Validation of the GLIM criteria for diagnosis of malnutrition and quality of life in patients with inflammatory bowel disease: A multicenter, prospective, observational study

Abstract

The Global Leadership Initiative on Malnutrition (GLIM) has recently been proposed as a consensus criterion for identifying malnutrition. However, data on the application of GLIM criteria in patients with inflammatory bowel disease (IBD) are limited. Therefore, this study aimed to explore the validity of this neoteric criterion for identifying malnutrition and investigate the association between malnutrition and quality of life (QoL) in patients with IBD. This multicenter, prospective, observational study assessed hospitalized patients with IBD at four general hospitals. Nutritional status was evaluated using criteria from the World Health Organization (WHO) related body mass index (BMI) cut-off value, Subjective Global Assessment (SGA), European Society for Clinical Nutrition and Metabolism (ESPEN) criteria of malnutrition in 2015, and GLIM criteria. Kappa (K) values were calculated to determine interrater validity and consistency among different prevalence of malnutrition. Patients' QoL was assessed by the Inflammatory Bowel Disease Questionnaire (IBDQ). A total of 238 hospitalized patients with IBD were enrolled, with a mean age of 38.5±14.0 years, 68.5% of them were male, and 177 with Crohn's disease (CD). Among all patients, 39.5% were underweight (BMI < 18.5kg/m2), and the prevalence of malnutrition was 66.0%, 47.5%, and 60.1% according to SGA, ESPEN, and GLIM criteria, respectively. Moreover, the prevalence of malnutrition was significantly higher among patients with CD than those with ulcerative colitis (UC), according to GLIM criteria (69.5% vs. 32.8%, p<0.001). The GLIM criteria showed a substantial concordance with ESPEN criteria (K=0.67, 95% confidence interval [CI] 0.58-0.76, p<0.001), and a fair concordance with the SGA (K=0.57, 95% CI 0.46-0.68, p<0.001) and WHO criteria (K=0.52, 95% CI 0.43-0.62, p<0.001). An impairment in the nutritional status was accompanied by a progressive reduction in the patients' QoL. The prevalence of malnutrition is high in patients with IBD. The GLIM criteria may be an appropriate and effective tool to identify malnutrition in the IBD populations due to its substantial concordance with ESPEN and a fair concordance with SGA and WHO-related BMI. GLIM-defined malnutrition showed an enormous adverse impact on patients' QoL.