Global Leadership Initiative On Malnutrition Research Articles

The ability of GLIM and MNA-FF to diagnose malnutrition and predict sarcopenia and frailty in hospitalized adults over 60 years of age

IntroductionMalnutrition remains common in adults over 60 years old. Although there are screening and diagnostic tools for malnutrition, there is no globally used approach to diagnosing malnutrition in older adults admitted to the hospital. In this study, we verified the agreement between the Global Leadership Initiative on Malnutrition (GLIM) and the Mini Nutritional Assessment (MNA) and the ability of the instruments to identify frailty and sarcopenia associated with malnutrition.MethodsFor adults over 60 years old, malnutrition diagnosis was performed using the Mini Nutritional Assessment Full Form (MNA-FF) tool and the GLIM criteria, which included calf circumference and fat-free mass index to assess muscle mass, with and without the Mini Nutritional Assessment Short Form (MNA-SF) screening. Health conditions were assessed in older adults, and the association of these conditions with malnutrition was analyzed using both tools.ResultsA total of 432 adults over 60 years old were investigated with a mean age of 71.14 ± 8 years. The GLIM criteria with the nutritional screening tool identified 61–63% of older adults as malnourished. Of these, 63–64% were severely malnourished. The MNA-FF tool classified 20% of those assessed as malnourished. The agreement between the MNA-FF and GLIM was better with the use of screening, with a kappa (K) value of −0.10 and − 0.11. Sarcopenia was associated with malnutrition as identified by the MNA-FF (OR: 3.08, 95% CI: 1.84–5.14) and only by the GLIM ANTHRO (OR: 1.66, 95% CI: 1.05–2.63). Frailty was associated with the MNA-FF (OR: 15.99, 95% CI: 2.16–118.36), GLIM ANTHRO (OR: 2.21, 95% CI: 1.31–3.71), and GLIM BIA (OR: 2.45, 95% CI: 1.45–4.12).ConclusionIt is possible to verify that divergent conceptual frameworks are used to understand malnutrition by the MNA-FF and GLIM and that the GLIM obtained a greater number of malnutrition diagnoses. Both the GLIM ANTHRO and the MNA-FF associated malnutrition with frailty and sarcopenia, with higher hazard ratios for the MNA-FF.

Evaluating the Diagnosis of Malnutrition Based on Global Leadership Initiative on Malnutrition (GLIM) Criteria in Community-Dwelling Older Adults (Singapore Longitudinal Aging Study)

Background: A minority of studies using the GLIM criteria for malnutrition diagnosis have performed formal empirical validation. Objectives: To evaluate the concurrent and predictive validity of GLIM criteria with and without prior screening among community-dwelling older adults in Singapore. Method: In the Singapore Longitudinal Aging Study (SLAS-2, n = 2477), malnutrition was diagnosed using single-step and two-step GLIM procedures using the Mini Nutritional Assessment Short Form (MNA-SF) and Elderly Nutritional Index for Geriatric Malnutrition Assessment (ENIGMA) for initial screening. Criterion validity was evaluated using MNA-Full Form (MNA-FF) as reference malnutrition diagnosis. Prognostic validity was evaluated using logistic and Cox regression analyses with respect to impaired quality of life (QoL) and 10-year mortality. Results: GLIM malnutrition with and without MNA-SF or ENIGMA screening showed significant associations with known clinical correlates; single-step GLIM malnutrition: sensitivity = 80%, specificity = 83%; two-step MNA-SF-GLIM malnutrition: sensitivity = 80%, specificity = 85%; two-step ENIGMA-GLIM malnutrition: sensitivity = 74%, specificity = 88%; positive predictive values of around 20% and negative predictive values above 98%. Cohen’s kappa values of agreement were uniformly low (0.26 to 0.32). All showed significant associations with about 50% increased odds of impaired QoL and 10-year mortality, adjusted for age, sex, ethnicity, education levels, and housing type, with the ENIGMA-GLIM malnutrition showing the highest risk estimates. Compared to MNA-FF malnutrition prevalence of 4.1%, GLIM-based malnutrition increased prevalence (14.6% to 19.7%) estimates. Conclusions: The GLIM criteria showed good construct and criterion validity. It increased the number of individuals diagnosed with malnutrition. The agreement between diagnoses of malnutrition was low. Diagnostic and prognostic accuracy vary with the screening instrument used. Early identification of malnutrition using appropriate tools can provide opportunities to delay or prevent the risk of important adverse outcomes such as impaired QoL and mortality.

