ESPEN Criteria Research Articles

GLIM versus ESPEN criteria for the diagnosis of early malnutrition in oncological outpatients.

e24065 Background: Malnutrition is one of the most prevalent problems among oncological patients. It reduces the response to treatments and negatively impacts survival. In 2019, a consensus criteria for diagnosing malnutrition (GLIM criteria) were proposed by most scientific nutrition societies. The objective of our work is 1) to assess the diagnostic capacity of the GLIM criteria in ambulatory patients with cancer and 2) to compare the GLIM with the ESPEN criteria to evaluate the contributions of these new criteria with respect to the existing ones. Methods: Observational, cross-sectional, and single-center study carried out at the Medical Oncology Department in the Lozano Blesa Clinical Hospital in Zaragoza (Spain). One hundred and sixty-five outpatients with tumors in the upper gastrointestinal tract, head and neck, and colorectal locations were recruited. All of them received the MST, MUST, and Nutriscore screening tools along with the ESPEN and GLIM diagnostic criteria. Results: The prevalence of malnutrition was 46.7% according to the GLIM criteria and 21.2% using the ESPEN tool. Patients diagnosed by GLIM had a higher body mass index (BMI, 24.3 kg/m2) and muscle mass (MM, 16.1 kg/m2) than those diagnosed by ESPEN (21.2 kg/m² and 14.3 kg/m2 respectively, both p = 0.001). The MST, MUST, and Nutriscore tools had a higher degree of concordance with GLIM compared to ESPEN (MST 0.53 vs 0.26; MUST 0.36 vs 0.66; Nutriscore 0.28 vs 0.54). Conclusions: The found prevalence of malnutrition in cancer patients is higher using the GLIM instead of ESPEN criteria. This disparity can be explained at least in part by the difficulty of the ESPEN criteria for malnutrition to diagnose patients with high baseline BMI or MM. The use of criteria with greater sensitivity, such as the new GLIM criteria, could help early diagnosis and thus early intervention in cancer patients. [Table: see text]

Malnutrition is associated with poor trajectories of activities of daily living in geriatric rehabilitation inpatients: RESORT

Malnutrition is associated with poor functional performance in geriatric rehabilitation inpatients. However, it is unclear if malnourished patients have poor functional trajectories over time. This study aimed to determine the association between (the risk of) malnutrition at admission and trajectories of Activities of Daily Living (ADL) and Instrumental ADL (IADL) from pre-admission to post-discharge in geriatric rehabilitation inpatients. An observational, longitudinal study was conducted in the REStORing health of acutely unwell adulTs (RESORT) cohort of geriatric rehabilitation inpatients. A total of 618 patients (mean age 82.1 ± 7.8 years, 57.4 % females) were included. The prevalence of the risk of malnutrition, by Malnutrition Screening Tool (MST) was 41.3 % (n = 255) and malnutrition by the Global Leadership Initiative on Malnutrition (GLIM) and European Society for Clinical Nutrition and Metabolism (ESPEN) criteria were 53.5 % (n = 331) and 13.1 % (n = 81) respectively. Malnutrition by the GLIM criteria but not the ESPEN criteria nor the risk of malnutrition, was associated with ADL trajectories of ‘remained poor’ (OR: 3.33, 95 %CI: 1.21−9.19) and ‘deteriorated’ (OR: 1.68, 95 %CI: 1.13−2.52) compared to the ‘recovered’ trajectory. The risk of malnutrition and malnutrition were not associated with IADL trajectories. Malnutrition at admission was associated with poor ADL trajectories but not IADL trajectories in geriatric rehabilitation inpatients.

Malnutrition Risk among Older Mexican Adults in the Mexican Health and Aging Study.

