Evidence mapPaperPMID 42499111Full record

ArticleMedicine2026

Combined nutritional indices and DSST-defined cognitive performance in relation to all-cause mortality in older adults: A population-based analysis using NHANES 2011 to 2014 with mortality follow-up.

Xian Wu, Junpeng Wang, Jun Zheng, Tianming Zhao, Kecheng Yao

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Article in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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4 · The record

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5 · Who and what money

Authors and funding

5 authors.

Xian WuDepartment of Geriatrics, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China.ORCID 0009-0006-9427-9672
Junpeng WangDepartment of Geriatrics, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China.
Jun ZhengDepartment of Clinical Nutrition, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China.
Tianming ZhaoClinical Medical Research Center for Precision Diagnosis and Treatment of Lung Cancer and Management of Advanced Cancer Pain of Hubei Province, Yichang, China.
Kecheng YaoDepartment of Geriatrics, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China.

Funding

the Natural Science Foundation of Hubei Province 2024AFB296the Science Foundation of China Three Gorges University 2023PTCM11)the Yichang Medical and Health Research Project A23-1-025
6 · The paper itself

Abstract

Malnutrition and cognitive impairment are 2 common and interrelated conditions among older adults, each of which is linked to adverse health outcomes. Previous studies have usually examined these factors separately, and less is known about their combined association with mortality. This study examined whether the coexistence of nutritional risk (NR), defined using multiple nutritional indices, and digit symbol substitution test (DSST)-defined low cognitive performance was associated with all-cause mortality in older adults. Data were obtained from the National Health and Nutrition Examination Survey 2011 to 2014 with mortality follow-up through 2019. Nutritional status was evaluated using 3 validated indices that capture distinct dimensions of nutritional health: the Geriatric Nutritional Risk Index, Prognostic Nutritional Index, and Controlling Nutritional Status. Participants were classified as having high NR if any index indicated abnormal status. DSST-defined low cognitive performance was defined as a digit symbol substitution test score below the 25th percentile. Survey-weighted Cox regression models were applied to estimate hazard ratios and 95% confidence intervals for all-cause mortality after adjustment for demographic, socioeconomic, and clinical covariates. Among 1937 participants aged 60 years or older, 338 deaths occurred during a median follow-up of 6.6 years. In fully adjusted models, neither DSST-defined low cognitive performance nor high NR alone was significantly associated with mortality. Participants with both high NR and DSST-defined low cognitive performance had a higher mortality hazard (hazard ratio = 1.60; 95% confidence interval: 1.24-2.06; P = .032). Survival analysis revealed a gradual increase in mortality risk across the 4 combined exposure categories. The coexistence of high NR and DSST-defined low cognitive performance was associated with higher all-cause mortality among older adults and should be interpreted as a joint risk profile rather than evidence of synergy. These findings support the potential value of considering nutritional and cognitive information together in geriatric risk assessment.

Indexed as

CognitionCognitive DysfunctionMalnutritionMortalityNutritional StatusNutrition AssessmentAgedAged, 80 and overCause of DeathFemaleFollow-Up StudiesGeriatric AssessmentHumansMaleMiddle AgedNutrition Surveyscognitive performanceCONUTDSSTGNRImortalitynutritional riskPNI

Identifiers

PMID42499111
PMCPMC13406369

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.