Diagnostic Criteria For Malnutrition Research Articles

Skeletal muscle quantity and quality evaluation in heart failure: comparing thoracic versus abdominopelvic CT approaches.

Given the critical role of skeletal muscle in healthy aging, low muscle mass (myopenia) and quality (myosteatosis) can be used as predictors of poor functional and cardiometabolic outcomes. Myopenia is also a part of sarcopenia and malnutrition diagnostic criteria. However, there is limited evidence for using chest computed tomography (CT) to evaluate muscle health. We aimed to compare chest CT landmarks to the widely used L3 vertebra for single-slice skeletal muscle evaluation in patients with heart failure (HF). Patients admitted for acute decompensated HF between January 2017 and December 2018 were retrospectively analyzed. Body composition measurements were made on CT of the chest and abdomen/pelvis with or without contrast one month before discharge. Skeletal muscle index (SMI) and intermuscular adipose tissue percentage (IMAT%) were calculated at several thoracic levels (above the aortic arch, T8, and T12) and correlated to the widely used L3 level. A total of 200 patients were included, 89 (44.5%) female. The strongest correlation of thoracic SMI (for muscle quantity) and IMAT% (for muscle quality) with L3 was at the T12 level (r = 0.834, p < 0.001 and r = 0.757, p < 0.001, respectively). Cutoffs to identify low muscle mass for T12 SMI (derived from the lowest sex-stratified L3 SMI tertile) were 31.1cm²/m² in men and 26.3cm²/m² in women. SMI and IMAT% at T12 had excellent correlations with the widely used L3 level for muscle quantity and quality evaluation in patients with HF.

Implementation of nutritional screening tools, nutritional assessment tools, and diagnostic criteria for malnutrition in convalescent rehabilitation wards: A nationwide survey

The utilization of recommended nutritional assessment measures in rehabilitation settings remains unclear. This study explored methods for identifying nutritional disorders using data from a nationwide survey conducted in convalescent rehabilitation wards. This cross-sectional study analyzed the annual survey, including methods for identifying malnutrition, the risk of malnutrition, and overnutrition in Kaifukuki (convalescent) rehabilitation wards. Methods identifying malnutrition and risk of malnutrition were grouped into nutritional screening tools (NSTs), nutritional assessment tools (NATs), diagnostic criteria for malnutrition (DCM), and suboptimal methods (e.g., hypoalbuminemia). NSTs, NATs, and DCM were further categorized as "acceptable tools." The association between applying acceptable tools, hospital-based data (e.g., the number of beds), and ward-based data (e.g., assessor for nutritional status) was analyzed by logistic regression analysis with multiple imputations. In total, 885 hospitals with Kaifukuki rehabilitation wards responded to the survey, and 754 hospitals were included in the analysis. Registered dietitians assessed the nutritional status in 88% of the hospitals, whereas other professionals (e.g., nurses) evaluated the nutritional status in the remainder. NSTs (e.g., Mini Nutritional Assessment Short-Form), NATs (e.g., Subjective Global Assessment), DCM (e.g., Global Leadership Initiative on Malnutrition criteria), and suboptimal tools were used in 13.1%, 5.4%, 4.8%, and 74.6% of cases, respectively. Most hospitals used acceptable measures (e.g., body mass index) for overnutrition (91.2%). Multiple logistic regression analysis showed that assessments by registered dietitians (adjusted odds ratio[OR]: 2.20.95% confidence interval[CI]: 1.09-4.45) and hospital-owned food services, a proxy for limited clinical practice time of dietitians, were associated with a low likelihood of implementing acceptable measures (adjusted OR: 0.64, 95%CI: 0.43-0.97). Acceptable malnutrition measures, including the NSTs, NATs, and DCM, have not been widely applied in convalescent rehabilitation settings. The implementation of recommended tools for identifying malnutrition may be promoted when registered dietitians assess the patients' nutritional status.

