{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T10:12:26Z","timestamp":1771495946072,"version":"3.50.1"},"reference-count":35,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Nutritional risk is increasingly recognized as a relevant but under-assessed dimension of rheumatoid arthritis (RA), particularly in older adults managed in outpatient settings. Simple nutritional indices such as the Prognostic Nutritional Index (PNI) may help identify individuals at increased nutritional risk beyond conventional disease activity measures. This study aimed to characterize nutritional risk in older adults with RA using the Prognostic Nutritional Index, explore sex-specific patterns, and identify clinical associations of PNI variability, with complementary analyses focusing on high nutritional risk. Methods: We conducted an observational cross-sectional study including 275 consecutive adults aged \u226550 years with RA attending routine follow-up at a tertiary rheumatology clinic. Nutritional risk was assessed using the PNI, calculated from serum albumin and total lymphocyte count, and analyzed primarily as a continuous variable and secondarily using established cut-off values. Clinical characteristics, inflammatory markers, body mass index, laboratory parameters, and patient-reported outcomes were recorded. Analyses were stratified by sex. Multivariable linear regression models were used to identify factors associated with PNI variability, and complementary logistic regression analyses were performed to explore factors independently associated with high nutritional risk (PNI &lt; 40). Results: More than half of the cohort (53.3%) exhibited PNI values compatible with nutritional risk. Men showed lower PNI values than women, with a markedly greater prevalence of high nutritional risk (18.0% vs. 5.0%, p &lt; 0.001). In multivariable linear regression analyses, higher C-reactive protein levels and increasing age were independently associated with lower PNI values, whereas sex was not an independent determinant of PNI. In multivariable logistic regression analyses, increasing age and male sex were independently associated with high nutritional risk. In multivariable linear regression models restricted to men, hemoglobin emerged as the principal independent correlate of PNI. In complementary logistic regression analyses focusing on high nutritional risk (PNI &lt; 40), hemoglobin remained the sole independent predictor (OR = 0.94, 95% CI 0.91\u20130.98; p &lt; 0.01), supporting a robust association with clinically relevant nutritional risk. Conclusions: Nutritional risk assessed by the PNI is common among older adults with RA. Although sex does not independently determine PNI as a continuous measure, male sex is associated with severe nutritional risk. The PNI captures a clinically relevant dimension of disease burden that extends beyond joint inflammation and traditional activity indices, supporting its use as a pragmatic nutritional screening tool in routine rheumatology practice.<\/jats:p>","DOI":"10.3390\/nu18040673","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T08:51:09Z","timestamp":1771491069000},"page":"673","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nutritional Risk in Older Adults with Rheumatoid Arthritis: Sex-Specific Patterns and Clinical Implications of the Prognostic Nutritional Index"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2358-6767","authenticated-orcid":false,"given":"Joan M.","family":"Nolla","sequence":"first","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lidia","family":"Valencia-Muntal\u00e0","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3373-7503","authenticated-orcid":false,"given":"Laura","family":"Berbel-Arcob\u00e9","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diego","family":"Benavent","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0034-2270","authenticated-orcid":false,"given":"Paola","family":"Vidal-Montal","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pol","family":"Maym\u00f3-Paituvi","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7874-6747","authenticated-orcid":false,"given":"Montserrat","family":"Roig-Kim","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2060-146X","authenticated-orcid":false,"given":"Mart\u00ed","family":"Aguilar-Coll","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1614-8064","authenticated-orcid":false,"given":"Javier","family":"Narv\u00e1ez","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"G\u00f3mez-Vaquero","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, University of Barcelona, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1016\/S0140-6736(23)01525-8","article-title":"Rheumatoid arthritis","volume":"402","author":"Matteo","year":"2023","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1002\/art.43105","article-title":"Immune aging in rheumatoid arthritis","volume":"77","author":"Weyand","year":"2025","journal-title":"Arthritis Rheumatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1007\/s12016-022-08943-z","article-title":"Inflammaging and frailty in immune-mediated rheumatic diseases: How to address and score the issue","volume":"64","author":"Salaffi","year":"2023","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.arr.2017.09.001","article-title":"Health relevance of the modification of low-grade inflammation in ageing (inflammageing) and the role of nutrition","volume":"40","author":"Calder","year":"2017","journal-title":"Ageing Res. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1182\/blood-2018-06-856500","article-title":"Anemia of inflammation","volume":"133","author":"Weiss","year":"2019","journal-title":"Blood"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.clnu.2007.10.007","article-title":"Prognostic impact of disease-related malnutrition","volume":"27","author":"Norman","year":"2008","journal-title":"Clin. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Tian, P., Xiong, J., Wu, W., Shi, S., Chen, A., Chen, K., Chen, W., Wu, A., and Liao, Y. (2023). Impact of malnutrition on mortality in rheumatoid arthritis patients: A cohort study from NHANES 1999\u20132014. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.993061"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1186\/s12986-025-01005-z","article-title":"Prognostic nutritional index, sarcopenia, and risk of mortality: A national population-based study","volume":"22","author":"Wu","year":"2025","journal-title":"Nutr. