Association Between Proton Pump Inhibitor Use and Malnutrition Risk in the US General Population Using the GLIM Framework (NHANES 1999-2020)
Abstract
Background: Proton pump inhibitors (PPIs) are the global gold standard for acid-related disorders; however, their proliferation into long-term, often non-indicated use raises significant concerns regarding qualitative nutrient depletion.
Objective: This study primarily aimed to evaluate the independent association between PPI use and malnutrition risk according to the Global Leadership Initiative on Malnutrition (GLIM) criteria in a nationally representative US population.
Methods: We conducted a cross-sectional analysis of 23 363 adults from the NHANES 1999-2020 database. Malnutrition was operationalized via the GLIM approach, integrating phenotypic criteria (weight loss, low BMI, or DXA-derived reduced muscle mass) with etiologic criteria (inflammation or reduced calorie intake). Robust Poisson regression models estimated relative risks (RRs) for general malnutrition, while logistic regression estimated odds ratios (ORs) for severe malnutrition. Models were adjusted for sociodemographics, food security, comorbidities, and appetite-affecting medications.
Results: The prevalence of malnutrition was 18.9% (95% CI: 18.4%-19.4%) and PPI use was associated with a 10% increased risk of malnutrition (RR 1.10; 95% CI: 1.01-1.19; p = 0.031) in the adjusted model. For severe malnutrition, PPI exposure was a robust independent predictor (OR 1.36; 95% CI: 1.13-1.63; p = 0.001). Notably, sex-stratified analysis revealed a RR associated with PPIs was significantly more pronounced in…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 23 participants or records.
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