TNF-α-1031T/C gene polymorphism as a predictor of malnutrition in patients with gastric cancer.

Malnutrition is a complex clinical syndrome, the exact mechanism of which is yet not fully understood. Studies have found that malnutrition is associated with anorexia and inadequate intake, tumor depletion, leptin, tumor-induced metabolic abnormalities in the body, and catabolic factors produced by the tumor in the circulation and cytokines produced by the host immune system. Among these, single nucleotide polymorphisms (SNPs) are present in the gene encoding the pro-inflammatory cytokine TNF-α. The objective of this study was to investigate TNF-α -1,031 T/C gene polymorphism as an unfavorable predictor of malnutrition in patients with gastric cancer. The study group consisted of 220 gastric cancer patients treated at Affiliated Jinhua Hospital, Zhejiang University School of Medicine. Malnutrition was mainly assessed by the Global Consensus on Malnutrition Diagnostic Criteria (GLIM). DNA was extracted from peripheral leukocytes of whole blood samples using an animal DNA extraction kit. DNA was amplified using a 1.1× T3 Super PCR mixture and genotyped using SNP1 software. There are three major genetic polymorphisms in TNF-α. Among the 220 patients with gastric cancer, there were 7 patients with the CC genotype, 61 with the CT genotype and 152 with the TT genotype. Compared to patients with the TT genotype, patients with the C allele had an approximately 2.5-fold higher risk of developing malnutrition (p = 0.003; OR = 0.406). On the basis of multivariate analysis, patients with the CC genotype had an approximately 20.1-fold higher risk of developing malnutrition (p = 0.013; OR = 20.114), while those with the CT genotype had an almost 3.7-fold higher risk of malnutrition (p = 0.002; OR = 3.218). SNP (-1,031 T/C) of the TNF-α may be a useful marker in the assessment of the risk of nutritional deficiencies in gastric cancer patients. Patients with gastric cancer carrying the C allele should be supported by early nutritional intervention, but more research is still needed to explore confirmation.

Performance of a simplified nutrition screening tool for outpatient radiotherapy cancer patients.

Public hospitals in Thailand recently adopted a new nutrition screening tool to satisfy documentation requirements for reimbursements through the diagnosis-related group system. However, data on the performance of this instrument remains limited. This study was designed to assess the validity and cutoff points of the Society of Parenteral and Enteral Nutrition of Thailand (SPENT) nutrition screening tool against the patient-generated subjective global assessment (PG-SGA) and malnutrition diagnostic criteria proposed by the global leadership initiative on malnutrition (GLIM) in cancer patients receiving outpatient radiation therapy. A cross-sectional study of 350 patients was conducted from August 2018 to September 2020. All patients were screened for malnutrition using the SPENT nutrition screening tool. The instrument's sensitivity, specificity, positive predictive value, negative predictive value, and agreement were calculated using either the PG-SGA or GLIM malnutrition diagnosis as benchmarks. The cutoff that gave the highest sensitivity and specificity of the SPENT nutrition screening tool was selected. The mean age standard deviation of the 350 cancer patients was 59.9 (13.9) years, and 191 (54.6%) were men. Head and neck cancers were the most common type (35.7%). Against PG-SGA and GLIM malnutrition diagnosis, the SPENT nutrition screening tool demonstrated good sensitivity (85.3% and 82.8%), specificity (84.1% and 59.4%), positive predictive value (90.5% and 64.0%), negative predictive value (76.3% and 79.9%), with moderate strength of agreement (Cohen kappa 0.678, P < .001 and 0.414, P < .001). Using only the first 2 out of 4 questions revealed an acceptable sensitivity and specificity. The SPENT nutrition screening tool is an accurate, sensitive, and specific tool for malnutrition screening in cancer patients receiving outpatient radiotherapy.

GLIM in chronic kidney disease: What do we need to know?