Few studies assess the malnutrition risk of older Mexican adults because most studies do not assess nutritional status. This study proposes a modified version of the Mini Nutritional Assessment (MNA) to assess the risk of malnutrition among older Mexicans adults in the Mexican Health and Aging Study (MHAS). Data comes from the 2012, 2015, and 2018 waves of the MHAS, a nationally representative study of Mexicans aged 50 and older. The sample included 13,338 participants and a subsample of 1911 with biomarker values. ROC analysis was used to calculate the cut point for malnutrition risk. This cut point was compared to the definition of malnutrition from the ESPEN criteria, BMI, low hemoglobin, or low cholesterol. Logistic regression was used to assess predictors of malnutrition risk. A score of 10 was the optimal cut point for malnutrition risk in the modified MNA. This cut point had high concordance to identify malnutrition risk compared to the ESPEN criteria (97.7%) and had moderate concordance compared to BMI only (78.6%), and the biomarkers of low hemoglobin (56.1%) and low cholesterol (54.1%). Women, those older than 70, those with Seguro Popular health insurance, and those with fair/poor health were more likely to be malnourished. The modified MNA is an important tool to assess malnutrition risk in future studies using MHAS data.

Weight loss and malnutrition risk in geriatric patients

HintergrundMangelernährung stellt eine große Herausforderung im klinischen Alltag dar und ist mit einer erhöhten Mortalität assoziiert.Ziel der ArbeitIm vom Bundesministerium für Bildung und Forschung (BMBF) geförderten Forschungsprojekt Prävention und Behandlung von Mangelernährung bei geriatrischen Patienten im Krankenhaus werden Routinedaten ausgewertet. Ziel ist es, die Ursachen eines in der Klinik erworbenen Mangelernährungsrisikos aufzudecken.Material und MethodenAusgewertet werden anonymisierte Daten von insgesamt 2058 PflegeheimbewohnerInnen aus 19 Pflegeeinrichtungen mit mindestens 3‑tägigem Klinikaufenthalt. Mangelernährungsrisiko wird mithilfe der kombinierten Screenings MUST/PEMU (Malnutrition Universal Screnning Tool/Pflegerische Erfassung von Mangelernährung und deren Ursachen) , die manifeste Mangelernährung entsprechend den ESPEN-Kriterien (European Society for Clinical Nutrition and Metabolism) bestimmt.ErgebnisseEin initialer Anteil von 36,2 % (n = 744) weist ein Mangelernährungsrisiko und 12,7 % (n = 262) eine manifeste Mangelernährung auf; die Anteile steigen nach Klinikaufenthalt auf 48,6 % (n = 881) bzw. 14,3 % (n = 259). Die logistische Regressionsanalyse zeigt eine signifikant steigende Wahrscheinlichkeit, ein Mangelernährungsrisiko während des Klinikaufenthaltes zu entwickeln, wenn Einweisungsdiagnosen der ICD-10-Gruppen (International Classification of Diseases and Related Health Problems) Krankheiten des Atmungssystems (OR 2,686; 95 %-KI 1,111–4,575) und Nebendiagnosen der Gruppe Osteopathien und Chondropathien (OR 1,892; 95 %-KI 1,149–3,115) vorliegen sowie bei einem höheren BMI (OR 1,108; 95 %-KI 1,038–1,181), positiveren Gewichtsveränderungen 6 Monate vor Krankenhaus (OR 1,055; 95 %-KI 1,017–1,094) und einer steigenden Anzahl an Behandlungstagen (OR 1,048; 95 %-KI 1,029–1,067).DiskussionSowohl die Identifikation einer initialen Mangelernährung als auch die Prävention eines innerklinischen Mangelernährungsrisikos stellt eine große Herausforderung für die Kliniken dar. Beides ist aber gleichermaßen erforderlich.Zusatzmaterial onlineZusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-021-01900-z) enthalten.