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Di Vincenzo, O., Luisi, M.L.E., Alicante, P., Ballarin, G., Biffi, B., Gheri, C.F., and Scalfi, L. (2023). The assessment of the risk of malnutrition (undernutrition) in stroke patients. Nutrients, 15.","DOI":"10.3390\/nu15030683"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2503","DOI":"10.2147\/DMSO.S420924","article-title":"Prognostic nutritional index (PNI) as a predictor in patients with metabolic syndrome and heart failure","volume":"16","author":"Zhang","year":"2023","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e3539","DOI":"10.1097\/MD.0000000000003539","article-title":"Clinical significance of the prognostic nutritional index for predicting short- and long-term surgical outcomes after gastrectomy: A retrospective analysis of 7781 gastric cancer patients","volume":"95","author":"Lee","year":"2016","journal-title":"Medicine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1080\/17520363.2024.2430942","article-title":"Immune nutrition indices are associated with disease activity in rheumatoid arthritis: A cross-sectional study","volume":"18","author":"Tecer","year":"2024","journal-title":"Biomark. Med."},{"key":"ref_13","first-page":"1","article-title":"A correlation between prognostic nutritional index and sarcopenia in patients with rheumatoid arthritis","volume":"86","author":"Shi","year":"2025","journal-title":"Br. J. Hosp. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1093\/mr\/roac001","article-title":"Potential of the prognostic nutritional index to determine the risk factor for severe infection in elderly patients with rheumatoid arthritis","volume":"33","author":"Isoda","year":"2023","journal-title":"Mod. Rheumatol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Wang, J., Zhu, R., Fang, H., Xing, X., Ge, L., and Cai, G. (2024). Association of prognostic nutritional index with the presence and all-cause mortality of rheumatoid arthritis: The National Health and Nutrition Examination Survey 2003\u20132018. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-20795-0"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"553","DOI":"10.3899\/jrheum.2024-1258","article-title":"Sex differences in rheumatoid arthritis: New insights from clinical and patient-reported outcome perspectives","volume":"52","author":"Koc","year":"2025","journal-title":"J. Rheumatol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Carmona, L., Aurrecoechea, E., and Garc\u00eda de Y\u00e9benes, M.J. (2023). Tailoring rheumatoid arthritis treatment through a sex and gender lens. J. Clin. Med., 13.","DOI":"10.20944\/preprints202311.1009.v1"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"van Vollenhoven, R.F. (2009). Sex differences in rheumatoid arthritis: More than meets the eye. BMC Med., 7.","DOI":"10.1186\/1741-7015-7-12"},{"key":"ref_19","first-page":"1987","article-title":"Disease activity score 28 as an instrument to measure disease activity in patients with early rheumatoid arthritis","volume":"34","author":"Kautiainen","year":"2007","journal-title":"J. Rheumatol."},{"key":"ref_20","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_21","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/1477-7525-1-79","article-title":"The Functional Assessment of Chronic Illness Therapy (FACIT) measurement system: Properties, applications, and interpretation","volume":"1","author":"Webster","year":"2003","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/00005650-199603000-00003","article-title":"A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity","volume":"34","author":"Ware","year":"1996","journal-title":"Med. Care"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1136\/ard.2009.123919","article-title":"Treating rheumatoid arthritis to target: Recommendations of an international task force","volume":"69","author":"Smolen","year":"2010","journal-title":"Ann. Rheum. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1177\/0961203319853357","article-title":"Changing hospitalization trends for systemic lupus erythematosus and rheumatoid arthritis in England","volume":"28","author":"Hannah","year":"2019","journal-title":"Lupus"},{"key":"ref_25","first-page":"e2021238","article-title":"Rheumatoid arthritis disease activity assessment in routine care: Performance of the most widely used composite disease activity indices and patient-reported outcome measures","volume":"92","author":"Salaffi","year":"2021","journal-title":"Acta Biomed."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Olsen, M.N., Tangvik, R.J., and Halse, A.K. (2020). Evaluation of nutritional status and methods to identify nutritional risk in rheumatoid arthritis and spondyloarthritis. Nutrients, 12.","DOI":"10.3390\/nu12113571"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1007\/s10067-024-06927-2","article-title":"Evaluation of the prognostic nutritional index (PNI) as a tool for assessing disease activity in rheumatoid arthritis patients","volume":"43","author":"Gezer","year":"2024","journal-title":"Clin. Rheumatol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Kim, Y.R., Jung, Y., Kang, I., and Yeo, E.J. (2025). Understanding sex differences in autoimmune diseases: Immunologic mechanisms. Int. J. Mol. Sci., 26.","DOI":"10.20944\/preprints202506.0943.v1"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1002\/acr.25537","article-title":"Metabolic consequences of rheumatoid arthritis","volume":"77","author":"Barry","year":"2025","journal-title":"Arthritis Care Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1038\/s41569-018-0064-2","article-title":"Inflammageing: Chronic inflammation in ageing, cardiovascular disease, and frailty","volume":"15","author":"Ferrucci","year":"2018","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1136\/pgmj.2005.037564","article-title":"Malnutrition and ageing","volume":"82","author":"Hickson","year":"2006","journal-title":"Postgrad. Med. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1136\/bmjnph-2020-000085","article-title":"Nutrition, immunity and COVID-19","volume":"3","author":"Calder","year":"2020","journal-title":"BMJ Nutr. Prev. Health"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2685","DOI":"10.1017\/S1368980017001203","article-title":"What influences diet quality in older people? A qualitative study among community-dwelling older adults from the Hertfordshire Cohort Study, UK","volume":"20","author":"Bloom","year":"2017","journal-title":"Public Health Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1093\/nutrit\/nuv024","article-title":"Relationship between living alone and food and nutrient intake","volume":"73","author":"Hanna","year":"2015","journal-title":"Nutr. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2421","DOI":"10.1017\/S1368980009005448","article-title":"Factors influencing eating a varied diet in old age","volume":"12","author":"Dean","year":"2009","journal-title":"Public Health Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/4\/673\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T08:55:26Z","timestamp":1771491326000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/4\/673"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,19]]},"references-count":35,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["nu18040673"],"URL":"https:\/\/doi.org\/10.3390\/nu18040673","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,19]]}}}