The relationship between nutrition, hemoglobin, and frailty in elderly patients with Myelodysplastic Syndromes: A mediation effect analysis

Abstract Objective The purpose of this study is to identify the hematological and non-hematological factors influencing frailty, to investigate the relationship between nutrition, hemoglobin, and frailty, and to clarify the mediating effect of hemoglobin. This research aims to provide a mechanistic basis for the development and implementation of precise frailty intervention measures in clinical practice. Methods A convenience sampling method was used. From January to July 2024, 152 elderly patients with MDS were recruited from 10 hospitals under the Chinese Hematology Specialty Alliance Nursing Alliance. Data collection utilized a general information questionnaire, the Geriatric-8 (G-8) scale, and the Mini Nutritional Assessment Short-Form (MNA-SF). Correlation and regression analyses were conducted to identify nutritional factors influencing frailty. The mediating role of hemoglobin in the relationship between nutrition and frailty was analyzed using Hayes' PROCESS macro (version 4.2) with the simple mediation model (Model 4). Bootstrap methods were employed to validate the path effects, accounting for relevant covariates. Results The total frailty score of elderly MDS patients ranged 3~17 (12.34 ± 2.76). Among the participants, 86 patients (56.58%) were identified as frail. Correlation analysis revealed a positive correlation between frailty and nutrition ( r= 0.715, P< 0.01) and hemoglobin concentration (r= 0.701, P< 0.01). The analysis of the mediating effect revealed that hemoglobin acted as a partial mediator in the relationship between nutrition and frailty(β= 0.078; 95%CI: 0.019, 0.138), accounting for 16.8% of the total effect. This mediation effect was statistically significant. Conclusion The results shows that frailty is moderately positively correlated with nutrition and hemoglobin. Hemoglobin acts as a mediator between nutrition and frailty.This study provides new insights and mechanisms for research on frailty in MDS patients. Healthcare providers should focus on optimizing nutritional management and emphasize the bridging role of hemoglobin when addressing frailty in these patients. This approach offers a new target for precise frailty interventions, enabling targeted prevention and reversal of frailty and ultimately enhancing long-term quality of life and overall well-being in elderly patients with MDS.