GLIM vs ESPEN criteria for the diagnosis of early malnutrition in oncological outpatients

Malnutrition is one of the most prevalent problems among oncological patients. It reduces the response to treatments and negatively impacts survival. In 2019, a consensus criteria for diagnosing malnutrition (GLIM criteria) were proposed by most scientific nutrition societies. The objective of our work is 1) to assess the diagnostic capacity of the GLIM criteria in ambulatory patients with cancer and 2) to compare the GLIM with the ESPEN criteria to evaluate the contributions of these new criteria with respect to the existing ones. Observational, cross-sectional, and single-center study carried out at the Medical Oncology Department in the Lozano Blesa Clinical Hospital in Zaragoza (Spain). One hundred and sixty-five outpatients with tumors in the upper gastrointestinal tract, head and neck, and colorectal locations were recruited. All of them received the MST, MUST, and Nutriscore screening tools along with the ESPEN and GLIM diagnostic criteria. The prevalence of malnutrition was 46.7% according to the GLIM criteria and 21.2% using the ESPEN tool. Patients diagnosed by GLIM had a higher body mass index (BMI, 24.3kg/m2) and muscle mass (MM, 16.1kg/m2) than those diagnosed by ESPEN (21.2kg/m2 and 14.3kg/m2 respectively, both p=0.001). The MST, MUST, and Nutriscore tools had a higher degree of concordance with GLIM compared to ESPEN (MST 0.53 vs 0.26; MUST 0.36 vs 0.66; Nutriscore 0.28 vs 0.54). The found prevalence of malnutrition in cancer patients is higher using the GLIM instead of ESPEN criteria. This disparity can be explained at least in part by the difficulty of the ESPEN criteria for malnutrition to diagnose patients with high baseline BMI or MM. The use of criteria with greater sensitivity, such as the new GLIM criteria, could help early diagnosis and thus early intervention in cancer patients.

Comparison of espen and glim criteria for malnutrition diagnosis in patients with chronic gastrointestinal diseases

Comparison of espen and glim criteria for malnutrition diagnosis in patients with chronic gastrointestinal diseases

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.

Mortality in malnourished older adults diagnosed by ESPEN and GLIM criteria in the SarcoPhAge study.

BackgroundThe Global Leadership Initiative on Malnutrition (GLIM) criteria have been recently launched by consensus of the major nutrition societies. GLIM criteria are partly constructed on the previous definition of malnutrition developed by the European Society of Clinical Nutrition and Metabolism (ESPEN). We aimed to assess malnutrition according to the ESPEN and GLIM criteria at baseline and to determine the corresponding risk of mortality during a 4‐year follow‐up in community‐dwelling older adults from the SarcoPhAge (Sarcopenia and Physical Impairment with advancing Age) study. The relationship between malnutrition and incidence of 4‐year adverse health consequences (institutionalization, hospitalization, falls, and fractures) was assessed.MethodsThis prospective population‐based cohort was part of SarcoPhAge, which included 534 older adults in Belgium, followed up from 2013 to 2019. Community‐dwelling healthy volunteers ≥65 years old were recruited. Mortality and adverse health consequences were collected annually by interview or phone call. Baseline malnutrition was defined according to the GLIM and ESPEN criteria. Agreement between the two definitions was reported by Cohen's kappa coefficient. Adjusted Cox regression and Kaplan–Meier survival curves were performed for malnutrition. Logistic regression was used for the other outcomes.ResultsFrom 534 subjects in SarcoPhAge, the records for 411 participants (73.2 ± 6.05 years old; 55.7% women) had all the variables needed to apply the GLIM criteria. Prevalence of baseline malnutrition was 23.4% for GLIM and 7% for ESPEN criteria (k = 0.30, low agreement). The adjusted Cox regression showed a significant increased mortality risk according to malnutrition status as defined by the GLIM [adjusted hazard ratio = 4.41 (95% confidence interval: 2.17–8.97)] and ESPEN [adjusted hazard ratio = 2.76 (95% confidence interval: 1.16–6.58)] criteria. Survival curves differed significantly between malnourished and non‐malnourished groups, regardless of the definition used (log rank P < 0.001 for both). No association was found between baseline malnutrition according to these two criteria and 4‐year risk of institutionalization, hospitalization, falls, or fractures (all P > 0.05).ConclusionsMalnutrition according to the GLIM criteria was associated with a 4.4‐fold higher mortality risk, double that of the ESPEN criteria, during a 4‐year follow‐up. No association was found between malnutrition according to these two criteria and incidence of other health adverse consequences. GLIM criteria anticipate mortality and might guide interventions, with important implications for clinical practice and research.