The lack of consensus on diagnostic criteria for malnutrition has hampered developments in research and clinical practice pertaining to nutrition. This opinion paper describes the applicability and other aspects of using the Global Leadership Initiative on Malnutrition (GLIM) criteria for diagnosing malnutrition in patients with chronic kidney disease (CKD). We examine the purpose of GLIM, the particularities of CKD that can affect the nutritional and metabolic status and the diagnosis of malnutrition. In addition, we make an appraisal of previous studies that used GLIM in the context of CKD and discuss the value and relevance of using the GLIM criteria in patients with CKD.

Factors influencing the prevalence of frailty in older adults with fractures: the association of nutritional status with frailty.

To investigate the association between frailty, malnutrition, comorbid medical conditions and activities of daily living (ADL) in older adult patients with fractures, and to analyse the influential factors of frailty. The FRAIL scale including five components: fatigue, resistance, ambulation, illness, and loss of weight, was used to evaluate frailty. Participants were divided into frailty, pre-frailty and non-frailty groups. The ADL was assessed using the Barthel Index, while the nutrition risk screening tool, NRS-2002, was used to assess the nutritional risk, and the Global Leadership Initiative on Malnutrition diagnostic criteria were used to diagnose the nutritional status. Statistical analysis was performed using univariate and multivariate logistic regression to determine the factors associated with frailty. A total of 166 patients were included in the study, and the incidences of frailty, pre-frailty and non-frailty were 39.2%, 33.1% and 27.7%, respectively. The severe dependence rate (ADL scale of <40) in the frailty, pre-frailty and non-frailty groups was 49.2%, 20.0% and 6.52%, respectively. The prevalence of nutritional risk was 33.7% (56/166), including 56.9% (31/65) in the frailty group and 32.7% (18/55) in the pre-frailty group. Of the 166 patients, 45 (27.1%) were diagnosed with malnutrition, including 47.7% (31/65) in the frailty group and 23.6% (13/55) in the pre-frailty group. Frailty in older adult patients with fractures is widespread, and the prevalence of malnutrition is high. The occurrence of frailty may be related to an advanced age, increased medical comorbidity and impairment in ADL.

Effect of preoperative nutritional support in malnourished patients with pancreatobiliary cancer: a quasi-experimental study

BackgroundIn malnourished patients, postoperative morbidity, hospitalization period, and medical expenses are reportedly to be high. We evaluated the clinical impact of a preoperative nutritional support program (PNSP) among malnourished cancer patients.MethodsFor this quasi-experimental study, we enrolled 90 patients who underwent major pancreatobiliary cancer surgery. Malnutrition was defined as at least one of the following: (1) Patient-Generated Subjective Global Assessment (PG-SGA) grade B or C; (2) > 10% weight loss within 6 months; (3) body mass index <18.5 kg/m2; and (4) serum albumin level < 3.0 g/dL. Forty-five malnourished patients allocated to the PNSP group received in-hospital PNSP for a median of 6 (4–35) days. In the PNSP group, the nutrition support team calculated the patients’ daily nutritional requirements based on their nutritional status and previous day’s intake. The supplementation targets were as follows: total calorie intake, 30–35 kcal/kg/day; protein intake, 1.2–1.5 g/kg/day; and lipid intake, 1–1.5 g/kg/day. Patients who did not meet the diagnostic criteria for malnutrition were allocated to the well-nourished group and underwent surgery without receiving the PNSP (n = 45). We compared the perioperative nutritional indices (as measured using PG-SGA), postoperative outcome, and quality of life (QOL) according to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0.ResultsIn the PNSP group, the proportion of patients with serum prealbumin <16 mg/dL decreased significantly after PNSP (29.5% vs. 8.9%, p = 0.013). Moreover, patients with PG-SGA grade A had a statistically significant increase (2.2% vs. 50%, p < 0.001). The overall and major complication rates were higher in the PNSP group than in the well-nourished group without significance (51.1%, 33.3%; 42.2%, 26.7%, respectively). However, the overall and major complication rates were similar between the subgroup with PG-SGA improvement after PNSP and the well-nourished group (40.9% vs. 42.2%, p = 0.958; 27.3% vs. 26.7%, p = 0.525, respectively). QOL indicators in the PNSP group were comparable with those in the well-nourished group after PNSP.ConclusionPNSP may improve perioperative nutritional status and clinical outcomes among malnourished patients with pancreatobiliary cancer.