Global Leadership Initiative on Malnutrition criteria: Clinical benefits for patients with gastric cancer.

Malnutrition is a prevalent condition among patients with gastric cancer and is associated with poor survival outcomes. This study aimed to evaluate the clinical utility of the Global Leadership Initiative on Malnutrition (GLIM) criteria in predicting survival among patients with gastric cancer. The multicenter retrospective cohort study (INSCOC study) included 1406 patients enrolled between December 2012 and April 2020, with follow-up data collected until June 2023. Various indices for muscle evaluation, such as calf circumference (CC) and body weight-standardized hand grip strength (HGS/W), were used to diagnose malnutrition. Kaplan-Meier curves were used to analyze the relationship between nutrition status, as defined by GLIM criteria, and survival outcomes in these patients. The analysis revealed that using CC or HGS/W as positive indicators of malnutrition effectively identified patients with survival-related malnutrition. The incidence of malnutrition was 54.5%, with patients' median overall survival times of 1169 days for stage I and 575 days for stage II cancer (P < 0.001). Malnutrition was identified as an independent risk factor for survival. Additionally, a nomogram developed through Cox regression analysis demonstrated precise predictive capability, incorporating factors such as tumor node metastasis staging, Karnofsky Performance Status Scale, direct bilirubin levels, and nutrition intervention. The study concludes that the GLIM criteria are effective in diagnosing malnutrition and predicting survival in patients with gastric cancer. Nutrition interventions significantly enhance survival outcomes, underscoring the importance of standardized nutrition treatments in improving patient prognosis.

Implementing the Global Leadership Initiative on Malnutrition (GLIM) criteria in Crohn's disease: prevalence of malnutrition and association with clinical outcomes

Background & AimsLimited data exist regarding the implementation of the Global Leadership Initiative on Malnutrition (GLIM) criteria for diagnosing malnutrition in Crohn’s disease (CD), and its association with CD prognosis. In the present study eighteen GLIM combinations and a combined one were implemented to identify differences in the prevalence of malnutrition and to investigate potential associations with clinical outcomes at 6 months. MethodsDifferent methodologies to diagnose malnutrition were used at baseline, namely the Subjective Global Assessment (SGA), eighteen different combinations of phenotypic and etiologic GLIM criteria and a combined version based on all GLIM combinations (GLIMcv) to test differences in the estimated prevalence and outcomes’ prognosis. At 6 months, data for clinical outcomes were collected (i.e. hospitalization, antibiotics use, intensification/change of biologic agent, initiation of biologic agent/corticosteroids, surgery, disease activity), and an overall adverse clinical outcome index was created. Results250 people with CD (54.8% males, mean age 41.2±14.1 years, 37.2% with active disease) were enrolled. Prevalence of malnutrition based on SGA and GLIMcv was 23% and 52%, respectively, and 5.8-63% based on different GLIM combinations. Malnutrition diagnosed with GLIMcv was associated with an increased likelihood of intensification/change of biologic agent [Odds ratio (OR): 1.82, 95% Confidence interval (CI): 1.00-3.42, p=0.05] and an overall adverse clinical outcome (OR: 2.18, 95% CI: 1.23-3.87, p=0.008) at 6 months, after adjustment for age, sex, disease location and duration. Malnutrition diagnosed through SGA was not associated with clinical outcomes at 6 months. ConclusionsBased on GLIMcv, half of the sample was diagnosed with malnutrition. Malnutrition significantly increased the likelihood of uncontrolled disease requiring treatment upgrading and leading to an overall adverse clinical outcome short term.

