{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T16:56:06Z","timestamp":1781283366388,"version":"3.54.1"},"reference-count":43,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Endocrino Diabet &amp;amp; Metabol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The metabolic vulnerability index (MVX)\u2014a composite biomarker reflecting metabolic malnutrition and inflammation\u2014has been linked to increased mortality risk in populations with cardiovascular disease. Thyroid function, a key regulator of metabolism and inflammation, may confound or modify this relationship, but evidence in the general population is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the interplay between MVX and its subcomponents (inflammation vulnerability index, IVX and metabolic malnutrition index, MMX), thyroid function, and mortality risk in the general population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In the PREVEND prospective study, which included 5446 participants (mean age 54\u2009years; 49.9% male), both MVX (estimated using six metabolites measured simultaneously through nuclear magnetic resonance spectroscopy) and thyroid function (FT3, FT4, TSH) were evaluated at baseline. Hazard ratios (HRs) with 95% confidence intervals (CIs) for all\u2010cause mortality were estimated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During a median follow\u2010up of 14.1\u2009years, 806 deaths were recorded. Spline analyses showed graded dose\u2013response relationships of MVX, IVX and MMX with mortality risk. In separate analyses adjusted for several established risk factors, the HRs (95% CIs) of mortality were 1.28 (1.18\u20131.38), 1.23 (1.14\u20131.32) and 1.16 (1.07\u20131.25) per 1 standard deviation increment in MVX, IVX and MMX, respectively. The HRs remained consistent on further adjustment for FT3, FT4 and TSH. Sex as well as levels of FT3, FT4 and TSH did not significantly modify the associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The MVX and its subcomponents (IVX and MMX) are independently associated with all\u2010cause mortality, consistent with graded dose\u2013response relationships. Thyroid function does not confound or modify these associations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/edm2.70162","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T18:24:13Z","timestamp":1770402253000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations of Multimarkers of Metabolic Malnutrition and Inflammation With All\u2010Cause Mortality and Their Interplay With Thyroid Function"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2625-0273","authenticated-orcid":false,"given":"Setor K.","family":"Kunutsor","sequence":"first","affiliation":[{"name":"Section of Cardiology, Department of Internal Medicine, Rady Faculty of Health Sciences University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reyhaneh","family":"Rikhtehgaran","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Internal Medicine, Rady Faculty of Health Sciences University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanning","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Academic Center for Thyroid Diseases Erasmus University Medical Center  Rotterdam the Netherlands"},{"name":"Department of Epidemiology Erasmus University Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margery A.","family":"Connelly","sequence":"additional","affiliation":[{"name":"Labcorp  Morrisville North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Shalaurova","sequence":"additional","affiliation":[{"name":"Labcorp  Morrisville North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Layal","family":"Chaker","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Academic Center for Thyroid Diseases Erasmus University Medical Center  Rotterdam the Netherlands"},{"name":"Department of Epidemiology Erasmus University Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan J. L.","family":"Bakker","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen University of Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin P. 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