Nutritional Status and Bone Microarchitecture in a Cohort of Systemic Sclerosis Patients.

Systemic sclerosis (SSc) is a connective tissue disease characterized by initial microvascular damage, immune system activation and progressive fibrosis with insufficiency of internal organs. Gastrointestinal (GI) involvement is characterized by atrophy of the smooth muscle and small bowel hypomotility, mainly resulting from an autonomic nerve dysfunction. These modifications significantly affect gut transit and nutrient absorption, thus leading to malnutrition deficit induced by malabsorption. Nutritional deficit induced by malabsorption might also lead to bone alterations. This study aims to evaluate the relationship between malnutrition and bone status. Thirty-six postmenopausal female patients fulfilling the ACR 2013 criteria for SSc underwent dual-energy X-ray absorptiometry scan (DXA) to detect quantitative lumbar spine bone mineral density (BMD) and trabecular bone score (TBS) analysis to detect bone quality. Data from DXA also allow to assess body composition and provide several quantitative parameters, including free fat mass index (FFMI) that identifies the patient with malnutrition (values <15 kg/m2 in women and 17 kg/m2 in men), according to the ESPEN criteria. Body mass index (BMI) was calculated for all SSc patients and every patient completed a diary reporting GI symptoms. Two groups of SSc patients with or without diagnosed malnutrition according to FFMI parameter were identified. Malnourished SSc patients showed significantly lower weight (p = 0.01) and BMI (p = 0.001), as well as lower serum levels of hemoglobin (p = 0.009), albumin (p = 0.002), PTH (p = 0.02) and 25OH-vitamin D (p = 0.008). DXA analysis showed significantly lower lumbar L1-L4 T-score (p = 0.009) and BMD values (p = 0.029) in malnourished SSc patients. Consistently, TBS values were significantly lower in malnourished patients (p = 0.008) and correlated with BMD (at any site) and serum albumin levels (p = 0.02). In addition, FFMI positively correlated with bone parameters as well as with symptoms of intestinal impairment in malnourished SSc patients. Finally, GI symptoms significantly correlated with BMD but not with TBS. This pilot study shows that in malnourished SSc patients (2015 ESPEN criteria: FFMI<15 kg/m2), an altered bone status significantly correlates with GI involvement, in terms of symptoms being mainly due to intestinal involvement together with the presence of selected serum biomarkers of malnutrition.

Assessing Malnutrition in Systemic Sclerosis With Global Leadership Initiative on Malnutrition and European Society of Clinical Nutrition and Metabolism Criteria.

Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis of the skin and internal organs. Gastrointestinal tract (GIT) involvement may lead to malnutrition, which can in turn negatively affect morbidity, mortality, and quality of life. The aim of the study was to assess the prevalence of malnutrition in SSc patients with both the European Society of Clinical Nutrition and Metabolism (ESPEN) and the Global Leadership Initiative on Malnutrition (GLIM) criteria and to assess whether it relates with disease activity and severity. Adult SSc patients were included in the study. Biochemical analyses, disease activity index (DAI), disease severity scale (DSS), anthropometric data, and body composition parameters for GLIM and ESPEN assessment were recorded at enrollment. One hundred and two SSc patients were enrolled (86 females, mean age 55 ± 14 years). The prevalence of malnutrition was 8.8% (9 of 102), according to ESPEN, and 16.6% (17 of 102), according to GLIM criteria. GLIM severity grading of malnutrition was moderate in 12.7% (13 of 102) and severe in 3.9% (4 of 102) . In SSc patients with malnutrition according to GLIM criteria, DAI and DSS were significantly higher than in SSc patients without malnutrition (P < .0001), whereas no association was observed between malnutrition and DAI or DSS when using the ESPEN criteria. Prevalence of malnutrition is higher with GLIM than with ESPEN criteria. Irrespective of the method used, prevalence of malnutrition in SSc is lower than one would expect in a chronic, autoimmune disease with GIT involvement.