GLIM criteria for diagnosing malnutrition in institutionalized older adults

the Global Leadership Initiative on Malnutrition (GLIM) was created to unify the diagnosis of malnutrition worldwide. The main objective of this work is to evaluate the validity of the GLIM criteria for diagnosing malnutrition in a population over 65 years of age living in a nursing home. In addition, the order of importance of the GLIM criteria for diagnosing malnutrition was also analyzed. a cross-sectional study was carried out with 130 older adults institutionalized in a nursing home. To study the validity of the GLIM criteria, sensitivity and specificity were calculated and a Receiver Operating Characteristic (ROC) curve was calculated using the MNA questionnaire as the reference diagnostic method. A Lasso regression model was used to determine the order of importance of the criteria. according to GLIM and MNA the prevalence of malnutrition was 26.2 % and 18.5 %, respectively. The GLIM criteria were found to have a sensitivity of 100 %, a specificity of 91 % and a very good level of precision (AUC = 0.95). The order of importance of the criteria from highest to lowest are loss of muscle mass, weight loss, presence of inflammation, low BMI and decreased nutrient intake or assimilation. the GLIM criteria presented a satisfactory level of validity and are therefore an acceptable method to diagnose malnutrition in institutionalized older adults.

Two-step GLIM approach using NRS-2002 screening tool vs direct GLIM criteria application in hospital malnutrition diagnosis: A cross-sectional study.

The two-step Global Leadership Initiative on Malnutrition (GLIM) approach was recently introduced to malnutrition diagnosis in a hospital setting. This study compares the diagnostic performance of this approach that uses the Nutritional Risk Screening-2002 (NRS-2002) as a screening tool and the direct application of GLIM malnutrition diagnostic criteria in hospitalized patients. This cross-sectional study involved 290 adult and older adult patients who were hospitalized. A trained nutritionist implemented the two-step GLIM approach, including NRS-2002 (in the first step) and GLIM criteria (in the second step) for each patient. Then, the accuracy, kappa index, area under the receiver operating characteristic curve (AUC ROC), sensitivity, and specificity of malnutrition diagnostic performance of the two-step GLIM approach and NRS-2002 were evaluated compared to thedirect use of GLIM criteria. The NRS-2002 identified 145 (50.0%) patients as at risk of malnutrition. The prevalence of malnutrition using the two-step GLIM approach and GLIM malnutrition diagnosis criteria were 120 (41.4%) and 141 (48.6%), respectively. The kappa index showed substantial and almost perfect agreement for NRS-2002 (κ = 68%) and the two-step GLIM approach (κ = 85%) with GLIM malnutrition diagnostic criteria, respectively. Furthermore, the AUC ROC (0.926; 95% confidence interval (CI): 0.89-0.96) and accuracy (92.8%) of the two-step GLIM approach compared to the GLIM criteria indicated an acepptable ability to distinguish between malnourished and well-nourished patients. The two-step GLIM approach using NRS-2002 as a screening tool (in step one) had acceptable malnutrition diagnostic performance compared to the direct application of GLIM criteria in hospitalized patients.

The potential of body mass index-adjusted calf circumference as a proxy for low muscle mass in the global leadership initiative on malnutrition criteria

Background & AimsReduced muscle mass is one of the diagnostic components for Global Leadership Initiative on Malnutrition (GLIM), with various assessment methods proposed. Calf circumference (CC), a representative anthropometric marker of skeletal muscle mass, is now recommended to adjustment based on body mass index (BMI). This study aimed to evaluate the validity and efficacy of BMI-adjusted CC in very older adults, compared with other methods of assessing muscle mass. MethodsThis prospective cohort study included 284 patients aged 65 years and older who were admitted to the Department of Geriatric Medicine at the National Center for Geriatrics and Gerontology Hospital. Health indicators, including nutritional status, were assessed upon admission. Three months after discharge, a telephone survey was conducted to assess patients’ living conditions and survival status. Skeletal muscle mass was estimated using a dual-energy X-ray absorptiometry (DXA); moreover, anthropometric measurements (unadjusted and BMI-adjusted CC) were used as markers of muscle mass. Logistic regression analysis was performed to examine the association between mortality and GLIM-based malnutrition, using each muscle mass assessment method. ResultsThe mean age of the patients was 86.2 ± 6.2 years, and 60.9% were women. The prevalence of GLIM-based malnutrition ranged from 55.3% to 58.8% across the three methods used to assess reduced muscle mass. Three months after discharge, 244 patients were followed up, of whom 29 (11.9%) died. Multivariate logistic regression analysis, adjusted for age, sex, and comorbidities, showed that all methods significantly predicted 3-month mortality, with odds ratios of 5.67, 5.44, and 4.90 for unadjusted CC, BMI-adjusted CC, and appendicular skeletal muscle mass index using DXA, respectively. The prevalence and survival-predictive ability were similar across all methods. ConclusionGLIM-based malnutrition, diagnosed using different methods for assessing muscle mass, similarly predicted 3-month mortality in patients admitted to an acute geriatric ward. These results suggest that BMI-adjusted CC are sufficient alternatives when technical measurements such as DXA are not feasible.

