Establishing a new body mass index cutoff value for malnutrition diagnosis using the Global Leadership Initiative on Malnutrition (GLIM) tool in Chinese older adults.

Abstract

The body weight of the Chinese population rose rapidly over the past two decades. The old 2001 body mass index (BMI) cutoff value for malnutrition may underestimate malnutrition diagnosis. We explored the BMI cutoff value for malnutrition diagnosis based on national BMI data from the past 30 years and applied it to the Global Leadership Initiative on Malnutrition (GLIM) criteria when investigating malnutrition in hospitalized older patients. To explore the BMI cutoff value for malnutrition, we established a linear stepwise model to predict the annual increasing BMI trend based on data from the national BMI data set. The new cutoff value was applied to a large-scale data set from a cross-sectional study pertaining to older hospitalized patients recruited from 30 large hospitals in China. The BMI increased from 21.8 to 23 kg/m2 in two decades. We calculated that the net BMI increase will be 1.49 kg/m2 from 1999 to 2019. We subsequently proposed that the BMI cutoff value for malnutrition should rise to 20kg/m2 . This cutoff value was applied to the validation data set, containing 8725 patients, and the GLIM-determined malnutrition rate was 24.58% (using the Nutrition Risk Screening 2002 [NRS-2002]) and 23.32% (using the Mini Nutritional Assessment-Short Form [MNA-SF]). The results significantly differed from those obtained using the 2001 Chinese BMI criteria. The GLIM tool has good applicability in Asian populations, especially in Chinese older patients. The BMI cutoff value for malnutrition should be adjusted to 20 kg/m2 for Chinese adults.