Geriatric Nutritional Risk Index and risks of all-cause, cardiovascular, and diabetes-related mortality in adults with obesity: A nationally representative cohort study

Objectives: This study aimed to examine the association between the Geriatric Nutritional Risk Index (GNRI) and mortality outcomes, encompassing all-cause, cardiovascular, and diabetes-associated deaths, among adults living with obesity. Methods: ) enrolled in ten consecutive cycles of the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018. Vital status was determined via linkage to the National Death Index, with follow-up extending through December 31, 2019. Multivariate Cox proportional hazards models, restricted cubic spline analyses, and stratified subgroup evaluations were performed. Results: Throughout the observation period, 2110 deaths from all causes, 715 cardiovascular-related deaths, and 111 diabetes-attributed deaths were recorded. Following comprehensive covariate adjustment, low GNRI (<98) exhibited markedly higher risks of all-cause death (hazard ratio [HR]: 1.67; 95% confidence interval [CI]: 1.43, 1.96), cardiovascular death (HR: 1.61; 95% CI: 1.20, 2.13), and diabetes-associated death (HR: 2.44; 95% CI: 1.41, 4.17) relative to those with high GNRI (≥98). Non-linear relationships were detected for all-cause and cardiovascular mortality, with threshold values identified at GNRI levels of 100.5 and 98.7, respectively. The observed associations persisted consistently across the majority of demographic and clinical strata. Conclusions: Lower GNRI scores demonstrated independent associations with heightened mortality among adults with obesity. These results offer supportive evidence for incorporating nutritional risk screening into routine clinical management approaches for this patient population.