{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T21:50:54Z","timestamp":1783720254594,"version":"3.55.0"},"reference-count":34,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T00:00:00Z","timestamp":1701216000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The geriatric nutritional risk index (GNRI) is an easily calculable index that can be determined using three common clinical variables. The GNRI is suggested to be related to sarcopenia in cirrhotic patients. However, the relationship between the GNRI and the prognosis in patients with liver cirrhosis (LC) has not been reported. The aim of the present research is to study the association of the GNRI with the nutritional status, hepatic function reserve, and prognosis in patients with liver cirrhosis (LC). Materials and Methods: A total of 370 cirrhotic patients whose nutritional statuses were evaluated using anthropometric measurements and bioimpedance analysis were studied. The associations between the GNRI and nutritional status and the GNRI and hepatic function reserve were analyzed. We also investigated the GNRI and prognosis of patients with LC. Results: The median age of the enrolled patients was 66 years old, and 266 (71.9%) patients had viral hepatitis-related LC. The GNRI was shown to decrease with the progression of chronic liver disease, represented by an increased FIB-4 index and severe Child\u2013Pugh and mALBI grades. In addition, a low GNRI (&lt;92) was associated with severe cirrhosis-related metabolic disorders, including a low branched-chain amino acid-to-tyrosine ratio (BTR) and a low zinc value. The GNRI was positively correlated with two nutrition-related anthropometric variables (% arm circumference and % arm muscle circumference), and a low GNRI was related to a low skeletal muscle mass index (SMI) (&lt;7.0 kg\/m2 for men or &lt;5.7 kg\/m2 for women), as determined by using bioimpedance analysis. In addition, patients with a low GNRI (&lt;92) had a poorer prognosis than those with a high GNRI (\u226592) (log-rank test: p = 0.0161, and generalized Wilcoxon test, p = 0.01261). Conclusions: Our results suggest that a low GNRI is related to severe chronic liver disease, low muscle volume, and a poor prognosis of patients with cirrhosis.<\/jats:p>","DOI":"10.3390\/medicina59122099","type":"journal-article","created":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T12:01:00Z","timestamp":1701259260000},"page":"2099","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Low Geriatric Nutritional Risk Index Is Associated with Low Muscle Volume and a Poor Prognosis among Cirrhotic Patients"],"prefix":"10.3390","volume":"59","author":[{"given":"Hirayuki","family":"Enomoto","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukihisa","family":"Yuri","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5517-8303","authenticated-orcid":false,"given":"Takashi","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoto","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoyuki","family":"Takashima","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhiro","family":"Aizawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamiko","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohei","family":"Yoshihara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Yoshioka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoki","family":"Kawata","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuta","family":"Kawase","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1844-2865","authenticated-orcid":false,"given":"Ryota","family":"Nakano","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Shiomi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Fukunishi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7051-618X","authenticated-orcid":false,"given":"Shinichiro","family":"Shinzaki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroko","family":"Iijima","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hyogo Medical University, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3533","DOI":"10.1016\/j.clnu.2020.09.001","article-title":"ESPEN practical guideline: Clinical nutrition in liver disease","volume":"39","author":"Bischoff","year":"2020","journal-title":"Clin. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2019). EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J. Hepatol., 70, 172\u2013193.","DOI":"10.1016\/j.jhep.2018.06.024"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1002\/hep.32049","article-title":"Malnutrition, Frailty, and Sarcopenia in Patients with Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases","volume":"74","author":"Lai","year":"2021","journal-title":"Hepatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1093\/ajcn\/82.4.777","article-title":"Geriatric Nutritional Risk Index: A new index for evaluating at-risk elderly medical patients","volume":"82","author":"Bouillanne","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.amjcard.2022.10.016","article-title":"Meta-Analysis on the Association Between Nutritional Status and Outcomes after Transcatheter Aortic Valve Implantation","volume":"186","author":"Kazemian","year":"2023","journal-title":"Am. J. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Nakagawa, N., Maruyama, K., and Hasebe, N. (2021). Utility of Geriatric Nutritional Risk Index in Patients with Chronic Kidney Disease: A Mini-Review. Nutrients, 13.","DOI":"10.3390\/nu13113688"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1186\/s12935-020-01628-7","article-title":"Geriatric nutritional risk index as a predictor of complications and long-term outcomes in patients with gastrointestinal malignancy: A systematic review and meta-analysis","volume":"20","author":"Xie","year":"2020","journal-title":"Cancer Cell Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"865","DOI":"10.21873\/invivo.12775","article-title":"The Geriatric Nutritional Risk Index Predicts Tolerability of Lenvatinib in Patients with Hepatocellular Carcinoma","volume":"36","author":"Kinoshita","year":"2022","journal-title":"In Vivo"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1055\/a-2091-2072","article-title":"Geriatric Nutritional Risk Index and the Survival of Patients with Hepatocellular Carcinoma: A Meta-Analysis","volume":"55","author":"Xu","year":"2023","journal-title":"Horm. Metab. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1111\/hepr.13934","article-title":"Geriatric nutritional risk index as an easy-to-use assessment tool for nutritional status in hepatocellular carcinoma treated with atezolizumab plus bevacizumab","volume":"53","author":"Hiraoka","year":"2023","journal-title":"Hepatol. