ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
Association between Geriatric Nutritional Risk Index (GNRI) and All-Cause Mortality in Centenarians, with a Focus on Nonlinear and Threshold Effects: A Multi-Method Observational Study
Provisionally accepted
- 1Lanzhou University Second Hospital, Lanzhou, China
- 2Department of Neurology, the First Affiliated Hospital of Dalian Medical University, Dalian, China
- 3Qinghai University Affiliated Hospital, Xining, China
- 4Central Laboratory,Hainan Hospital of ChinesePeople's Liberation Army General Hospital, Hainan, China
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Background: The Geriatric Nutritional Risk Index (GNRI) is a simple index for assessing nutritional status in older adults. Its association with mortality has been shown in general elderly populations, but data in centenarians are scarce. We aimed to examine the relationship between GNRI and all-cause mortality in centenarians. Methods: We included 1002 centenarians with complete clinical and follow-up data and categorized them into quartiles according to GNRI. All-cause mortality was the primary endpoint. Cox proportional hazards models, restricted cubic splines, subgroup analyses and sensitivity analyses were used to evaluate the association between GNRI and mortality. To enhance robustness, propensity score matching (PSM) was performed. Results: Among the 1002 centenarians (18% male), the overall mortality rate was 92.7%. In multivariable Cox models, GNRI was inversely associated with mortality (per 1-unit increase: HR 0.97, 95% CI 0.96–0.98, p < 0.001). Restricted cubic spline analysis showed a nonlinear relationship between GNRI and mortality, with a gradual increase in death risk at lower GNRI values. A clear threshold was identified at GNRI = 96.378. When GNRI < 96.378, each 1-unit increase in GNRI was associated with a 4% reduction in mortality risk (HR 0.96, p < 0.001), whereas when GNRI ≥96.378, mortality risk no longer changed significantly (HR 1.01, p = 0.443). Subgroup analyses showed no significant interactions between GNRI and most covariates, except sex, and this pattern persisted after PSM. PSM-based sensitivity analyses yielded consistent results: the inverse association between GNRI and mortality remained (per 1-unit increase: HR 0.98, 95% CI 0.97–0.99, p < 0.001), and the threshold effect at GNRI = 96.378 was confirmed (GNRI < 96.378: HR 0.95, p < 0.001; GNRI ≥96.378: HR 1.02, p = 0.136). Conclusion: GNRI is strongly and nonlinearly associated with all-cause mortality in centenarians, with a key threshold around 96. This threshold may provide a quantitative target for individualized nutritional assessment and intervention in this extremely old population.
Keywords: All-cause mortality, centenarians, Geriatric Nutritional Risk Index, Malnutrition, Nutritional risk assessment
Received: 09 Nov 2025; Accepted: 03 Feb 2026.
Copyright: © 2026 Liu, Tang, Wang, Xie, Huang, Zhu and Zheng. 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:
Qiao Zhu
Xining Zheng
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