The GLIM criteria for defining malnutrition can predict physical function and prognosis in patients with cardiovascular disease.

The Global Leadership Initiative on Malnutrition (GLIM) published a new international standard for defining malnutrition in 2018. The GLIM criteria were compared with the European Society for Clinical Nutrition and Metabolism (ESPEN) criteria in relation to physical function and mortality risk in patients with cardiovascular disease (CVD). A total of 921 CVD patients≥20 years old (67.8±13.4 years, 631 men) hospitalised for heart failure, acute coronary syndrome and other conditions were stratified according to the presence or absence of malnutrition according to the GLIM and ESPEN criteria. Physical function was assessed by measuring grip strength, 6-minute walking distance and quadriceps isometric strength before hospital discharge, and the endpoint was all-cause mortality. During the median follow-up period of 2.3 years (interquartile range, 0.9-3.5 years), 194 deaths occurred in the study population. Malnutrition defined by the GLIM criteria was significantly associated with low physical function. Malnutrition defined by both the GLIM and ESPEN criteria was significantly related to all-cause mortality (P<0.05). Malnutrition defined according to the GLIM criteria was a predictor of both low physical function and mortality in patients with CVD.

The nutritional status of people with alkaptonuria: An exploratory analysis suggests a protein/energy dilemma.

BackgroundAlkaptonuria (AKU) is a disorder of tyrosine/protein metabolism leading to accumulation of homogentisic acid. Clinical management historically recommended reducing dietary protein intake, especially in childhood, which has since been discredited in the literature. For the first time, analysis of baseline cross‐sectional nutritional surveillance data from a large cohort of AKU patients is presented, which has clinical implications in all aspects of treatment planning.MethodSeventy‐four patients (mean 55 years) admitted to the National Alkaptonuria Centre (NAC), underwent a global nutritional assessment, which included objective anthropometry, bioimpedance measures, habitual nutritional intake using a 7‐day food diary and key nutritional biomarkers, including 24 hours urinary nitrogen, serum albumin, total protein and total 25‐hydroxy vitamin D. All data was compared with cohort norms or recommended nutrient intakes for health (RNI). The potential beneficial impact of protein and anti‐inflammatory nutrients such as vitamin C, selenium, and zinc were statistically interrogated against the AKU severity score index (AKUSSI)—a validated measure of disease progression stratified by age.ResultsFifty percent of AKU patients reported some level of protein restriction at some point in their lives. In comparison with national data sets, AKU patients present with significantly lower than predicted mid‐upper arm circumference, grip strength, BMI, total energy and protein intake, and higher than predicted percentage body fat. They therefore meet the ESPEN criteria as “clinically undernourished.” Severity fluctuates over the life course. No statistical association is identified between protein intake, expressed as %RNI or g/kg, or anti‐inflammatory nutrients, including vitamin C as a high dose supplement on the severity of the disease, when correlated against the validated AKUSSI score.ConclusionAKU patients are at risk of protein depletion associated with a “perfect storm” of risk factors: historical, poorly evidenced recommendations to reduce total protein intake; limited mobility as the condition progresses, compromising muscle integrity; frequent hospital admissions for major surgery associated with multiple joint replacements, creating pinch points of high metabolic demand and the potential impact of the disease itself. As this is the first time this risk has been identified, the authors consider the dietetic implications of nitisinone treatment, which requires dietary protein control to manage the acquired tyrosinaemia. The lack of statistically significant evidence to support dietary manipulation of any kind to impede disease progression in AKU is demonstrated.

