Malnutrition assessed by nutritional risk scores and major adverse cardiovascular and cerebrovascular events in older adults: A systematic review and meta-analysis.

Abstract

Major adverse cardio- and cerebrovascular events (MACCE) are critical determinants of clinical outcomes in older patients. However, the relationship between nutritional status and the prognosis of cardiovascular and cerebrovascular diseases remains underexplored. This meta-analysis investigates the association of commonly used nutritional scores with MACCE in older adults. A systematic search of the Cochrane Library, Embase, PubMed, and Web of Science was conducted up to November 28, 2025, to identify clinical studies examining nutritional scores and MACCE in older adults. The primary outcome was the risk of MACCE. Meta-analyses were performed using RStudio to pool hazard ratios (HRs) with their corresponding 95% confidence intervals (CIs) to quantify the association between various nutritional scores and MACCE. Our meta-analysis included 28 studies comprising 80,860 individuals. Data were stratified based on derivation from univariate or multivariate Cox regression. Pooled results from multivariate-adjusted data revealed that malnutrition, as assessed by the geriatric nutritional risk index (GNRI: HR [95% CI]: 1.38 [1.22, 1.55]), the prognostic nutritional index (PNI: 1.34 [1.02, 1.76]), and the nutritional risk index (NRI: 1.37 [1.08, 1.73]), was significantly associated with an elevated risk of MACCE. Furthermore, increasing scores on the controlling nutritional status (CONUT) index (1.19 [1.12, 1.26]) and decreasing scores on the GNRI (0.95 [0.93, 0.98]) and PNI (0.95 [0.93, 0.97]) were each significantly correlated with a higher risk of MACCE. In conclusion, nutritional scores demonstrate a significant association with the risk of MACCE and its secondary outcomes in the older population.