Malnutrition Diagnosis and Food Consumption in Subacute Post-Stroke Patients During Rehabilitation.

Stroke survivors frequently encounter malnutrition, adversely impacting clinical outcomes. Nevertheless, malnutrition and food consumption in post-stroke patients have not been frequently assessed, and their correlation with rehabilitation outcomes remains inadequately explored. The objective of this observational study was to evaluate malnutrition at admission in these patients, assess food consumption during a six-week rehabilitation program, and analyze their correlation with rehabilitation outcomes. Subacute post-stroke patients were evaluated at admission (T0) and after a six-week rehabilitation treatment (T1). At T0, we assessed clinical and demographic characteristics, and we diagnosed malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. Weight, BMI, hematochemical parameters, and activities of daily living with the modified Barthel Index (mBI) were evaluated at both T0 and T1; recovery was registered as a change in the mBI (ΔmBI = mBIT1 - mBIT0). Patients' food consumption was recorded through visual plate waste estimation of three meals a day, 5 days a week, for six weeks of hospitalization for rehabilitation. A total of 109 patients completed the study (51 women, mean age 69 ± 11). According to the GLIM criteria, 105 of these patients were at risk of malnutrition, while 43 were malnourished, with 15 severely malnourished. Malnourished patients wasted more food, with respect to non-malnourished patients, as measured by visual plate waste of total meals (25 ± 17% vs. 15 ± 14%; p = 0.001) and reached a lower ΔmBI. A linear regression analysis found a significant correlation between the ΔmBI, the waste of a "second dish", which contained mainly protein, and serum albumin at admission, even after controlling for age. Malnutrition assessed with the GLIM criteria at admission and food consumption are two important nutritional parameters to evaluate in post-stroke patients hospitalized for rehabilitation due to their association with recovery.

Global Leadership Initiative on Malnutrition Criteria and Immunonutritional Status Predict Chemoadherence and Survival in Stage II/III Gastric Cancer Treated with XELOX Chemotherapy.

Adjuvant chemotherapy is crucial for the treatment of advanced gastric cancer. However, various factors negatively impact chemoadherence, with malnutrition after gastrectomy being a critical determinant. This study aims to analyze the impact of malnutrition, assessed through the Global Leadership Initiative on Malnutrition (GLIM) and other immunonutritional indices, on chemoadherence and its subsequent effect on survival. This retrospective study included 116 patients who underwent curative gastrectomy and received oxaliplatin and capecitabine (XELOX). Preoperative nutritional status was assessed using the GLIM criteria along with other immunonutritional indices, such as the prognostic nutritional index (PNI), C-reactive protein-to-albumin ratio (CAR), neutrophil-lymphocyte ratio (NLR), controlling nutritional status (CONUT) score, and modified Glasgow Prognostic Score (mGPS). Chemotherapy adherence was measured using relative dose intensity (RDI). Statistical analyses included least absolute shrinkage and selection operator (LASSO) regression to identify the key predictors of RDI and Cox proportional hazards models and assess the impact on survival. Overall, 116 patients were included in this analysis. In the multivariate analysis using LASSO regression, higher GLIM severity was independently associated with a lower RDI (coefficient = -0.0216; p < 0.01). Other significant factors influencing RDI included older age (p < 0.01), female sex (p = 0.02), higher mGPS (p = 0.03), higher CONUT score (p = 0.04), and higher CAR (p = 0.05), all of which were associated with a lower RDI. The Cox proportional hazards analysis revealed that higher RDI was significantly associated with better survival (hazard ratio [HR] = 0.06; p < 0.005). This study highlights the critical role of immunonutritional status, particularly as measured using the GLIM criteria, in maintaining adherence to chemotherapy and improving survival outcomes in patients with gastric cancer. Routine preoperative nutritional assessments using GLIM can help identify high-risk patients, and early nutritional interventions may improve chemotherapy adherence and outcomes. These findings support the integration of nutritional strategies, specifically targeting those identified by the GLIM, into standard care to enhance the efficacy and survival of chemotherapy.

