Joint Associations ofthe Geriatric Nutrition Risk Index and Frailty with All-Cause and Cause-Specific Mortality in Diabetes Patients - A Prospective Cohort Study

Sep 29, 2026

Study examines how the geriatric nutritional risk index (GNRI) and frailty index (FI) independently and jointly relate to all-cause and cause-specific mortality among diabetes patients. A prospective cohort uses 1,790 participants from NHANES (1999–2018), with GNRI and FI categorized into low and high groups and combined into four exposure categories. Weighted Cox models, Kaplan-Meier curves, and restricted cubic spline regression quantify associations across follow-up, revealing dose-response patterns and elevated mortality when low GNRI coexists with high FI, especially in men.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

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Introduction

Original Article Endocrinol Metab 2025;40:916-927 [https://doi.org/10.3803/EnM.2025.2441](https://doi.org/10.3803/EnM.2025.2441)[ ](https://doi.org/10.3803/EnM.2025.2441)[pISSN 2093-596X](pISSN 2093-596X) · eISSN 2093-5978 Joint Associations ofthe Geriatric Nutrition Risk Index and Frailty with All-Cause and Cause-Specific Mortality in Diabetes Patients: A Prospective Cohort Study Chenke Gu1,2, *, Qiuyue Jia1,3, *, Youxiang Wang3, Weikang Li1, Suying Ding 1,2,3,4, Jingfeng Chen1,2,3,4 1Health Management Center, The First Affiliated Hospital of Zhengzhou University; 2School of Nursing and Health, Zhengzhou University; 3Department of Epidemiology, College of Public Health, Zhengzhou University; 4Institute of Interconnected Intelligent Health Management of Henan Province, Zhengzhou, China Background: This study investigated the independent and joint impacts ofthe geriatric nutritional risk index (GNRI) and frailty index (FI) on all-cause and cause-specific mortality in patients with diabetes. Methods: This study included 1,790 National Health and Nutrition Examination Survey participants between 1999 and 2018. GNRI and FI were used to assess patients with diabetes, who were categorized into low GNRI and high GNRI groups, as well as low FI and high FI groups, to evaluate older adults’nutritional status. These groups were combined into four categories. Weighted Cox proportional hazards models, Kaplan-Meier survival curves, and restricted cubic spline regression models were applied to assess the independent and joint associations of GNRI and FI with all-cause and cause-specific mortality in patients with diabetes. Results: The median follow-up period was 100 months, during which 720 deaths occurred. An independent linear dose-response relationship between GNRI, FI, and all-cause mortality risk was observed. The combination of low GNRI and high FI was significantly associated with increased risk of all-cause mortality (hazard ratio, 1.65; 95% confidence interval [CI], 1.02 to 2.68) for the low GNRI+low FI group, 2.03 (95% CI, 1.61 to 2.55) for the high GNRI+high FI group, and 3.65 (95% CI, 2.38 to 5.58) for the low GNRI+high FI group. Stratified analysis (reference: high GNRI+low FI group) showed an increased mortality risk among men in the low GNRI+high FI group. Conclusion: The combination of low GNRI and high FI was independently and jointly associated with increased risk of all-cause, cardiovascular disease, diabetes, and hypertension mortality, particularly among men. Keywords: Geriatric nutritional risk index; Frailty index; All-cause mortality; Cause-specific mortality; Joint association Received: 8 May 2025, Revised: 27 July 2025, Accepted: 3 September 2025 Corresponding authors: Jingfeng Chen Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China Tel: +86-13513715320, Fax: +86-371-66278593, E-mail: [fccjfchen@zzu.edu.cn](fccjfchen@zzu.edu.cn) Suying Ding Health Management Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China Tel: +86-15838023097, Fax: +86-371-66278593, E-mail: [fccdingsy@zzu.edu.cn](fccdingsy@zzu.edu.cn) *These authors contributed equally to this work. Copyright © 2025 Korean Endocrine Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 916 [www.e-enm.org](www.e-enm.org) GNRI, Frailty, and Mortality in Diabetes Patients INTRODUCTION Diabetes is the eighth leading cause of disability, with its prevalence continuing to rise globally [1] . It is characterized by high incidence, high mortality, and substantial consumption of medical resources, making it a significant challenge

FAQs

What relationship did the study examine between GNRI/FI and mortality in diabetes patients?

The study evaluated the independent and joint associations of GNRI and FI with all-cause and cause-specific mortality among patients with diabetes.

How were participants classified in the prospective cohort study?

Participants were assessed with GNRI and FI, each divided into low and high groups, then combined into four exposure categories.

What did the results show about the combined low GNRI and high FI group?

Low GNRI with high FI was significantly associated with higher all-cause mortality risk, with hazard ratios reported and stratified findings indicating elevated mortality risk among men.

Sep 29, 2026

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