Association between geriatric nutritional risk index and colorectal adenoma risk in an asymptomatic screening population

Abstract

BACKGROUND

Gastrointestinal cancers pose a major global health burden. Nutritional status has also been associated with cancer risk. The geriatric nutritional risk index (GNRI) is a validated tool for assessing nutritional risk. This study investigated the utility of the GNRI in predicting gastrointestinal tumor risk in an asymptomatic population.

AIM

To investigate the association between GNRI and incident gastrointestinal neoplasia in an asymptomatic population undergoing annual health examinations.

METHODS

We retrospectively enrolled 175 consecutive subjects who visited our hospital in January 2020 to December 2023, voluntarily completed a colonoscopy, and had complete baseline data. Demographics, anthropometrics, routine biochemistry, tumor markers, and endoscopic histopathology were collected. GNRI was calculated, and participants were classified as well-nourished, at-risk, or malnourished. Univariable and multivariable logistic regression were used to analyze the relationship between GNRI and colorectal neoplasia. Receiver operating characteristic analysis was performed to assess GNRI’s discriminative ability for colorectal adenoma.

RESULTS

According to the GNRI, 86 (49.1%) participants were well-nourished, 62 (35.4%) were at risk, and 27 (15.4%) were malnourished. Polyp detection rates were 38.4%, 56.5%, and 70.4%, and adenoma detection rates were 22.1%, 45.2%, and 58.3% (P < 0.05). Malnourished individuals had the highest proportion of advanced adenomas (P < 0.05). Multivariable analysis identified age [odds ratio (OR) = 1.037; 95% confidence interval (CI): 1.003-1.072], triglycerides (OR = 1.468; 95%CI: 1.036-2.080) and carcinoembryonic antigen (OR = 1.254; 95%CI: 1.053-1.493) as independent risk factors, whereas GNRI (OR = 0.692; 95%CI: 0.589-0.813), albumin (OR = 0.815; 95%CI: 0.722-0.920) and body mass index (OR = 0.889; 95%CI: 0.803-0.984) were independent protective factors (all P < 0.05). The area under the curve (AUC) of GNRI for predicting adenoma was 0.874 (95%CI: 0.77-0.92), outperforming albumin alone (AUC = 0.743) and body mass index alone (AUC = 0.656). At the optimal cutoff of 95.6, GNRI yielded sensitivity and specificity of 84.5% and 81.2%, respectively.

CONCLUSION

GNRI is a powerful and reliable predictor of colorectal premalignant lesions in health-screening settings and effectively stratifies adenoma risk across nutritional states. GNRI has potential as an adjunctive risk-stratification tool.

Keywords: Geriatric nutritional risk index; Colorectal adenoma; Nutritional assessment; Risk of occurrence; Predictive performance

Core Tip: This health screening-based cohort study demonstrates that the geriatric nutritional risk index (GNRI) effectively stratifies the risk of colorectal premalignant lesions in asymptomatic adults. With an optimal cutoff of 95.6, the GNRI predicted adenoma occurrence with high accuracy (area under the curve = 0.874), outperforming individual measurements of serum albumin or body mass index. Lower GNRI values were independently associated with increased adenoma detection rates and advanced histology, supporting the use of the GNRI as a simple, noninvasive tool for prioritizing high-risk individuals for gastrointestinal tumor surveillance.