Frailty and Malnutrition in Surgical Outcomes of Elderly Breast Cancer Patients.

We evaluate the impact of frailty and malnutrition on breast cancer surgery outcomes in older adults using the ACS 5-factor modified frailty index (MFI) and Global Leadership Initiative on Malnutrition (GLIM) definition. Single institution retrospective review of a prospective database of the older adult (>60 years old) breast cancer surgery patients (2000-2016); cases stratified into groups as per MFI (0-2) and GLIM. Characteristics, 90-day post-op events, and 5-year follow-up data were analyzed to report survival and complication outcomes. Among 436 patients at diagnosis, 213 (48.9%) were >80 years old. 377 (86.5%) were alive at 5 years. 274 (62.8%) had MFI > 0, and 69 (15.8%) had malnutrition. Patients ≥ 80, MFI > 0, and PR-negative tumors had worse 5-year survival. There was no survival difference in patients >80 with/without malnutrition (HR = 1.01, p = 0.971), and there was no difference in mastectomy or lumpectomy (p = 0.560) between patients ≥ 80 or patients younger than 80; however, 94% of immediate reconstruction were in pts < 80. On multivariate regression, complications were associated with age < 80, readmission, MFI > 0, and history of HTN; serious complications were associated with age < 80, readmission, anticoagulation, and not receiving endocrine therapy. MFI showed a significant predictive value for 5-year survival for patients ≥ 80 and should be part of the preoperative evaluation.

Prevalence of malnutrition based on different combinations of Global Leadership Initiative on Malnutrition (GLIM) phenotypic and etiologic criteria and association with the course of Crohn's Disease (CD)

Prevalence of malnutrition based on different combinations of Global Leadership Initiative on Malnutrition (GLIM) phenotypic and etiologic criteria and association with the course of Crohn's Disease (CD)

Mediterranean-DASH Diet Intervention for Neurodegenerative Delay Diet and Psychological Problems in Maintenance Hemodialysis Patients by the Structural Equation Modeling Analysis of Malnutrition and Inflammation Markers Approach

ObjectiveAlthough it is known that diet quality affects psychological problems in hemodialysis patients, there is need to explain the role of modifiable risk factors in this relationship. Therefore, the aim of this study was a) to investigate the relationship between diet quality and modifiable risk factors to depression and anxiety in end-stage renal disease (ESRD) patients receiving maintenance hemodialysis; b) to explore the mediating roles of modifiable factors in the relationship with diet quality to depression and anxiety. MethodsThis cross-sectional study included 216 patients with ESRD receiving maintenance hemodialysis treatment. We assessed participants' dietary records for Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND) quality, Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition and Hospital Anxiety and Depression (HAD)-scale for psychological problems. Furthermore, biochemical findings and anthropometric measurements were performed to evaluate nutritional markers, metabolic risk factors and inflammation. We applied hierarchical regression analysis to estimate modifiable risk factors for depression and anxiety and Structural-Equation-Modeling analysis to determine the mediating role of modifiable risk factors between diet quality and psychological problems. ResultsDepression symptoms were observed in 59.2% (n=128) of the participants, whilst the rate was 35.1% (n=76) for anxiety. Depression and anxiety were found to be negatively correlated with MIND levels after covariate adjusting model, and the rates of explanation were found to be 16.2% and 12.2%, respectively. C-reactive protein (CRP), albumin levels and the presence of malnutrition were shown to be significant predictors of depression (ΔF=14.761 and ΔR2:0.071 for covariate-adjusted model). Albumin levels, CRP, hemodialysis duration, and malnutrition were found to be independent predictors of anxiety (ΔF=16.174 and ΔR2:0.077 for covariate-adjusted model). It was found that CRP and malnutrition partially mediated the association of MIND score with depression, and CRP mediated the association with anxiety. ConclusionIt was concluded that adherence to the MIND diet is associated with a better nutritional profile and reduced inflammation, which in turn may be linked to fewer psychological problems.These further studies are needed to validate and expand upon our findings.

