Reference body mass index values and the prevalence of malnutrition according to the Global Leadership Initiative on Malnutrition criteria

Abstract

The Global Leadership Initiative on Malnutrition (GLIM) released new criteria for diagnosing and grading malnutrition. This study aimed to investigate the optimal reference values of body mass index (BMI) for discriminating severe malnutrition according to the GLIM criteria, as well as the prevalence of GLIM-defined malnutrition in the clinical setting. This study included 6783 patients aged ≥40 years, who were admitted to an academic hospital. Of the 1987 patients who presented with low BMI in period 1, optimal BMI cut-off values were determined using receiver operating characteristic analyses against in-hospital mortality in younger (aged <70 years) and older age groups. Next, 4796 patients from period 2 were screened using a validated nutritional screening tool. Patients had their nutritional condition assessed after screenings were analyzed using the GLIM criteria, which included body weight changes, BMI, reduced muscle mass, nutritional intake, and disease burden. Additionally, patients diagnosed with malnutrition were classified as having moderate or severe malnutrition, according to the obtained BMI values from the period 1 data. The optimal cut-off BMI values were 17.0kg/m2 for younger patients and 17.8kg/m2 for older patients. Patients at risk of malnutrition included 14.5% and 42.0% of admitted younger and older patients in period 2, respectively. GLIM-defined malnutrition was diagnosed in 18.0% of all patients (10.6% and 25.7% in younger and older patients, respectively). After adapting the BMI cut-off values according to the period 1 results, 9.0% and 9.0% of all patients were diagnosed as having moderate and severe malnutrition, respectively. Patients with GLIM-defined malnutrition showed significantly higher in-hospital mortality compared to those without malnutrition. The Asian reference values of BMI to grade malnutrition severity according to the GLIM criteria, as well as the prevalence of GLIM-defined malnutrition were determined. These reference values will contribute to implementing the GLIM criteria in Asian populations.