The combined effect of geriatric nutritional risk index and abdominal obesity on peripheral arterial disease in an elderly hypertensive population: a longitudinal cohort study

Patients with abdominal obesity may be at risk of a double burden of obesity and malnutrition, which may lead to an increased burden of disease. A total of 4,735 elderly hypertensive patients aged ≥ 60 years were included in the final analysis in this prospective study, which started from May to August 2018. Cox multivariate regression model was used to explore the association between geriatric nutritional risk index (GNRI) and new-onset peripheral artery disease (PAD) in different patients, and restricted cubic splines (RCS) were used to analyze the nonlinear relationship. The mean age of patients with hypertension was 67.6 years at baseline. A total of 279 (5.9%) new-onset PAD cases occurrences over a median observation period of 4 years. GNRI was used to assess nutritional risk in elderly patients with hypertension and calculated after weighting serum albumin and weight loss, and the specific formula was as follows: GNRI = [1.489 × serum albumin (g/L)] + [41.7 × (actual weight/ideal weight)]. PAD was defined as ABI ≤ 0.90 on either side of the limb. The full adjusted Cox regression model showed that compared with the upper tertile (GNRI > 112), the hazard ratio of new PAD in the lower tertile (GNRI < 106) was 2.13 (95%CI: 1.54–2.96) in the total population and 2.52 (95%CI: 1.70–3.73) in the abdominal obesity patients, and nonlinear relationships between GNRI and new-onset PAD were found in the total population and patients with abdominal obesity. However, no association or threshold between GNRI and new-onset PAD was found in patients with non-abdominal obesity. The combined effect showed that the malnutrition-abdominal obesity group had a higher risk of new-onset PAD (HR:2.26, 95%CI: 1.21–4.21). Among Chinese adults with hypertension, a lower GNRI increases the risk of PAD, which may have important implications for risk stratification of PAD, especially in patients with abdominal obesity.