Malnutrition defined by global leadership initiative on malnutrition criteria impedes home discharge in acute care hospital admissions

Background & aimsLimited evidence exists on the association between malnutrition diagnosis using the Global Leadership Initiative on Malnutrition (GLIM) criteria in hospitalized acute care patients and their outcomes; several aspects still require clarification. This study aimed to evaluate the relationship between malnutrition, as defined by the GLIM criteria, at the time of acute hospital admission and discharge to home. MethodsThis retrospective observational study was conducted at a hospital that provides acute care in Japan. Adult patients admitted between July 2023 and April 2024 were included in this study. The primary outcome was the number of patients discharged to home, with in-hospital mortality as the secondary outcome. To ensure the reliability of the cohort-wide results, background factors were adjusted using propensity score matching. The two groups were compared based on the presence or absence of malnutrition, as defined by the GLIM criteria at admission. Furthermore, multiple logistic regression analysis was conducted, with the outcome as the dependent variable and malnutrition, diagnosed using the GLIM criteria, as the explanatory variable, adjusting for covariates. ResultsA total of 1,007 patients were included in the final analysis, of whom 492 (49%) were diagnosed without malnutrition, while 515 (51%) were diagnosed with malnutrition according to the GLIM criteria. In the multivariate logistic regression analysis after matching, malnutrition defined by the GLIM criteria emerged as an independent factor associated with discharge to home (odds ratio [OR] = 0.37, 95% confidence interval = 0.25–0.56, P < 0.001) when adjusting for age, sex, and various comorbidities. Among the GLIM sub-criteria, reduced muscle mass, reduced food intake or assimilation, and disease burden or inflammation were independently associated with discharge to home. Notably, disease burden/inflammation exhibited the lowest OR among the GLIM sub-criteria for discharge. ConclusionMalnutrition diagnosed using the GLIM criteria upon admission in patients admitted to a regional hospital providing acute care was associated with decreased rates of discharge to home and increased in-hospital mortality. Specifically, attention should be paid to the criteria for reduced muscle mass and disease burden or inflammation within the GLIM framework.

Global Leadership Initiative on Malnutrition-defined malnutrition coexisting with visceral adiposity predicted worse long-term all-cause mortality among inpatients with decompensated cirrhosis

Background/objectivesMalnutrition coexisting with abdominal adipose tissue accumulation bring a double burden on prognosis. More recently, the Global Leadership Initiative on Malnutrition (GLIM) has reached a novel consensus concerning the diagnostic criteria, that is, a two-step modality combining nutritional risk screening and subsequent phenotypic/etiologic parameters for comprehensive evaluation in hopes of harmonizing the malnutrition diagnosis. We aimed to elucidate their synergistic impact among inpatients with decompensated cirrhosis concerning long-term mortality.Subjects/methodsMalnutrition, visceral obesity, and visceral adiposity were defined by the Global Leadership Initiative on Malnutrition (GLIM), visceral fat area (VFA), and visceral to subcutaneous adipose tissue area ratio (VSR) on computed tomography, respectively. Accordingly, the patients were categorized into different groups given their nutritional status and visceral obesity/adiposity. Multivariate Cox regression was performed to identify independent risk factors associated with 1-year all-cause mortality. Kaplan–Meier curves with log-rank tests were compared among distinct groups.ResultsTotally, 295 patients were recruited. GLIM, VFA, and VSR identified 131 (44.4%), 158 (53.6%), and 59 (20%) patients with malnutrition, visceral obesity and visceral adiposity, respectively. Malnutrition coexisted with visceral obesity in 55 (MO group) relative to visceral adiposity in 40 patients (MA group). Multivariate Cox analysis showed that MA (hazard ratio: 2.48; 95% confidence interval: 1.06, 5.79; P = 0.036) was independently associated with dire outcome rather than MO. Moreover, patients with cirrhosis in the MA group had the worst survival status when compared with other groups (log-rank test: P < 0.001).ConclusionsThe current study indicated that coexisting GLIM-defined malnutrition and VSR-defined visceral adiposity were in relation to worse long-term mortality among inpatients. It is imperative to delicately manage nutritional status and provide personalized treatment in this vulnerable subgroup for achieving better prognosis.

