| Comparative prognostic performance of nutritional, immune-inflammatory, and anthropometric indices for cardiovascular and all-cause mortality in older adults with cardiovascular disease (NHANES 2009–2018) |
Hoang Le Huy Nguyen 
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Department of Geriatrics and Gerontology, School of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam |
Correspondence:
Hoang Le Huy Nguyen, Tel: +84-946-639-943,
Email: lucian.nguyen@icloud.com
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Received: 6 February 2026 • Revised: 13 May 2026 • Accepted: 8 June 2026 |
| Abstract |
Background
Cardiovascular disease (CVD) in older adults is compounded by malnutrition and chronic inflammation. We compared the long-term prognostic performance of three categories of routinely available indices: nutritional (Prognostic Nutritional Index [PNI], Geriatric Nutritional Risk Index [GNRI], Controlling Nutritional Status [CONUT]); immune-inflammatory (Systemic Immune-Inflammation Index [SII]); and anthropometric (Weight-Adjusted Waist Index [WWI]).
Methods
We analyzed 1,804 NHANES 2009–2018 participants aged ≥60 years with established CVD, linked to the National Death Index. Survey-weighted Cox models with restricted cubic splines estimated associations with cardiovascular and all-cause mortality, adjusted for demographic, socioeconomic, behavioral, and comorbid covariates. Sensitivity analyses included landmark exclusion of early deaths (6, 12, 24 months), a complete-case analysis, and additional adjustment for total energy and protein intake.
Results
The nutritional indices (PNI, GNRI, CONUT) showed L-shaped associations with cardiovascular mortality that persisted after sequential exclusion of early deaths and after additional adjustment for total energy and protein intake. Each 1-point increase in PNI corresponded to an adjusted hazard ratio (aHR) of 0.91 (95% CI 0.87–0.95) for cardiovascular mortality; moderate-to-severe malnutrition by PNI carried a 4.61-fold higher hazard. PNI yielded the best model fit (lowest AIC/BIC); CONUT had the highest discrimination. The SII association attenuated when deaths within 24 months were excluded. The WWI predicted all-cause but not cardiovascular mortality.
Conclusions
The nutritional indices (PNI, GNRI, CONUT) showed durable associations with cardiovascular mortality, whereas the SII signal was acute and the WWI predicted only all-cause mortality. These findings are hypothesis-generating; prospective external validation is required before routine clinical use. |
| Key Words:
Aged, Cardiovascular Diseases, Mortality, Nutrition Assessment, Inflammation |
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