{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T15:57:59Z","timestamp":1764172679507,"version":"build-2065373602"},"reference-count":45,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"JSPS KAKENHI","doi-asserted-by":"publisher","award":["JP23K08669"],"award-info":[{"award-number":["JP23K08669"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Malnutrition, which is closely associated with frailty and sarcopenia, is common in older adults and is linked to adverse perioperative complications in musculoskeletal surgery. However, its influence on postoperative health-related quality of life (HRQOL) remains unclear. This study aimed to investigate the impact of preoperative malnutrition on HRQOL one year after surgery in elderly patients with degenerative cervical myelopathy (DCM). Methods: We retrospectively analyzed 188 patients aged \u2265 65 years who underwent elective surgery for DCM between 2017 and 2024. Preoperative nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), with GNRI \u2264 98 indicating malnutrition risk. Patient-reported outcome measures were assessed using the EuroQol Five-Dimension Questionnaire (EQ-5D) both preoperatively and at one year postoperatively. The minimum clinically important difference (MCID) threshold was applied to evaluate significant changes. Multivariate logistic regression was used to identify independent risk factors for postoperative deterioration in EQ-5D score. Results: Of the 188 patients, 35 were classified as having malnutrition risk. While preoperative EQ-5D scores were comparable between the two groups, the postoperative EQ-5D score was significantly lower in the malnutrition risk group than in the no-risk group (0.58 vs. 0.67, p = 0.003). Deterioration in EQ-5D scores exceeding the MCID threshold occurred more frequently in the malnutrition risk group (37.1% vs. 21.2%, p = 0.049). Furthermore, multivariate analysis identified preoperative GNRI \u2264 98 as an independent risk factor for deterioration in EQ-5D score exceeding the MCID threshold (OR 2.40, 95% CI 1.03\u20135.52). Conclusions: Preoperative malnutritional status was significantly associated with impaired postoperative HRQOL in elderly patients with DCM. These findings highlight the need for preoperative nutritional assessment and optimization in this vulnerable population.<\/jats:p>","DOI":"10.3390\/nu17182912","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T12:15:17Z","timestamp":1757420117000},"page":"2912","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Preoperative Malnutrition on Postoperative Quality of Life in Older Adults Undergoing Surgery for Degenerative Cervical Myelopathy: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2329-123X","authenticated-orcid":false,"given":"Yuki","family":"Taniguchi","sequence":"first","affiliation":[{"name":"Surgical Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan"},{"name":"Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hideki","family":"Nakamoto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"So","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4908-309X","authenticated-orcid":false,"given":"Hiroyuki","family":"Nakarai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4495-1134","authenticated-orcid":false,"given":"Kosei","family":"Nagata","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichi","family":"Kono","sequence":"additional","affiliation":[{"name":"Surgical Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan"},{"name":"Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuhei","family":"Saito","sequence":"additional","affiliation":[{"name":"Surgical Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reo","family":"Inoue","sequence":"additional","affiliation":[{"name":"Surgical Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Okawa","sequence":"additional","affiliation":[{"name":"Surgical Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sakae","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasushi","family":"Oshima","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuhiko","family":"Fukatsu","sequence":"additional","affiliation":[{"name":"Surgical Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"unstructured":"United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019: Highlights, United Nations. ST\/ESA\/SER.A\/423.","key":"ref_1"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e2450241","DOI":"10.1001\/jamanetworkopen.2024.50241","article-title":"Global