Association of the Geriatric Nutritional Risk Index with CognitiveFunction Level and Cognitive Impairment among Older Adults withCardiometabolic Disease

Introduction: This study aimed to assess the association of Geriatric Nutritional Risk Index (GNRI) with cognitive function level and cognitive impairment risk among older adults with cardiometabolic disease using data from the National Health and Nutrition Examination Survey (NHANES). Methods: Using cross-sectional data from the NHANES, this research included 1,937 participants aged 60 years or older with at least one cardiometabolic disease (diabetes, hypertension, stroke, or congestive heart failure). Cognitive function was assessed using the CERAD tests, Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST). Multivariable linear and logistic regression analyses were used to estimate the β coefficients and odds ratios (ORs) with 95% confidence intervals (CIs) for the associations of GNRI with cognitive function level and risk of cognitive impairment. Results: A total of 1937 participants aged≥60 years with cardiometabolic disease were included. The results showed that per 1-SD increase in GNRI was associated with increased cognitive function levels, including CERAD: Trial 1 (β=0.11, 95% CI: 0.03-0.19), CERAD: Trial 3 (β=0.12, 95% CI: 0.04-0.21), CERAD: Delayed Recall (β=0.21, 95% CI: 0.11-0.32), CERAD test (β=0.53, 95% CI: 0.23-0.82), and AFT (β=0.34, 95% CI: 0.11-0.57) scores. Restricted cubic splines showed significantly positive linear dose-response associations between GNRI and cognitive function. Compared to participants with the lowest quartile (Q1) of GNRI, those with the highest quartile (Q4) had a lower cognitive impairment risk (OR=0.59, 95% CI: 0.41-0.85). Discussion: Potential mechanisms underlying GNRI’s protective effect against cognitive impairment may involve the pleiotropic neuroprotection of albumin and body mass index-mediated brain structural changes. Conclusion: Higher GNRI is independently associated with better cognitive function and reduced risk of cognitive impairment in older adults with cardiometabolic diseases. To mitigate cognitive risk, implementing GNRI screening may identify high-risk older adults with cognitive impairment, prompting timely nutritional support that improves cognitive health and disease management.