AND/ASPEN and GLIM Malnutrition Diagnostic Tools Identify Similar Malnutrition-Related Risk Factors

ObjectivesOur aim is to determine whether different malnutrition diagnostic tools [European Society of Clinical Nutrition and Metabolism (ESPEN), Academy of Nutrition and Dietetics/American Society of Parenteral and Enteral Nutrition (AND/ASPEN) and the Global Leadership Initiative on Malnutrition (GLIM)] are associated with common malnutrition-related risk factors in a sample of newly admitted hospital patients. MethodsThis study is a prospective observational study. Newly admitted hospital patients were screened for nutritional risk. At-risk patients were then assessed for malnutrition using ESPEN, AND/ASPEN and GLIM criteria. Bivariate analyses were computed for all predictors and tested with the result of the nutritional assessment of each of the diagnostic tools. Similarly, a logistic regression was then conducted to determine the predictors associated with each malnutrition diagnostic criteria. Results578 patients were screened for malnutrition, of which 121(20.93%) were nutritionally at risk and were subjected to nutritional assessment. The regression model suggested that the presence of pressure ulcers (OR 21.252, 95% CI 4.495–100.485), higher Charlson Comorbidiy Index (CCI) score (OR 1.321, 95% CI 1.098–1.591), lower Body Mass Index (BMI) (OR 0.478, 95% CI 0.389–0.588), and older age (OR 1.035, 95% CI 1.005–1.065) were significant predictors of malnutrition diagnosed on ESPEN criteria. While female gender [(OR 2.406, 95% CI 1.446–4.004); (OR 2.300; 95% CI 1.397–3.786)], lower BMI [(OR 0.842, 95% CI 0.792–0.895); (OR 0.835 95% CI 0.785–0.888)], higher CCI score [(OR 1.323,95% 1.185–1.477); (OR = 1.294, 95% CI 1.164–1.438)] and pressure ulcers presence [(OR 15.501, 95% CI 3.650–66.661); (OR 15.816; 95%CI 3.683–67.926)] were significant predictors of malnutrition diagnosed through AND/ASPEN and GLIM criteria respectively. Admission to the orthopedics unit indicated 91% lower risk of malnutrition on both tools respectively [(OR 0.090, 95% CI 0.008–0.968); (OR 0.090, 95% CI 0.008–0.962)]. ConclusionsThe presence of pressure ulcers, higher CCI score and lower BMI were the significant predictors that were associated with malnutrition on all tools. AND/ASPEN and GLIM diagnostic tools predicted the same risk factors. Funding SourcesLebanese American University.

Nutritional Status According to the GLIM Criteria in Patients with Chronic Heart Failure: Association with Prognosis.

Background: The Global Leadership Initiative on Malnutrition (GLIM) criteria were recently proposed to build a global consensus on the diagnostic criteria for malnutrition. This study aimed to evaluate the GLIM criteria for its prognostic significance in outpatients with heart failure (HF), and to compare them to a previous validated method, such as the Mini Nutritional Assessment (MNA). Methods: This was a post hoc observational analysis of a prospectively recruited cohort, which included 151 subjects that attended an outpatient HF clinic. At baseline, all patients completed the nutritional screening MNA short form and the nutritional assessment MNA. In a post hoc analysis, we evaluated the GLIM criteria at baseline. The outcomes were based on data from a five-year follow-up. The primary endpoint was all-cause mortality. Secondary endpoints were cardiovascular (CV) mortality and recurrent HF-related hospitalizations. We also investigated whether the GLIM criteria had better prognostic power than the MNA. Results: Abnormal nutritional status was identified in 19.8% of the patients with the GLIM criteria and in 25.1% with the MNA. In the multivariate analyses (age, sex, NYHA functional class, diabetes, and Barthel index), nutritional status assessed by the MNA, but not by the GLIM criteria, was an independent predictor of all-cause mortality, CV mortality, and recurrent HF-related hospitalizations during the five-year follow-up. Conclusions: Malnutrition assessed by MNA, but not by the GLIM criteria, was an independent predictor of all-cause mortality, CV mortality, and recurrent HF-related hospitalization in our cohort of outpatients with HF.

