The Hidden Role of Undernutrition in Geriatric Syndromes Among Prefrail Older Adults

Introduction: Undernutrition frequently coexists with geriatric syndromes in older adults and may share common pathophysiological mechanisms, particularly among prefrail individuals.However, evidence regarding these associations in prefrail older adults remains limited.This study aimed to investigate the relationship between undernutrition and specific geriatric syndromes in this population.Methods: This cross-sectional study included 624 community-dwelling prefrail adults aged ≥65 years evaluated at University of Health Sciences Türkiye, Gülhane Training and Research Hospital, Clinic of Geriatrics between 2018 and 2025.Prefrailty was defined according to Fried's physical frailty phenotype.Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF), with scores ≤11 indicating undernutrition.Geriatric syndromes, including polypharmacy, depression, insomnia, urinary incontinence, falls, cognitive impairment, and functional decline, were evaluated.Binary logistic regression analyses were performed to examine associations between geriatric syndromes and undernutrition, with sensitivity analyses restricted to participants with severe undernutrition (MNA-SF ≤7).Results: The mean age was 77.6±4.9 years, and 61.5% were women.Undernutrition was present in 8.5% of participants.Although depression, falls, cognitive impairment, and functional decline were more common among undernourished individuals, only insomnia remained independently associated with undernutrition after adjustment for age, sex, and education [odds ratio (OR): 2.27, 95% confidence interval (CI): 1.23-4.17,p=0.008].This association persisted in sensitivity analyses of severe undernutrition (OR: 2.48, 95% CI: 1.39-4.44,p=0.002).Conclusion: Insomnia was independently associated with undernutrition among prefrail older adults.These findings highlight the importance of incorporating sleep assessment into the comprehensive geriatric evaluation and suggest that targeting insomnia may represent a clinically relevant strategy to improve nutritional status and to prevent the progression to frailty.