Modified Geriatric Nutritional Risk Index: A High-Sensitivity Marker with L-Shaped Association for Sarcopenia in Hospitalized Older Adults – Frontiers

Report on a Novel Screening Tool for Sarcopenia in Older Inpatients and its Alignment with Sustainable Development Goals

1.0 Introduction: Promoting Healthy Aging in Line with SDG 3

This report details a cross-sectional study on the efficacy of a novel screening tool for sarcopenia in hospitalized older adults. The research addresses a critical gap in geriatric care, directly contributing to the United Nations Sustainable Development Goal 3 (Good Health and Well-being), which aims to ensure healthy lives and promote well-being for all at all ages. By improving the early detection of sarcopenia, a condition linked to malnutrition and inflammation, this work also supports SDG 2 (Zero Hunger) by tackling malnutrition in vulnerable populations and SDG 10 (Reduced Inequalities) by enhancing healthcare equity for the elderly.

2.0 Study Overview and Methodology

The study aimed to validate a modified Geriatric Nutritional Risk Index (mGNRI) that incorporates C-reactive protein (CRP) levels and weight changes for predicting sarcopenia.

• Participants: 153 hospitalized older patients with a mean age of 80.2 years.
• Diagnosis: Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) criteria.
• Analysis: The study compared the diagnostic performance of the new mGNRI against traditional indices, namely the Geriatric Nutritional Risk Index (GNRI) and the Nutritional Risk Index (NRI), using multivariable logistic regression and receiver operating characteristic (ROC) analysis.

3.0 Key Findings: Advancing Health Diagnostics and Nutritional Assessment

The results demonstrate the superior efficacy of the mGNRI, highlighting its potential to advance clinical practices in line with global health objectives.

1. Prevalence of Sarcopenia: The prevalence of sarcopenia was found to be 24.2%, underscoring the significant health challenge this condition poses to aging populations, a key concern for SDG 3.
2. Superior Performance of mGNRI: The mGNRI was significantly lower in patients with sarcopenia. The analysis revealed a critical intervention threshold, providing an actionable insight for healthcare providers.
   • An mGNRI score below 55.48 was associated with a 16.8% reduction in sarcopenia odds for each unit increase.
   • A score below 55 indicated an 8.4-fold increased risk of sarcopenia, a significantly higher risk than identified by traditional indices.
3. Enhanced Diagnostic Power: The mGNRI demonstrated superior sensitivity in identifying at-risk individuals.
   • mGNRI (cutoff Achieved a sensitivity of 80.4% and an Area Under the Curve (AUC) of 0.752.
   • GNRI (cutoff Showed a lower sensitivity of 75.6%.

4.0 Implications for Sustainable Development Goals

The integration of an inflammation-sensitive nutritional index like the mGNRI into standard geriatric assessments has profound implications for achieving several SDGs.

• SDG 3 (Good Health and Well-being): The tool facilitates early and targeted interventions for sarcopenia, improving health outcomes, reducing non-communicable disease burdens, and promoting healthy aging among the elderly.
• SDG 2 (Zero Hunger): By providing a more accurate measure of nutritional risk that includes inflammation, the mGNRI helps address the complex issue of malnutrition (Target 2.2) in older adults, ensuring their specific dietary needs are met.
• SDG 10 (Reduced Inequalities): Implementing a simple, effective, and low-cost screening tool improves access to quality diagnostics for older persons, reducing health disparities based on age and promoting their inclusion.

5.0 Conclusion and Recommendations

The modified Geriatric Nutritional Risk Index (mGNRI) is a practical and highly sensitive tool for sarcopenia screening in older inpatients. Its ability to identify a clear intervention threshold (mGNRI

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

   The article primarily addresses issues related to the following Sustainable Development Goals (SDGs):

   • SDG 2: Zero Hunger: The article’s central theme is nutrition, specifically the development of a tool (mGNRI) to assess nutritional risk in older hospitalized patients. This directly connects to SDG 2’s aim to end all forms of malnutrition and address the nutritional needs of vulnerable populations, including the elderly.
   • SDG 3: Good Health and Well-being: The study focuses on sarcopenia, a health condition prevalent in older adults, and aims to improve its screening and diagnosis. This aligns with SDG 3’s objective to ensure healthy lives and promote well-being for all at all ages, particularly by improving the management of non-communicable diseases and age-related conditions.

2. What specific targets under those SDGs can be identified based on the article’s content?

   Based on the article’s focus, the following specific SDG targets can be identified:

   • Target 2.2: “By 2030, end all forms of malnutrition… and address the nutritional needs of… older persons.” The article directly contributes to this target by proposing a more effective screening tool (mGNRI) to identify nutritional risk and sarcopenia, a malnutrition-related condition, specifically within the older inpatient population. The study’s purpose is to facilitate “targeted interventions to address nutritional and inflammatory needs.”
   • Target 3.4: “By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.” Sarcopenia is a non-communicable, age-related condition that increases the risk of adverse health outcomes. The development of a superior screening tool with a “critical intervention threshold (mGNRI

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

   Yes, the article mentions and implies several indicators that can measure progress:

   • Prevalence of sarcopenia: The article states the “prevalence of sarcopenia was 24.2% (37/153)” in the studied population. This prevalence rate serves as a direct indicator of the scale of malnutrition and age-related muscle loss in older persons (relevant to Target 2.2).
   • Nutritional Risk Scores: The article uses and evaluates several indices, including the Geriatric Nutritional Risk Index (GNRI), Nutritional Risk Index (NRI), and the proposed modified Geriatric Nutritional Risk Index (mGNRI). The values from these indices, particularly the mGNRI threshold of
   • Biomarkers of Inflammation: The mGNRI incorporates C-reactive protein (CRP) levels as a measure of inflammation. Monitoring CRP levels is an implied indicator for assessing health risks associated with non-communicable conditions (relevant to Target 3.4).
   • Diagnostic Accuracy of Screening Tools: The article provides specific metrics to measure the effectiveness of health screening, such as sensitivity (80.4%) and the area under the curve (AUC) of 0.752 for the mGNRI. These metrics are crucial indicators for evaluating the capacity of health systems to prevent and manage diseases effectively (relevant to Target 3.4).

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article.

   SDGs	Targets	Indicators
   SDG 2: Zero Hunger	Target 2.2: End all forms of malnutrition and address the nutritional needs of older persons.	Prevalence of sarcopenia in older inpatients (reported as 24.2%). Scores from nutritional risk indices (GNRI, NRI, and mGNRI). Proportion of patients below the critical intervention threshold (mGNRI
   SDG 3: Good Health and Well-being	Target 3.4: Reduce mortality from non-communicable diseases through prevention and treatment and promote well-being.	Diagnostic accuracy of screening tools (Sensitivity: 80.4%, AUC: 0.752). Levels of inflammatory biomarkers (C-reactive protein – CRP). Odds Ratio (OR) for sarcopenia risk associated with nutritional scores (e.g., OR=8.40 for mGNRI

Source: frontiersin.org