The relationship between the uric acid to prealbumin ratio and frailty, muscle strength, and malnutrition risk in older geriatric outpatients: a retrospective cross-sectional study

Abstract

Frailty, sarcopenia, and malnutrition are common in older adults; however, simple biomarkers reflecting both inflammatory and nutritional status remain limited. We aimed to evaluate the relationship between the uric acid-to-prealbumin ratio (UPR) and frailty, muscle strength, and the risk of malnutrition. In this retrospective study, 435 patients aged ≥ 65 years who were admitted to the geriatric outpatient clinic between August 2023 and January 2026 were included. Patients were divided into tertiles according to UPR levels. Within the scope of comprehensive geriatric assessment, the Mini Nutritional Assessment-Short Form (MNA-SF), Clinical Frailty Scale (CFS), handgrip strength (HGS), SARC-F, and physical performance tests were evaluated. The relationships between UPR and geriatric syndromes were analyzed using correlation, logistic regression, and ROC analyses. Sarcopenia assessment, based on both muscle strength and fat-free mass index (FFMI), was restricted to patients with valid DXA measurements ( n = 187, 43.0%). Higher UPR levels were significantly associated with lower MNA-SF scores, lower HGS, higher SARC-F and CFS scores, prolonged Timed Up and Go Test (TUGT) duration, and lower gait speed (all p < 0.05). In adjusted multivariate analyses, increased UPR levels were independently associated with low HGS (OR = 1.022), high SARC-F score (OR = 1.030), low MNA-SF score (OR = 1.028), low gait speed (OR = 1.072), and prolonged TUGT duration (OR = 1.039) (all p < 0.05). In ROC analysis, UPR showed statistically significant discriminative ability for these parameters, modest for most outcomes and moderate only for gait speed (AUC = 0.702). However, in the sensitivity analysis additionally adjusted for age and CRP, and after Benjamini-Hochberg correction for multiple comparisons, only the association between UPR and MNA-SF score remained statistically significant (aOR = 1.023, 95% CI: 1.003–1.044; p = 0.003). UPR may be associated with frailty, low muscle strength, malnutrition risk, and poor physical performance in older individuals. Given the cross-sectional design of this study and the absence of external validation, these findings should be interpreted as exploratory associations rather than evidence of clinical utility; UPR may be considered a simple, supportive marker reflecting both inflammatory and nutritional status, rather than a validated diagnostic or predictive biomarker. Prospective, multicenter studies with external validation are needed to confirm these findings and establish their clinical applicability.