P188 Evaluation of Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition in patients affected by inflammatory bowel disease (IBD) candidates for elective surgery

Abstract Background In inflammatory bowel disease (IBD), malnutrition has been associated with increased postoperative complications incidence, longer hospital stay and higher costs. ESPEN guidelines recommend that all IBD patients must be screened for malnutrition. Recently, so-called GLIM criteria were developed to uniform malnutrition diagnosis. Our aim was to determine the prevalence of malnutrition comparing the different malnutrition criteria. Methods The nutritional status of all IBD patients’ candidates to surgery in our Centre during 2019 was assessed. According to the GLIM criteria, the diagnosis of malnutrition is based on the presence of almost one phenotypic criteria (non-volitional weight loss, low body mass index and reduced muscle mass) and almost one aetiologic criteria (reduced food intake or assimilation; biochemical inflammation). The results were compared with that found adopting ESPEN 2015 criteria for malnutrition to evaluate their concordance. Results Fifty-three consecutive IBD patients [38 Crohn’s disease (CD) and 15 ulcerative colitis (UC)] were evaluated. The average values of Body Mass Index, Free Fat Mass Index ad Phase Angle were 22.69 kg/m2, 17.6 kg/m2 and 5.8° respectively. According to the Nutritional Risk Screening (NRS) test 40% (21 patients) of patients were at high nutritional risk. Forty-five per cent (24 patients) were malnourished according to GLIM criteria (14 with severe malnutrition and 10 with moderate malnutrition), while according to the ESPEN criteria only 26% (14 patients) (Table 1). The correlation between GLIM and ESPEN, calculated with the Cohen’s kappa coefficient (k) was moderate/good (k 0,605). Conclusion GLIM criteria indicate higher prevalence of malnutrition than ESPEN criteria. Interestingly, the same 14 patients malnourished for ESPEN have severe malnutrition (Stage 2) according to GLIM. Furthermore, seven malnourished patients according to GLIM criteria are not considered at nutritional risk according to NRS, probably because it does not consider the muscle mass loss. Patients with CD have a higher prevalence of aetiological factors, while UC patients have a higher prevalence of phenotypic factors. Malnutrition prevalence was higher in UC probably due to the ileostomy present before second-stage surgery 4 months after subtotal colectomy in acute severe cases. The concordance between GLIM and ESPEN 2015 appears moderate/good.

European Academy for medicine of ageing session participants' report on malnutrition assessment and diagnostic methods; an international survey

Malnutrition and nutrition-related diseases are associated with hospital admissions, disability, institutionalization, and mortality in older people. Specialists in Geriatric Medicine and nutrition evaluate nutritional status as part of the comprehensive geriatric assessment; however, malnutrition still remains under-recognized and under-managed. Our survey explored nutrition assessment approaches used in daily clinical practice by geriatricians across Europe. A 19-item survey on methods and instruments for malnutrition assessment in geriatric settings, and details of any national guidelines, was sent to 40 postgraduate fellows of the European Academy of Medicine of Aging (EAMA, 2017-2019 class). Thirty-six of the 40 eligible EAMA participants, representing 14 European countries, responded. In clinical practice, MNA and MNA-SF were most frequently used for screening (44.1%, 52.9%, respectively) and diagnosing (45.7%, 40.0%) malnutrition. Weight loss (n=36, 100%), body mass index (n=30, 85.7%), and low energy/food intake (n=27, 77.1%) were the most frequent clinical variables considered. The absolute and relative amount of weight loss, and over what time period, varied widely. These routinely considered clinical factors contribute to validated GLIM, ASPEN-AND and ESPEN criteria for diagnosis of malnutrition, but these criteria were seldom used (GLIM=0%, ASPEN=0%; n=9, ESPEN=25.7%). National guidelines were available in 9 of the 14 countries, and generally recommended MNA and MNA-SF for community-dwelling and hospitalized older patients. Albumin was often suggested as a nutritional marker. Nutritional assessment is systematically performed in geriatrics; but differs widely among geriatricians and countries. Harmonizing guidelines with the new international consensus might provide best-evidence care for older people across Europe.

