopoulou VV, et al  (2010) Serum albumin concentration and heart failure risk The Health, Aging, and Body Composition Study. Am Heart J 160:279–285

    Article  CAS  Google Scholar 

  29. Peng W, Zhang C, Wang Z, Yang W (2019) Prediction of all-cause mortality with hypoalbuminemia in patients with heart failure: A meta-analysis. Biomarkers 24:631–637

    CAS  Google Scholar 

  30. Fan Y, Gu X, Zou C (2019) Prediction of all-cause and cardiovascular mortality with weight loss in patients with chronic heart failure: a meta-analysis. Eur J Prev Cardiol. https://doi.org/10.1177/2047487319871122

    Article  Google Scholar 

Download references

Funding

This work was supported by the Medical Scientific Research Foundation of Zhejiang Province, China (2018KY695) and the Ningbo Health Branding Subject Fund (PPXK2018-01).

Author information

Author notes

  1. Hengdong Li and Kaidong Cen contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, No. 41 Northwest Street, Haishu District, Ningbo, 315000, Zhejiang, China

    Hengdong Li, Kaidong Cen, Weifeng Sun & Beili Feng

  2. Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315000, Zhejiang, China

    Hengdong Li & Beili Feng

Authors
  1. Hengdong Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kaidong Cen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Weifeng Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Beili Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Data collection: HD Li and KD Cen; Formal analysis: HD Li and KD Cen; Draft manuscript: WF Sun; Conceptualization: BL Feng; Revising and editing: BL Feng.

Corresponding author

Correspondence to Beili Feng.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 13 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, H., Cen, K., Sun, W. et al. Prognostic value of geriatric nutritional risk index in elderly patients with heart failure: a meta-analysis. Aging Clin Exp Res 33, 1477–1486 (2021). https://doi.org/10.1007/s40520-020-01656-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-020-01656-3

Keywords

Search

Navigation