Association of stress hyperglycemia ratio with malnutrition, sarcopenia, and frailty in older adults: a cross-sectional study.

Authors

Tubanur Kocaaslan, Ugur Balaban, Okan Turhan, Burcu Kelleci Cakir, Mert Esme, Burcu Balam Dogu, Meltem Gulhan Halil, Mustafa Cankurtaran, Cafer Balci

Published in

BMC geriatrics. Jul 04, 2026. Epub Jul 04, 2026.

Abstract

Stress hyperglycemia ratio (SHR), calculated using admission glucose and glycated hemoglobin (HbA1c), has emerged as a marker of acute metabolic stress and adverse outcomes. However, its relationship with major geriatric syndromes remains unclear. This study investigated the association between SHR and malnutrition, sarcopenia, and frailty in older adults attending a geriatric outpatient clinic.
This retrospective cross-sectional study included patients aged ≥ 65 years who underwent comprehensive geriatric assessment between January 2022 and January 2026. SHR was calculated as admission glucose divided by estimated average glucose derived from HbA1c and categorized into quartiles. Malnutrition was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF), probable sarcopenia risk using the SARC-F questionnaire, and frailty using the Clinical Frailty Scale (CFS). Restricted cubic spline analyses and multivariable logistic regression models were performed to evaluate associations between SHR quartiles and geriatric outcomes.
A total of 1,401 older adults were included (median age: 73 years [IQR: 69-78]; 66% female). The median SHR was 0.80 (IQR: 0.73-0.89). Restricted cubic spline analyses demonstrated significant nonlinear associations between SHR and geriatric outcomes, with lower SHR values associated with higher odds of malnutrition, probable sarcopenia, and frailty. In fully adjusted analyses, low SHR remained independently associated with probable sarcopenia (OR: 1.51, 95% CI: 1.02-2.25; p = 0.040) and frailty (OR: 1.62, 95% CI: 1.05-2.50; p = 0.031), whereas the association with malnutrition was no longer significant. Associations were more pronounced among participants without diabetes, particularly for probable sarcopenia (p for interaction = 0.038).
Lower SHR values were associated with increased vulnerability to geriatric syndromes, particularly probable sarcopenia and frailty, in older adults. These findings suggest that SHR may reflect impaired metabolic adaptation and reduced physiological reserve in aging populations. Further prospective studies are needed to establish the clinical utility of SHR as a marker of geriatric vulnerability.

PMID:
42401789
Bibliographic data and abstract were imported from PubMed on 05 Jul 2026.

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