Abstract
Background and aims: Muscle mass reduction (MMR) is one of the three etiologic criteria in the Global Leadership Initiative on Malnutrition (GLIM) framework. This study aimed to evaluate the value of MMR in GLIM criteria among ambulatory cancer patients. Methods: A single-center prospective cross-sectional study was conducted. All participants underwent calf circumference (CC) measurement and body composition measurement by bioelectrical impedance analysis (BIA). MMR was identified by CC, fat-free mass index (FFMI), appendicular skeletal muscle index (ASMI), or combinations of the above three indicators. Patients-generated Subjective Global Assessment (PG-SGA) was used as the comparator. Results: A total of 562 cancer patients receiving intravenous treatment were evaluated. Of the participants, 62.8% (355/562) were male. The median age of the patients was 59.0 years (range, 21–82 y). The median BMI was 22.8 kg/m2 (range, 14.6–34.5 kg/m2). A total of 41.8% of patients were evaluated as malnutrition (PG-SGA ≥ 4), and 11.9% were diagnosed with severe malnutrition (PG-SGA ≥ 9). For the GLIM criteria, the prevalence of malnutrition was 26.9%, and severe malnutrition was 12.3%. For all criteria combinations of GLIM together versus PG-SGA, sensitivity was 60.4% (53.8–66.7), specificity was 97.9% (95.4–99.1), while the accordance between GLIM and PG-SGA was moderate (κ = 0.614). The performance of the GLIM worsened when MMR was excluded (κ = 0.515), with reduced sensitivity (50.2% (43.7–56.8)) and the same specificity (97.9% (95.4–99.1)). Including FFMI and ASMI by BIA can further improve the performance of GLIM than using CC alone (κ = 0.614 vs. κ = 0.565). Conclusions: It is important to include MMR in the GLIM framework. Using body composition measurement further improves the performance of the GLIM criteria than using anthropometric measurement alone.
Highlights
Cancer patients are at high risk of malnutrition
Nutrients 2021, 13, x FOR PEER REVIEW A total of 686 patients were admitted to day oncology from 11 November 2020 to 106 of 12 December 2020, and 562 cancer patients participated in this study
Since Patients-generated Subjective Global Assessment (PG-Subjective Global Assessment (SGA)) is specially designed for cancer patients and has been used worldwide, we chose PG-SGA as the comparator to evaluate the performance of Global Leadership Initiative on Malnutrition (GLIM) using different definitions of criteria
Summary
Cancer patients are at high risk of malnutrition. It is estimated that approximately 30–90% of cancer patients suffer from malnutrition due to either the physical and metabolic effects of cancer or the adverse effects of anticancer treatments [1,2]. Routine nutritional screening and assessment are suggested in different clinical settings considering the adverse impacts of malnutrition on cancer patients. Muscle mass reduction (MMR) is one of the three etiologic criteria in the Global Leadership Initiative on Malnutrition (GLIM) framework. This study aimed to evaluate the value of MMR in GLIM criteria among ambulatory cancer patients. A total of 41.8% of patients were evaluated as malnutrition (PG-SGA ≥ 4), and 11.9% were diagnosed with severe malnutrition (PG-SGA ≥ 9). Including FFMI and ASMI by BIA can further improve the performance of GLIM than using CC alone (κ = 0.614 vs κ = 0.565). Using body composition measurement further improves the performance of the GLIM criteria than using anthropometric measurement alone
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