Poor nutrition scores predict mortality risk beyond body weight

Poor nutritional status was associated with higher mortality risk in an overweight population, highlighting risks that BMI alone may miss.

In a recent study published in Nutrients, researchers examined associations between nutritional status, particularly its prevalence, clinical determinants, and prognostic impacts, and long-term human survival. The study focused on individuals enrolled in the LIFE-Adult Study, a large, long-term cohort of 8,398 urban residents from Leipzig, Germany.

Why malnutrition can hide in plain sight

This gap partly reflects the prevalent assumption that populations in industrial societies, such as Europe and North America, reside in nutritional abundance. This assumption suggests that caloric oversupply and rising body mass index (BMI) are likely more prevalent clinical concerns, driving increased research in these areas. Nevertheless, systematic attempts to test this assumption remain limited.

How researchers measured nutritional risk

The present study aimed to address this knowledge gap and help direct future community-scale nutritional research by evaluating associations between four previously validated nutritional indices and subsequent all-cause mortality risk among 8,398 adults from the LIFE-Adult Study in Leipzig, Germany. Researchers tracked participants for a median follow-up of about 7.5 years to examine whether objective, laboratory-derived nutritional scores were associated with subsequent all-cause mortality.

The four nutritional scoring systems were the Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT) score, Nutritional Risk Index (NRI), and Triglyceride Cholesterol Body Weight Index (TCBI). At baseline, researchers divided participants into three groups by PNI, NRI, and TCBI scores.

Researchers grouped CONUT scores separately because their distribution did not allow the same three-way division. During the follow-up period, 444 participants died from all causes. Multivariable Cox proportional hazards regression models were used to assess associations between the nutritional scores and mortality after adjusting for demographic, socioeconomic, behavioral, and preexisting chronic health conditions.

Poorer nutrition scores tracked with higher mortality

At baseline, the cohort had an average BMI of 27.5 kg/m². About two-thirds of participants were classified as overweight or obese, while only 1% were underweight.

Survival analyses showed that poorer baseline nutritional status was associated with a higher risk of all-cause mortality. After adjustment for potential confounders, participants in the lowest PNI group had more than twice the hazard of death compared with those in the highest group.

The lowest NRI group was similarly associated with about twice the hazard of death, while the highest CONUT category was associated with an almost three-fold higher hazard. By comparison, TCBI showed no independent association with mortality after adjustment.

Could routine nutritional screening improve risk assessment?

Researchers found that poorer nutritional status was independently associated with higher all-cause mortality after adjusting for multiple potential confounding factors. The observational design does not establish that poor nutritional status caused the higher mortality risk, and the authors cautioned against using PNI as a standalone clinical decision tool.

These findings support further study of standardized nutritional assessment in routine care. Prospective studies and clinical trials are needed to determine whether adding nutritional scores to risk assessment, or acting on the results, improves health outcomes.

Notably, LIFE-Adult participants may have been healthier and more health-conscious than nonparticipants, which may limit how broadly the findings apply and could underestimate the prevalence of nutritional deficiencies.

Journal reference:

• Mühlberg, K. S., Steiner, S., Elbaranes, N., et al. (2026). Nutritional Status in a Contemporary Urban Population-Based Cohort: Prevalence, Clinical Associations and Long-Term Health Outcomes. Nutrients 18(19); 3228. DOI: 10.3390/nu18193228. https://www.mdpi.com/2072-6643/18/19/3228