Current Practice of Assessing and Monitoring Muscle Strength, Muscle Mass and Muscle Function during Nutritional Care by Dietitians in Switzerland-An Online Survey.

Muscle parameters are recommended as diagnostic criteria for malnutrition and sarcopenia in various guidelines. However, little is known about the application of muscle parameters in daily practice of nutritional care. The aim of this study was to investigate the current practice of the application of muscle parameters, along with its promoting factors and barriers by dietitians in Switzerland. A 29-item literature-based online survey was developed and distributed via the Swiss professional association of dietitians. The data were analyzed descriptively, and relationships between demographic data and usage were examined. Dietitians (n = 117) from all three language regions completed the survey and were included in the analysis. Musculature was classified as important for the assessment of nutritional status. Body weight (89.7%), handgrip strength (87.2%), bioimpedance analysis (BIA) (87.1%) and Body Mass Index (66.7%) were considered as most significant for evaluation of nutritional status. Seventy-point nine percent (70.9%) of dietitians include at least one muscle parameter in their assessment; BIA was the parameter most often included (73.5%). However, the frequency of use of muscle parameter in daily practice was rather low. Only 23.1% applied BIA on a weekly basis. Lack of knowledge (78.6%), practical experience (71.8%) and lack of equipment (77.8%) were most frequently stated as barriers for usage. The general application of muscle parameters in nutritional care is still lacking. There is an opportunity to further strengthen diagnosis and patient monitoring via a stronger application of muscle parameters in daily practice. Practical training and education could help promote their application.

AND/ASPEN and the GLIM malnutrition diagnostic criteria have a high degree of criterion validity and reliability for the identification of malnutrition in a hospital setting: A single-center prospective study.

Multiple malnutrition diagnostic tools are available in clinical practice, yet, evidence on their validity and reliability is limited. We aim to assess and compare the validity and reliability of the different combinations of indicators of the three most used diagnostic tools with two validated malnutrition screening tools. Nutrition risk screening was evaluated using the Mini Nutritional Assessment-Short Form (MNA-SF) and the Nutrition Risk Screening-2002 (NRS-2002). Nutrition assessment was conducted using different combinations of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN), the European Society for Clinical Nutrition and Metabolism (ESPEN), and the Global Leadership Initiative on Malnutrition (GLIM) criteria. Concurrent criterion validity and inter-rater reliability of the overall and the different combinations of indicators in the diagnostic tools were evaluated and compared. Sensitivity, specificity, positive predictive value, negative predictive value, and Cohen kappa were calculated to determine tool validity and reliability. The AND/ASPEN (132 [22.8%]) combination and GLIM-1 (133 [23.0%]) (weight loss + compromised food intake) predicted the highest number of malnourished patients and reported a high degree of concurrent criterion validity, agreement, and reliability. On the contrary, overall ESPEN (using any combination) and GLIM-2 (reduced body mass index [BMI] + compromised food intake) reported only moderate criterion validity and low agreement and reliability. Different combinations of diagnostic criteria led to varying validity and reliability, with the lowest validation results rising from the combinations of indicators using BMI as a criterion for malnutrition diagnosis.