healthspan-lifespan gaps among 183 World Health Organization Member States","volume":"7","author":"Garmany","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/S0140-6736(22)02612-5","article-title":"Malnutrition in older adults","volume":"401","author":"Dent","year":"2023","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1016\/j.jamda.2020.03.006","article-title":"Frailty, sarcopenia, and malnutrition frequently (co-)occur in hospitalized older adults: A systematic review and meta-analysis","volume":"21","author":"Luiking","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"doi-asserted-by":"crossref","unstructured":"Roberts, S., Collins, P., and Rattray, M. (2021). Identifying and managing malnutrition, frailty and sarcopenia in the community: A narrative review. Nutrients, 13.","key":"ref_5","DOI":"10.3390\/nu13072316"},{"doi-asserted-by":"crossref","unstructured":"Bloom, I., Shand, C., Cooper, C., Robinson, S., and Baird, J. (2018). Diet Quality and Sarcopenia in Older Adults: A Systematic Review. Nutrients, 10.","key":"ref_6","DOI":"10.3390\/nu10030308"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1002\/jpen.2028","article-title":"Perioperative Immunonutrition in Elderly Patients Undergoing Total Hip and Knee Arthroplasty: Impact on Postoperative Outcomes","volume":"45","author":"Nava","year":"2021","journal-title":"J. Parenter. Enteral Nutr."},{"doi-asserted-by":"crossref","unstructured":"Gregori, P., Franceschetti, E., Basciani, S., Impieri, L., Zampogna, B., Matano, A., Manzi, C., Carbone, L., Marano, L., and Papalia, R. (2023). Immunonutrition in Orthopedic and Traumatic Patients. Nutrients, 15.","key":"ref_8","DOI":"10.3390\/nu15030537"},{"doi-asserted-by":"crossref","unstructured":"Norman, K., Ha\u00df, U., and Pirlich, M. (2021). Malnutrition in Older Adults-Recent Advances and Remaining Challenges. Nutrients, 13.","key":"ref_9","DOI":"10.3390\/nu13082764"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1097\/BRS.0000000000001969","article-title":"Poor nutrition status and lumbar spine fusion surgery in the elderly: Readmissions, complications, and mortality","volume":"42","author":"Puvanesarajah","year":"2017","journal-title":"Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1302\/0301-620X.102B12.BJJ-2020-0874.R1","article-title":"Predicting postoperative complications in patients undergoing lumbar spinal fusion by using the modified five-item frailty index and nutritional status","volume":"102-B","author":"Kang","year":"2020","journal-title":"Bone Joint J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1007\/s00586-020-06622-1","article-title":"Does preoperative prognostic nutrition index predict surgical site infection after spine surgery?","volume":"30","author":"Ushirozako","year":"2021","journal-title":"Eur. Spine J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1097\/BRS.0000000000002119","article-title":"Nutritional status as an adjunct risk factor for early postoperative complications following posterior cervical fusion","volume":"42","author":"Lee","year":"2017","journal-title":"Spine"},{"doi-asserted-by":"crossref","unstructured":"EuroQol Group (1990). EuroQol\u2014A new facility for the measurement of health-related quality of life. Health Policy, 16, 199\u2013208.","key":"ref_14","DOI":"10.1016\/0168-8510(90)90421-9"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1002\/hec.673","article-title":"Estimating an EQ-5D population value set: The case of Japan","volume":"11","author":"Tsuchiya","year":"2002","journal-title":"Health Econ."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1007\/s00586-019-05945-y","article-title":"Minimum clinically important difference in outcome scores among patients undergoing cervical laminoplasty","volume":"28","author":"Kato","year":"2019","journal-title":"Eur. Spine J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.wneu.2016.09.011","article-title":"Patient satisfaction with posterior decompression surgery for cervical ossification of the posterior longitudinal ligament: Prognostic radiographic factors and patient-reported outcomes for the effectiveness of surgical treatment","volume":"96","author":"Ohya","year":"2016","journal-title":"World Neurosurg."