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1007\/s11605-023-05624-w","article-title":"Impact of Geriatric Nutritional Risk Index After Initial Hepatectomy for Hepatocellular Carcinoma: A Retrospective Cohort Study with the Hiroshima Surgical Study Group of Clinical Oncology (HiSCO)","volume":"27","author":"Imaoka","year":"2023","journal-title":"J. Gastrointest. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e32322","DOI":"10.1097\/MD.0000000000032322","article-title":"Geriatric nutritional risk index as a prognostic factor in patients with hepatocellular carcinoma following transarterial chemoembolization: A retrospective study","volume":"101","author":"Si","year":"2022","journal-title":"Medicine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3888","DOI":"10.1038\/s41598-023-31065-1","article-title":"The Geriatric Nutritional Risk Index predicts sarcopenia in patients with cirrhosis","volume":"13","author":"Saeki","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1007\/s00535-020-01748-x","article-title":"The transition in the etiologies of hepatocellular carcinoma-complicated liver cirrhosis in a nationwide survey of Japan","volume":"56","author":"Enomoto","year":"2021","journal-title":"J. Gastroenterol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1002\/hep.21178","article-title":"Development of a simple noninvasive index to predict significant fibrosis in patients with HIV\/HCV coinfection","volume":"43","author":"Sterling","year":"2006","journal-title":"Hepatology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1200\/JCO.2014.57.9151","article-title":"Assessment of liver function in patients with hepatocellular carcinoma: A new evidence-based approach-the ALBI grade","volume":"33","author":"Johnson","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1159\/000479984","article-title":"Validation and Potential of Albumin-Bilirubin Grade and Prognostication in a Nationwide Survey of 46,681 Hepatocellular Carcinoma Patients in Japan: The Need for a More Detailed Evaluation of Hepatic Function","volume":"6","author":"Hiraoka","year":"2017","journal-title":"Liver Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1159\/000528081","article-title":"Increased Spleen Volume in Hepatocellular Carcinoma Patients Treated with Atezolizumab plus Bevacizumab in Comparison to Lenvatinib: A Retrospective Analysis","volume":"101","author":"Hatanaka","year":"2023","journal-title":"Oncology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.2169\/internalmedicine.4298-19","article-title":"The Molar Ratio of Total Branched-chain Amino Acids to Tyrosine Predicts a Digit Symbol Test Abnormality in Cirrhotic Patients","volume":"59","author":"Mizuno","year":"2020","journal-title":"Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"6019","DOI":"10.21873\/anticanres.16113","article-title":"Prognostic Nutrition Index as an Indicator of Therapeutic Response to Lenvatinib Therapy in Hepatocellular Carcinoma","volume":"42","author":"Shibano","year":"2022","journal-title":"Anticancer Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1002\/hep4.1782","article-title":"Oral Zinc Supplementation Decreases the Risk of HCC Development in Patients With HCV Eradicated by DAA","volume":"5","author":"Hosui","year":"2021","journal-title":"Hepatol. Commun."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ullah, M.I., Alameen, A.A.M., Al-Oanzi, Z.H., Eltayeb, L.B., Atif, M., Munir, M.U., and Ejaz, H. (2023). Biological Role of Zinc in Liver Cirrhosis: An Updated Review. Biomedicines, 11.","DOI":"10.3390\/biomedicines11041094"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"687","DOI":"10.21873\/invivo.11825","article-title":"The Anthropometric Assessment With the Bioimpedance Method Is Associated With the Prognosis of Cirrhotic Patients","volume":"34","author":"Moriwaki","year":"2020","journal-title":"In Vivo"},{"key":"ref_24","first-page":"1","article-title":"Japanese anthropometric reference data 2001 (JARD 2001)","volume":"19","author":"Hosoya","year":"2002","journal-title":"Jpn. J. Nutr. Assess."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1111\/hepr.12774","article-title":"Japan Society of Hepatology guidelines for sarcopenia in liver disease (1st edition): Recommendation from the working group for creation of sarcopenia assessment criteria","volume":"46","author":"Nishikawa","year":"2016","journal-title":"Hepatol. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1111\/hepr.12112","article-title":"Free fatty acid as a marker of energy malnutrition in liver cirrhosis","volume":"44","author":"Hanai","year":"2014","journal-title":"Hepatol. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment","volume":"21","author":"Chen","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1111\/hepr.13679","article-title":"Reduced handgrip strength predicts poorer survival in chronic liver diseases: A large multicenter study in Japan","volume":"51","author":"Nishikawa","year":"2021","journal-title":"Hepatol. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"afad152","DOI":"10.1093\/ageing\/afad152","article-title":"The accuracy of screening instruments for sarcopenia: A diagnostic systematic review and meta-analysis","volume":"52","author":"Huang","year":"2023","journal-title":"Age Ageing"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1111\/ggi.14464","article-title":"Utility of SARC-F in daycare facilities for older people","volume":"22","author":"Kera","year":"2022","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"803924","DOI":"10.3389\/fnut.2022.803924","article-title":"Comparing SARC-CalF With SARC-F for Screening Sarcopenia in Adults With Type 2 Diabetes Mellitus","volume":"9","author":"Xu","year":"2022","journal-title":"Front. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e29568","DOI":"10.1097\/MD.0000000000029568","article-title":"Evaluation of SARC-F and SARC-CalF for sarcopenia screening in patients with chronic musculoskeletal pain: A prospective cross-sectional study","volume":"101","author":"Tsuji","year":"2022","journal-title":"Medicine"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.1002\/jcsm.13268","article-title":"Simple method for predicting muscle volume loss using geriatric nutritional risk index in hepatocellular carcinoma patients","volume":"14","author":"Hiraoka","year":"2023","journal-title":"J. Cachexia Sarcopenia Muscle"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/12\/2099\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:34:02Z","timestamp":1760132042000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/12\/2099"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,29]]},"references-count":34,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["medicina59122099"],"URL":"https:\/\/doi.org\/10.3390\/medicina59122099","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,29]]}}}