648 APPLICATION OF THE GLOBAL LEADERSHIP INITIATIVE ON MALNUTRITION (GLIM) CRITERIA IN PERIOPERATIVE MANAGEMENT OF ESOPHAGEAL CANCER PATIENTS

Abstract In 2019, the Global Leadership Initiative on Malnutrition (GLIM) established global malnutrition diagnostic criteria and classification methods. This study aimed to investigate the application of GLIM criteria in nutrition assessment and perioperative management in esophageal cancer patients undergoing esophagectomy. Methods A prospective institutional database of 212 esophageal cancer patients was reviewed. The property of the GLIM criteria in diagnosing malnutrition and predicting adverse therapeutic outcomes were evaluated. The two-step approach of initially screening malnutrition risk with conventional tools and then establishing diagnosis and classification with the GLIM criteria was investigated. The candidate malnutrition screening tools include the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Screening 2002, the Short-Form of Mini Nutritional Assessment, and the Geriatric Nutritional Risk Index. Results Among the included 192 patients, the proportions of moderate and severe malnutrition diagnosed by the GLIM criteria were 42.7% and 30.2% before surgery. In multivariable analyses, severe malnutrition was predictive of perioperative overall complications and major complications (both P &amp;lt; 0.001). Among the four candidates, malnutrition screened by the MUST showed highest sensitivity (90.7%), specificity (92.3%) and diagnosis consistency with the GLIM criteria. The two-step approach of MUST-GLIM showed comparable performance with pure GLIM criteria in predicting perioperative morbidities and survival outcomes, better than the conjunction of other three malnutrition screening tools with the GLIM criteria. Conclusion The GLIM criteria should be highlighted in perioperative management of esophageal cancer patients. The MUST is the recommended initial malnutrition screening tool in implementing the GLIM criteria.

Relationship between GLIM criteria and disease-specific symptoms and its impact on 5-year survival of esophageal cancer patients

Malnutrition is common in patients with esophageal cancer, which affects their prognosis. The global leadership initiative on malnutrition (GLIM) criteria was recently proposed as the world's first diagnostic criteria for malnutrition. However, the association between esophageal cancer patients and the GLIM criteria is unclear. The purpose of this study was to evaluate the percentage of patients diagnosed with malnutrition preoperatively using the GLIM criteria, assess the impact of disease-specific symptoms on the severity of malnutrition, and assess the prognostic relevance of GLIM defined malnutrition in patients with esophageal cancer. This was a retrospective single-center cohort study. Preoperative nutritional status of patients with esophageal cancer hospitalized between June 2009 and July 2011 was evaluated according to the GLIM criteria. Factors related to severe malnutrition as per the GLIM criteria were analyzed using multivariable logistic regression analysis. The association between the severity of malnutrition based on the GLIM criteria and 5-year survival was assessed using a multivariable Cox proportional hazard model. Overall, 117 esophageal cancer patients were nutritionally assessed. The percentage of moderate malnutrition and severe malnutrition was 21% and 23%, respectively. Subjective dysphagia [odds ratio (OR): 7.39, 95% confidence interval (CI): 1.46-37.52] and subjective esophageal obstruction (OR: 10.49, 95% CI: 3.47-31.70) were independent risk factors for severe malnutrition. The hazard ratio (HR) for 5-year mortality tended to be higher for moderate malnutrition (HR: 2.12, 95% CI: 0.91-4.95); however, it was not significantly associated with either moderate malnutrition or severe malnutrition (HR: 1.30, 95% CI: 0.52-3.27). Cases that were censored during the follow-up period probably affected the survival results. Subjective feelings of dysphagia and esophageal obstruction might be related to malnutrition severity in esophageal cancer patients. Malnutrition assessed by the GLIM criteria was not significantly associated with 5-year survival.

Nutritional Assessment in Adult Patients with Dysphagia: A Scoping Review.