Malnutrition as a Strong Predictor of the Onset of Sarcopenia.

This study aims to explore the association between malnutrition diagnosed according to both the Global Leadership Initiative of Malnutrition (GLIM) and the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria and the onset of sarcopenia/severe sarcopenia, diagnosed according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criterion, in the sarcopenia and physical impairment with advancing age (SarcoPhAge) cohort during a four-year follow-up. Adjusted Cox-regression and Kaplan-Meier curves were performed. Among the 534 community-dwelling participants recruited in the SarcoPhAge study, 510 were free from sarcopenia at baseline, of whom 336 had complete data (186 women and 150 men, mean age of 72.5 ± 5.8 years) to apply the GLIM and ESPEN criteria. A significantly higher risk of developing sarcopenia/severe sarcopenia during the four-year follow-up based on the GLIM [sarcopenia: Adjusted hazard ratio (HR) = 3.23 (95% confidence interval (CI) 1.73–6.05); severe sarcopenia: Adjusted HR = 2.87 (95% CI 1.25–6.56)] and ESPEN [sarcopenia: Adjusted HR = 4.28 (95% CI 1.86–9.86); severe sarcopenia: Adjusted HR = 3.86 (95% CI 1.29–11.54)] criteria was observed. Kaplan-Meier curves confirmed this relationship (log rank p < 0.001 for all). These results highlighted the importance of malnutrition since it has been shown to be associated with an approximately fourfold higher risk of developing sarcopenia/severe sarcopenia during a four-year follow-up.

SUN-PO219: Evaluation of Nutritional Status with Nutritional Risk Screening 2002 and Subjective Global Assessment, ESPEN Criteria, and Body Composition at Admission in a Hospital Ward

SUN-PO219: Evaluation of Nutritional Status with Nutritional Risk Screening 2002 and Subjective Global Assessment, ESPEN Criteria, and Body Composition at Admission in a Hospital Ward

Sarcopenia in systemic sclerosis: the impact of nutritional, clinical, and laboratory features.

We evaluated the presence of sarcopenia in a population of systemic sclerosis (SSc) patients, with respect to nutritional, clinical, and laboratory features. A total of 62 patients who met the ACR/EULAR 2013 classification criteria were enrolled. Sarcopenia was defined according to the Relative Skeletal Mass Index (RSMI) and hand grip strength (HGS). Body composition was assessed with the calculation of the Body Mass Index (BMI), lean body mass (LBM) and fat mass (FM). Malnutrition was evaluated according to the ESPEN criteria. Clinical evaluation included nailfold capillaroscopy and skin evaluation by modified Rodnan Skin Score (mRSS), pulmonary function tests (PFT) with diffusing capacity for carbon monoxide adjusted for hemoglobin (DLCO), high-resolution computed tomography (HR-CT) of the lungs, echocardiography and high-resolution manometry (HRM) for esophageal involvement. Laboratory evaluation included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin, creatinine, creatine kinase (CK), transaminases, lipid profile, glycemia, albumin, and vitamin-D. Antinuclear antibodies (ANA) and extractable nuclear antigens (ENA) were also assessed. Considering RSMI, the prevalence of sarcopenia is 42%. In this case, age, malnutrition, disease duration, mRSS, capillaroscopy score, esophageal involvement, ESR, and ANA titer are higher in the sarcopenic group, while DLCO and LBM are lower. Considering HGS, the prevalence of sarcopenia is 55%. Age, disease duration, malnutrition, FM, mRSS, capillaroscopy score, esophageal involvement, ESR, and ENA positivity are higher in the sarcopenic group, while DLCO is lower. By using both RSMI and HGS to assess sarcopenia in SSc, the results of this study demonstrated that this condition correlates with different nutritional, clinical, and biochemical parameters associated with the worsening of the disease.

