# Age and sex adjusted adiposity estimators predict all cause and pneumonia related mortality in hospitalized older patients with severe dysphagia receiving artificial nutrition

## TL;DR

This study shows that age- and sex-adjusted body fat formulas can help predict mortality risk in older patients with severe swallowing issues receiving feeding tubes.

## Contribution

The study demonstrates the clinical utility of adiposity estimators for mortality prediction in patients with severe dysphagia.

## Key findings

- Higher adiposity tertiles were linked to increased all-cause and pneumonia-related mortality.
- CUN-BAE and Deurenberg formulas showed better predictive discrimination over time.
- Adiposity estimators added incremental value for predicting all-cause mortality.

## Abstract

Older adults with severe dysphagia who require percutaneous endoscopic gastrostomy (PEG) feeding and/or total parenteral nutrition (TPN) have substantial mortality risk, yet practical tools for prognostic stratification are limited. Whether age- and sex-adjusted adiposity estimation formulas (CUN-BAE, ECORE-BF, and the Deurenberg formula) can improve risk prediction for all-cause and pneumonia-related mortality in this setting remains unclear.

This study is a secondary analysis of a previously established single-center Japanese retrospective cohort of 247 patients aged ≥50 years with severe dysphagia receiving percutaneous endoscopic gastrostomy (PEG) and/or total parenteral nutrition (TPN). Associations of adiposity estimators with all-cause and pneumonia-related mortality were evaluated using Kaplan–Meier analysis, Cox regression, restricted cubic splines (RCS), time-dependent ROC analysis, and the C-index. Incremental predictive value beyond the baseline model was assessed using net reclassification improvement (NRI) and integrated discrimination improvement (IDI), with sensitivity analyses including multiple imputation, exclusion of deaths within 30 days, and additional adjustment for the Clinical Frailty Scale.

Across tertiles, Kaplan–Meier curves separated significantly for both all-cause and pneumonia-related mortality. In fully adjusted Cox models, the highest tertile was associated with higher all-cause mortality (HR 2.02–2.33) and markedly higher pneumonia-related mortality (HR 3.78–5.09) compared with the lowest tertile, with evidence of monotonic trends. Restricted cubic spline analyses supported largely linear dose–response relationships. Predictive discrimination improved over time; at 3 years, CUN-BAE and Deurenberg showed higher AUCs than ECORE-BF for both endpoints. Incremental analyses indicated added value for all-cause mortality with CUN-BAE and Deurenberg.

Adiposity estimation formulas, particularly CUN-BAE and Deurenberg, provide clinically useful mortality risk stratification in severe dysphagia receiving PEG/TPN.