Malnutrition negatively affects the quality of life of patients with dysphagia. Despite the need for nutritional status assessment in patients with dysphagia, standard, effective nutritional assessments are not yet available, and the identification of optimal nutritional assessment items for patients with dysphagia is inadequate. We conducted a scoping review of the use of nutritional assessment items in adult patients with oropharyngeal and esophageal dysphagia. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched to identify articles published in English within the last 30 years. Twenty-two studies met the inclusion criteria. Seven nutritional assessment categories were identified: body mass index (BMI), nutritional screening tool, anthropometric measurements, body composition, dietary assessment, blood biomarkers, and other. BMI and albumin were more commonly assessed in adults. The Global Leadership Initiative on Malnutrition (GLIM), defining new diagnostic criteria for malnutrition, includes the categories of BMI, nutritional screening tool, anthropometric measurements, body composition, and dietary assessment as its required components, but not the blood biomarkers and the “other” categories. We recommend assessing nutritional status, including GLIM criteria, in adult patients with dysphagia. This would standardize nutritional assessments in patients with dysphagia and allow future global comparisons of the prevalence and outcomes of malnutrition, as well as of appropriate interventions.

MNA-SF as a screening tool for malnutrition diagnosed with the glim criteria in older persons with cancer.

We aimed to evaluate and compare the Short Form of the Mini Nutritional Assessment (MNA-SF) as a nutritional screening tool with the new Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria for malnutrition (the most current reference standard) among older patients with cancer. Patients ≥ 70years old, with a G8 screening tool ≤ 14, referred to an oncogeriatric clinic. MNA-SF and GLIM criteria were obtained. 40 patients were included (mean age 84.8 ± 5.5, 60% male). According to the GLIM diagnostic criteria, 57.5% were malnourished. The MNA-SF classified 80% as being malnourished or at risk of malnutrition. MNA-SF showed a high sensitivity (100%) and a low specificity (50%) to detect GLIM-defined malnutrition. The AUC of the ROC curve was 0.75. The MNA-SF scale is useful as a screening tool to detect malnutrition in older cancer outpatients.

A critical review of the GLIM criteria

-Disease-related malnutrition (DRM) is a frequent syndrome in clinical practice, in which the mutual relationship between disease and malnutrition is observed. It is a specific form of malnutrition with causes other than poverty and social problems that make it difficult food production and distribution. Inflammation, anorexia, changes in body composition or in energy and protein requirements contribute to the development of DRM. This is associated with an increase in morbidity, mortality and economic expenditure. There are numerous tools to identify patients at risk of malnutrition, but until now there was no general consensus on the diagnostic criteria for malnutrition. The GLIM criteria provide a diagnostic system that has been accepted by the main international scientific societies in the field of clinical nutrition. In this article we describe its development, its application in different populations of patients and its comparison with other criteria or different diagnostic tools that contribute to its validation. This makes it possible to point out the advantages and limitations that have been described so far with the use of the GLIM criteria.

European Society for Clinical Nutrition and Metabolism (ESPEN) Malnutrition Criteria for Predicting Major Complications after Hepatectomy and Pancreatectomy

Introduction: Recently, the diagnostic criteria for malnutrition has been proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN). This study aimed to investigate the effect of ESPEN malnutrition criteria as a predictor for major complication following hepatectomy and pancreatectomy.

Malnutrition Prevalence according to the GLIM Criteria in Head and Neck Cancer Patients Undergoing Cancer Treatment.