Malnutrition according to ESPEN consensus predicts hospitalizations and long-term mortality in rehabilitation patients with stable chronic obstructive pulmonary disease

Nutritional disorders are frequent in patients with chronic pulmonary obstructive disease (COPD) and have negative health impacts. This study aimed to explore the value of the European Society of Clinical Nutrition and Metabolism (ESPEN) definition of malnutrition (and/or its individual components) to predict hospitalizations and mortality at 2 years, and to determine the prevalence of malnutrition in COPD patients referred to pulmonary rehabilitation. The study was a prospective analysis of 118 patients with COPD free of exacerbations and/or hospital admissions in the previous two months. Main outcome variables were mortality, hospital admissions, and length of stay at 2-year follow-up; main covariates were malnutrition assessment according to the ESPEN definition and its components: unintentional weight loss, body mass index, and fat-free mass index (FFMI). Body composition was assessed by bioimpedance analysis. Kaplan-Meier survival curves and linear regression analyses were performed, adjusting for age and airflow obstruction as potential confounders. The observed prevalence of malnutrition was 24.6%. Malnutrition was associated with increased mortality risk (HR=3.9 [95% CI: 1.4-10.62]). FFMI was independently associated with increased mortality (HR=17.0 [95% CI: 2.24-129.8]), which persisted after adjustment for age and lung function (adjusted HR=13.0 [95% CI: 1.67-101.7]). Low age-related body mass index was associated with increased risk of hospital admissions. Malnutrition according to ESPEN criteria, highly prevalent in patients with stable COPD referred to pulmonary rehabilitation, was associated with 4 times greater mortality risk after 2 years. Low FFMI was associated with a 17-fold increase in mortality risk, suggesting independent predictive value.

Screening for malnutrition in patients admitted to the hospital with a proximal femoral fracture

IntroductionThe prevalence of malnutrition in patients admitted with a proximal femoral fracture is considered high and the negative effects on health are well-studied. The SNAQ and the MNA-SF are two screening tools routinely used during admission of acute medical patients. The aim of this study is to compare the screening capacity of the SNAQ score and the MNA-SF, and to evaluate their predictive values for malnutrition using the ESPEN criteria. Materials and methodsA single-centre study with data routinely collected prospectively from the original patient records was performed in the Haaglanden Medical Centre Bronovo in the Netherlands. All patients with a proximal femoral fracture consecutively admitted between December 19th 2016 and December 21st 2017 were included. The Intraclass Correlation Coefficient was used to assess the agreement between the malnutrition screening tools and the predictive values were calculated to compare the SNAQ with the MNA-SF using the ESPEN diagnostic criteria as the reference standard. ResultsData was available from 437 patients. Of all patients admitted with a proximal femoral fracture 16.9% was diagnosed as malnourished by the ESPEN criteria. When screened, 20.1% (SNAQ score) to 47.8% (MNA-SF) of all patients were classified as either at risk for malnutrition or as malnourished. A moderate agreement was found between the MNA-SF and the SNAQ (κ = 0.68). The sensitivity, specificity, PPV and NPV of the SNAQ score were 71.6%, 90.4%, 60% and 94% respectively, compared to 100%, 62.8%, 35.4% and 100% for the MNA-SF. DiscussionThe SNAQ has been proven to be a very specific screening tool and the positive predictive value tends to be higher than that of the MNA-SF. However, 28.4% of all malnourished patients with a proximal femoral fracture had a negative screening test when using the SNAQ score. ConclusionsNo benefits were observed for the SNAQ over the MNA-SF as a screening tool for malnutrition in admitted patients with a proximal femoral fracture. Missing a significant portion of malnourished patients or those at risk and consequent under treatment of fragile older patients should be avoided. The well-validated MNA-SF seems more preferable as a screening tool for this patient population.

Effect of malnutrition on mortality with new espen criteria in patients with hematological malignancies

Rationale: Malnutrition is common and has negative impacts in patients with cancer. However, its prevelance in patients with hematological malignancies has not been well described. The aim of this study is to identify the rate of malnutrition with new ESPEN criteria and point its effect on mortality in patients with hematological malignancies.