ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutritional Epidemiology
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1530452
This article is part of the Research TopicThe Relationship between Nutrition and Frailty/Multimorbidity: Prevention and Clinical Nutritional ManagementView all 19 articles
Association of Prognostic Nutritional Index (PNI) with All-Cause Mortality and Cardiovascular Mortality: A Nationwide Population-Based Cohort Study
Provisionally accepted
- 1Department of Anesthesiology, Shenzhen Longhua People's Hospital, Shenzhen, China
- 2The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- 3Shenzhen Longhua Clinical College of Medicine（People's Hospital of Longhua）, Guangdong Medical University, Shenzhen, China
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Background: The Prognostic Nutritional Index (PNI) has shown prognostic value in various diseases, but its association with mortality in the general population remains unclear.Methods: We analyzed data from 30,741 adults in the National Health and Nutrition Examination Survey (NHANES) 2007-2018. Cox proportional hazard models examined the association between PNI and mortality outcomes. Restricted cubic spline analyses were performed to assess nonlinear relationships. Subgroup analyses were conducted to evaluate effect modifications.Results: During follow-up, higher PNI values were associated with lower all-cause mortality (HR:0.95, 95% CI:0.94-0.96) and cardiovascular mortality (HR:0.94, 95% CI:0.93-0.96). Nonlinear relationships were identified with threshold effects at PNI = 50.24 for all-cause mortality and PNI = 51.50 for cardiovascular mortality. The protective associations were particularly strong among participants with liver disease (P for interaction < 0.001).Conclusion: PNI demonstrates significant predictive value for mortality outcomes in the general U.S. adult population, with identified threshold effects. These findings suggest PNI's potential utility as a valuable risk stratification tool in clinical practice.
Keywords: Prognostic Nutritional Index(PNI), Mortality, NHANES, threshold effect, Population-based Study
Received: 18 Nov 2024; Accepted: 12 Jun 2025.
Copyright: © 2025 Zhou, Zhou, Wang, Wang, Liang and Kuang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xin Kuang, Department of Anesthesiology, Shenzhen Longhua People's Hospital, Shenzhen, 518109, China
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