Malnutrition is highly prevalent in people with head and neck cancer (HCN) and is associated with poorer outcomes. However, variation in malnutrition diagnostic criteria has made translation of the most effective interventions into practice challenging. This study aimed to determine the prevalence of malnutrition in a HNC population according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and assess inter-rater reliability and predictive validity. A secondary analysis of data available for 188 patients with HNC extracted from two cancer malnutrition point prevalence studies was conducted. A GLIM diagnosis of malnutrition was assigned when one phenotypic and one etiologic criterion were present. Phenotypic criteria were ≥5% unintentional loss of body weight, body mass index (BMI), and subjective evidence of muscle loss. Etiologic criteria were reduced food intake, and presence of metastatic disease as a proxy for inflammation. The prevalence of malnutrition was 22.6% (8.0% moderately malnourished; 13.3% severely malnourished). Inter-rater reliability was classified as excellent for the GLIM criteria overall, as well as for each individual criterion. A GLIM diagnosis of malnutrition was found to be significantly associated with BMI but was not predictive of 30 day hospital readmission. Further large, prospective cohort studies are required in this patient population to further validate the GLIM criteria.

Comparison between the Global Leadership Initiative on Malnutrition and the European Society for Clinical Nutrition and Metabolism definitions for the prevalence of malnutrition in geriatric rehabilitation care.

The recently proposed Global Leadership Initiative on Malnutrition (GLIM) criteria may accurately reflect the nutritional status of older adults because they use information such as reduced muscle mass and chronic and acute disease to diagnose malnutrition. This study aimed to determine the prevalence and characteristics of malnutrition in older adults assessed by the GLIM and the European Society for Clinical Nutrition and Metabolism (ESPEN) diagnostic criteria for malnutrition (DCM) in post-acute geriatric care. This cross-sectional study included older patients admitted to rehabilitation care units. Malnutrition was evaluated using GLIM-DCM and ESPEN-DCM using a two-step process (initial screening and subsequent steps). The prevalence and differences observed between GLIM-DCM and ESPEN-DCM were reported, and the determinants of each criterion were identified. This study included 335 older patients (mean ± SD, age 80.0 ± 7.5 years; 54.0% women). The prevalence of older patients diagnosed with GLIM-DCM and ESPEN-DCM was 66.9% and 59.1%, respectively, and the agreement between ESPEN-DCM and GLIM-DCM was 80.9%. The results of multivariate analyses showed that all items of the phenotypic and etiologic criteria were independent determinants for GLIM-DCM, whereas disease burden/inflammation (P = 0.996), included in the etiologic criteria of GLIM-DCM, were not determinants of ESPEN-DCM. This study reported the prevalence of malnutrition according to GLIM-DCM and the differences in the characteristics of patients diagnosed with malnutrition based on GLIM-DCM and those diagnosed based on ESPEN-DCM in geriatric rehabilitation care units. Further studies are required to investigate the prevalence of malnutrition in different care settings. Geriatr Gerontol Int 2020; 20: 1221-1227.

European Society for Clinical Nutrition and Metabolism (ESPEN) Malnutrition Criteria for Predicting Major Complications After Hepatectomy and Pancreatectomy.

Recently, diagnostic criteria for malnutrition have been proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN). This study aimed to investigate the utility of the ESPEN malnutrition criteria as a predictor for major complications following hepatectomy and pancreatectomy. Data were reviewed from 176 consecutive patients who underwent hepatectomy (n = 103) or pancreatectomy (n = 73) between November 2017 and December 2019. Patients were divided into two groups according to the ESPEN malnutrition criteria using a prospectively collected database. The clinical data and the surgical outcomes of patients in the malnourished and normal groups were retrospectively analyzed. Thirty-five (20%) patients were diagnosed with malnourishment according to ESPEN criteria. The malnourished group had a significantly low preoperative albumin concentration (p = 0.001). After hepatectomy, major complications (Clavien grade ≥ 3a) occurred significantly more frequently in the malnourished group than in the normal group (p = 0.013). Multivariate analysis indicated that operative duration ≥ 300min (hazard ratio: 22.47, 95% CI: 2.17 to 232.73, p = 0.009) and malnourishment (hazard ratio: 14.56, 95% CI: 2.58 to 82.17, p = 0.002) were independently associated with major complications after hepatectomy. On the other hand, malnutrition was not associated with major complications after pancreatectomy. The ESPEN malnutrition criteria are a valuable predictor for major complications following hepatectomy.