Six novel nutritional-related indicators predict 3-year all-cause mortality among community-dwelling older adults in China: A cohort study based on CLHLS from 2014 to 2018

Malnutrition is a modifiable risk factor for mortality among older adults. However, simple and objective nutritional assessment tools remain limited in community settings. This study examined the associations between 6 nutrition-related indicators and all-cause mortality, aiming to identify the most predictive indicator. Data were obtained from the 2014 to 2018 wave of the Chinese Longitudinal Healthy Longevity Survey. Six nutrition-related indicators were examined: hemoglobin-albumin-lymphocyte-platelet (HALP) score, prognostic nutritional index (PNI), cholesterol-modified PNI (CPNI), triglyceride-total cholesterol-body weight index (TCBI), geriatric nutritional risk index (GNRI), and blood urea nitrogen to serum albumin ratio. Participants were categorized into tertiles for each indicator. Cox proportional hazards models, Kaplan-Meier curves, time-dependent receiver operating characteristic curves, and restricted cubic spline analyses were applied. A total of 1691 older adults were included, and 578 deaths occurred over a median follow-up of 3.3 years. Compared with the lowest tertile, the highest tertile of HALP score, PNI, TCBI, and GNRI were associated with lower mortality risk. In contrast, the highest tertile of CPNI and blood urea nitrogen to serum albumin ratio predicted higher mortality risk. Among these indicators, GNRI demonstrated the highest discriminative performance. restricted cubic spline analyses revealed significant nonlinear dose-response relationships between all-cause mortality and HALP score, CPNI, and TCBI. In conclusion, all 6 indicators were significantly associated with mortality risk, with the GNRI providing more effective predictive value among community-dwelling older adults.