Insights into the associated risk factors of malnutrition among nursing home residents: A longitudinal study

Background & AimsMalnutrition often remains undetected in older persons, leading to increased health problems and comorbidity, prolonged hospital stays and readmissions. In 2020, data from the interRAI Home Care (interRAI HC) instrument was used to determine malnutrition status according to some of the criteria of the Global Leadership Initiative on Malnutrition (GLIM). The interRAI HC instrument showed to be effective as a screening tool for the risk of malnutrition. The goal of the present study is to use the interRAI Long Term Care Facilities (interRAI LTCF) instrument for nursing home residents to identify factors related to older people’s health that are significantly associated with the development of malnutrition. MethodsThis study analyzes data collected in the period 2019-2023 from nursing home residents, 65 or older, with a follow-up period of 1 year. After applying the GLIM criteria to the available interRAI LTCF data, a cross-sectional sample a longitudinal sample were analyzed by means of bivariate analysis. Factors included in the bivariate analysis were based in previous studies and expert opinion. Unadjusted and adjusted regression models were built to explore associations between several potential risk factors and nutritional status. ResultsThe sample consisted of 5598 older people with a mean age of 83.98 ± 7.30 years old and 71.2 % being female. Most people needed extensive assistance with activities of daily living (70.9%) and had at least a mild cognitive impairment (63.9%). According to the GLIM definition using the interRAI items, 8.43% of the residents were malnourished and 4.67% of the residents became malnourished over the period of 1 year. The final adjusted logistic regression yielded significant odds ratios for seven determinants: age (O.R. 1.03; C.I.: 1.01;1.04), depressive symptoms (O.R.: 1.32; 1.01; 1.73), assistance needed for walking (O.R. 1.49; C.I.: 1.13; 1.95), wandering behavior (O.R. 1.16; C.I.: 1.01; 1.33), falls (O.R. 1.17; C.I.: 1.02; 1.35), visual impairment (O.R. 1.22; C.I.: 1.05; 1.42) and diabetes (protective factor - O.R.: 0.67; C.I.: 0.46; 0.98). ConclusionsThe study showed the main risk factor for malnourishment in nursing home residents, such as age, depressions, assistance for walking, wandering and visual impairment. These significant factors can be used to identify people at risk of malnourishment. Periodically screening residents with the interRAI LTCF can help identify malnourished residents or residents at risk of malnourishment.

Concurrent and predictive validity of the Global Leadership Initiative on Malnutrition criteria for adult patients in convalescent rehabilitation wards