},{"doi-asserted-by":"crossref","unstructured":"Nakajima, K., Miyahara, J., Ohtomo, N., Nagata, K., Kato, S., Doi, T., Matsubayashi, Y., Taniguchi, Y., Kawamura, N., and Higashikawa, A. (2023). Impact of body mass index on outcomes after lumbar spine surgery. Sci. Rep., 13.","key":"ref_18","DOI":"10.1038\/s41598-023-35008-8"},{"key":"ref_19","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."},{"doi-asserted-by":"crossref","unstructured":"Sasaki, M., Miyoshi, N., Fujino, S., Ogino, T., Takahashi, H., Uemura, M., Matsuda, C., Yamamoto, H., Mizushima, T., and Mori, M. (2020). The geriatric nutritional risk index predicts postoperative complications and prognosis in elderly patients with colorectal cancer after curative surgery. Sci. Rep., 10.","key":"ref_20","DOI":"10.1038\/s41598-020-67285-y"},{"doi-asserted-by":"crossref","unstructured":"Kanno, H., Goto, Y., Sasaki, S., Fukutomi, S., Hisaka, T., Fujita, F., Akagi, Y., and Okuda, K. (2021). Geriatric nutritional risk index predicts prognosis in hepatocellular carcinoma after hepatectomy: A propensity score matching analysis. Sci. Rep., 11.","key":"ref_21","DOI":"10.1038\/s41598-021-88254-z"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.numecd.2017.02.003","article-title":"Geriatric nutritional risk index as a nutritional and survival risk assessment tool in stable outpatients with systolic heart failure","volume":"27","author":"Sargento","year":"2017","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"23094990211006869","DOI":"10.1177\/23094990211006869","article-title":"Preoperative prognostic nutritional index as a predictive factor for medical complication after cervical posterior decompression surgery: A multicenter study","volume":"29","author":"Kurosu","year":"2021","journal-title":"J. Orthop. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e260","DOI":"10.1016\/j.wneu.2024.06.030","article-title":"The geriatric nutritional risk index is an independent predictor for adverse outcomes after anterior cervical discectomy and fusion","volume":"189","author":"Alam","year":"2024","journal-title":"World Neurosurg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"866","DOI":"10.14444\/8551","article-title":"Use of the geriatric nutritional risk index to assess risk for postoperative complications following posterior cervical decompression\/fusion","volume":"17","author":"Mendiratta","year":"2023","journal-title":"Int. J. Spine Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e70170","DOI":"10.1002\/jeo2.70170","article-title":"Geriatric Nutritional Risk Index is a risk factor for long-term decreases in patient-reported outcome measures following total knee arthroplasty","volume":"12","author":"Kokubu","year":"2025","journal-title":"J. Exp. Orthop."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s11657-024-01469-1","article-title":"Prognostic nutritional index (PNI) is an independent predictor for functional outcome after hip fracture in the elderly: A prospective cohort study","volume":"19","author":"Chen","year":"2024","journal-title":"Arch. Osteoporos."},{"doi-asserted-by":"crossref","unstructured":"Crovetto Mattassi, M., Henr\u00edquez Mella, C., and P\u00e9rez Bocaz, L. (2022). Association between sarcopenia and nutritional status in Chilean older people aged 65 years and older. Nutrients, 14.","key":"ref_28","DOI":"10.3390\/nu14245228"},{"doi-asserted-by":"crossref","unstructured":"Papadopoulou, S.K., Papadimitriou, K., Voulgaridou, G., Georgaki, E., Tsotidou, E., Zantidou, O., and Papandreou, D. (2021). Exercise and nutrition impact on osteoporosis and sarcopenia-the incidence of osteosarcopenia: A narrative review. Nutrients, 13.","key":"ref_29","DOI":"10.3390\/nu13124499"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"33","DOI":"10.3928\/00989134-20160613-03","article-title":"Association between sarcopenia and nutritional status in older adults: A systematic literature review","volume":"42","author":"Eglseer","year":"2016","journal-title":"J. Gerontol. Nurs."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/s10143-025-03398-0","article-title":"Sarcopenia as a predictor of poor functional outcome of cervical spine surgery: A systematic review and meta-analysis","volume":"48","author":"Tayal","year":"2025","journal-title":"Neurosurg. