A LOWER stress hyperglycaemia ratio (SHR) may be associated with an increased risk of sarcopenia and frailty in older adults, according to a new study. The findings suggest that SHR, a marker of acute metabolic stress calculated using admission glucose and glycated haemoglobin (HbA1c), could help identify older individuals with reduced physiological reserve.
Lower SHR Associated with Geriatric Syndromes
Researchers conducted a retrospective cross-sectional study of 1,401 adults aged 65 years and older who underwent comprehensive geriatric assessment at an outpatient clinic between January 2022 and January 2026. The median participant age was 73 years, and 66% were female.
SHR was calculated by dividing admission glucose by the estimated average glucose derived from HbA1c levels. Participants were grouped into SHR quartiles, while nutritional status, probable sarcopenia, and frailty were assessed using the Mini Nutritional Assessment–Short Form (MNA-SF), the SARC-F questionnaire, and the Clinical Frailty Scale (CFS), respectively.
Restricted cubic spline analyses revealed significant nonlinear relationships between SHR and all three geriatric outcomes. Lower SHR values were associated with higher odds of malnutrition, probable sarcopenia, and frailty. However, after adjustment for potential confounding factors, only probable sarcopenia and frailty remained independently associated with low SHR.
Stronger Associations in Adults Without Diabetes
In fully adjusted analyses, participants with lower SHR had a 51% higher likelihood of probable sarcopenia (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.02–2.25; p=0.040) and a 62% higher likelihood of frailty (OR, 1.62; 95% CI, 1.05–2.50; p=0.031). Although low SHR was initially associated with malnutrition, this relationship was no longer statistically significant after adjustment.
Subgroup analyses indicated that the associations between low SHR and geriatric syndromes were more pronounced among participants without diabetes, particularly for probable sarcopenia, suggesting that diabetes status may influence the relationship between metabolic stress and age-related functional decline.
The researchers propose that lower SHR may reflect impaired metabolic adaptation rather than favourable glycaemic status in older adults. As such, SHR could serve as a readily available biomarker to identify individuals at greater risk of geriatric syndromes, particularly sarcopenia and frailty. They note, however, that prospective studies are needed to determine whether SHR has clinical value for risk stratification and early intervention in ageing populations.
Reference
Kocaaslan T et al. Association of Stress Hyperglycemia Ratio with Malnutrition, Sarcopenia, and Frailty in Older Adults: a Cross-sectional Study. BMC Geriatr. 2026.
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