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1097\/BRS.0000000000004650","article-title":"Paraspinal sarcopenia is associated with worse patient-reported outcomes following laminoplasty for degenerative cervical myelopathy","volume":"48","author":"Pinter","year":"2023","journal-title":"Spine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3345","DOI":"10.1007\/s00586-025-08902-0","article-title":"Impact of frailty on short- and long-term outcomes following cervical laminoplasty for ossification of the posterior longitudinal ligament: A retrospective cohort study","volume":"34","author":"Cheng","year":"2025","journal-title":"Eur. Spine J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"815","DOI":"10.3171\/2023.6.SPINE23461","article-title":"Adverse effects of frailty on the outcomes of surgery for degenerative cervical myelopathy: Results from a prospective multicenter international data set of 757 patients","volume":"39","author":"Wilson","year":"2023","journal-title":"J. Neurosurg. Spine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e16323","DOI":"10.1016\/j.heliyon.2023.e16323","article-title":"Can artificial intelligence simplify the screening of muscle mass loss?","volume":"9","author":"Buccheri","year":"2023","journal-title":"Heliyon"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1007\/s00586-022-07481-8","article-title":"Impact of the preoperative nutritional status on postoperative kyphosis in geriatric patients undergoing cervical laminoplasty","volume":"32","author":"Takasawa","year":"2023","journal-title":"Eur. Spine J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.1097\/BRS.0000000000000641","article-title":"Postoperative cervical sagittal imbalance negatively affects outcomes after surgery for cervical spondylotic myelopathy","volume":"39","author":"Roguski","year":"2014","journal-title":"Spine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"E1342","DOI":"10.1097\/BRS.0000000000003592","article-title":"Comparison of clinical and radiographic outcomes of laminoplasty, anterior decompression with fusion, and posterior decompression with fusion for degenerative cervical myelopathy: A prospective multicenter study","volume":"45","author":"Inose","year":"2020","journal-title":"Spine"},{"key":"ref_39","first-page":"1001","article-title":"Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients","volume":"85","author":"Onodera","year":"1984","journal-title":"Nihon Geka Gakkai Zasshi"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/S0261-5614(03)00098-0","article-title":"ESPEN guidelines for nutrition screening 2002","volume":"22","author":"Kondrup","year":"2003","journal-title":"Clin. Nutr."},{"key":"ref_41","first-page":"38","article-title":"CONUT: A tool for controlling nutritional status. First validation in a hospital population","volume":"20","author":"Mancha","year":"2005","journal-title":"Nutr. Hosp."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/jpen.1440","article-title":"GLIM Criteria for the diagnosis of malnutrition: A consensus report from the global clinical nutrition community","volume":"43","author":"Jensen","year":"2019","journal-title":"J. Parenter. Enteral Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1079\/BJN20041258","article-title":"Malnutrition in hospital outpatients and inpatients: Prevalence, concurrent validity and ease of use of the \u2018malnutrition universal screening tool\u2019 (\u201cMUST\u201d) for adults","volume":"92","author":"Stratton","year":"2004","journal-title":"Br. J. Nutr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e106","DOI":"10.1016\/j.wneu.2020.10.041","article-title":"Which objective nutritional index is better for the prediction of adverse medical events in elderly patients undergoing spinal surgery?","volume":"146","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1002\/jpen.2310","article-title":"Validation of the perioperative nutrition screen for prediction of postoperative outcomes","volume":"46","author":"Williams","year":"2022","journal-title":"J. Parenter. Enteral Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/18\/2912\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:42:36Z","timestamp":1760035356000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/18\/2912"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,9]]},"references-count":45,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["nu17182912"],"URL":"https:\/\/doi.org\/10.3390\/nu17182912","relation":{},"ISSN":["2072-6643"],"issn-type":[{"type":"electronic","value":"2072-6643"}],"subject":[],"published":{"date-parts":[[2025,9,9]]}}}