Background & aimsThe Global Leadership Initiative on Malnutrition (GLIM) criteria has been recognised as major diagnostic criteria for malnutrition in adults worldwide; however, its validity in rehabilitation settings remains unclear. This study investigated the concurrent and predictive validity of the GLIM criteria for adult patients in convalescent rehabilitation wards. MethodsThis retrospective cohort study was conducted using pre-established datasets from convalescent rehabilitation wards in a hospital. The inclusion criteria were adults aged ≥18 years admitted to the wards between November 2018 and October 2020 who were available for body composition assessment. Malnutrition diagnoses were determined by registered dietitians (RDs) using the GLIM criteria. The Subjective Global Assessment (SGA) was performed by another RD and used for the malnutrition reference standard. The GLIM criteria sensitivity and specificity were examined for SGA. The odds ratios and hazard ratios of GLIM-defined malnutrition for the total score of the Functional Independence Measure (tFIM) effectiveness and non-home discharge were calculated using univariable and multivariable logistic regression analyses and Cox proportional hazard models. ResultsData from 723 patients were extracted from the dataset. GLIM-defined malnutrition was confirmed in 207 (28.6%) patients, 87 (12.0%) with moderate malnutrition and 120 (16.6%) with severe malnutrition. The SGA graded 146 (20.2%) patients with moderate malnutrition (grade B) and 86 (11.9%) with severe malnutrition (grade C). The GLIM criteria (malnutrition/ no malnutrition) had fair sensitivity (76.7%, 95% confidence interval [CI]: 70.7–82.0%) and good specificity (94.1%, 95% CI: 91.6–96.0%), indicating acceptable concurrent validity. GLIM-defined moderate malnutrition had poorer sensitivity than severe malnutrition (42.5% vs 81.4%). Logistic regression analyses revealed no evidence for the association between GLIM-defined malnutrition and poor tFIM effectiveness (adjusted odds ratio [AOR]: 1.09, 95% CI: 0.71–1.69) and non-home discharge (AOR: 1.19, 95% CI: 0.76–1.84). The Cox proportional hazard analyses also showed no effect of malnutrition on outcomes. ConclusionThe GLIM criteria had fair sensitivity and good specificity, indicating acceptable criteria for diagnosing malnutrition in rehabilitation settings. However, its predictive validity for functional recovery and discharge outcomes was insufficient.

Undernutrition, cognitive decline and dementia: The collaborative PROMED-COG pooled cohorts study

Background & aimsUndernutrition may negatively impact cognitive function, but evidence of this relationship is not yet consolidated. Under the “PROtein enriched MEDiterranean diet to combat undernutrition and promote healthy neuroCOGnitive ageing” (PROMED-COG) project, we evaluated the association between undernutrition, and cognitive decline and incident dementia in older adults. MethodsRetrospective data harmonization was performed on three Italian population-based studies: the Italian Longitudinal Study of Ageing (ILSA), the Progetto Veneto Anziani (Pro.V.A.), and the Bollate Eye Study-Follow-Up (BEST-FU). The associations between undernutrition, operationalized using the Global Leadership Initiative on Malnutrition (GLIM) criteria, and decline on the Mini-Mental State Examination (MMSE) or dementia incidence follow-up were evaluated with Cox proportional hazard regression models. ResultsThe pooled cohort comprised 9071 individuals (52% females) aged between 42 and 101 years. The prevalence of undernutrition at the baseline was 14.3%, significantly higher among females (15.4% vs 13%) and in older age, ranging from 3.5% in those aged <60 years to 28.8% in those 85+ years. Undernutrition was associated with both cognitive decline over a median 8.3-year follow-up (Hazard Ratio (HR) 1.20, 95% Confidence Interval (CI) 1.02–1.41, p = 0.028) and incidence of dementia over a median 8.6-year follow-up (HR = 1.57, 95%CI 1.01–2.43, p = 0.046). For cognitive decline, the association with undernutrition was more marked in males than females (HR = 1.36, 95%CI 1.05–1.77, p = 0.019 vs HR = 1.10, 95% CI 0.89–1.36, p = 0.375). ConclusionUndernutrition is prevalent among older people and is associated with an increased risk of experiencing cognitive decline and dementia. The prevention and early identification of undernutrition could be an important nonpharmacologic strategy to counteract neurodegeneration.

SP4.9 - Relationship Between Classifications for Cancer Cachexia and Overall Survival in Patients with Oesophagogastric Cancer

Abstract Aim Classifications for cancer cachexia remain heterogenous within the existing literature. The aim of this study is to compare prognostication using three established descriptors: the Fearon et al. consensus definition, Martin et al.’s weight loss grading system and the Global Leadership Initiative on Malnutrition (GLIM) criteria, in patients with oesophagogastric cancer. Methods Consecutive patients with newly diagnosed oesophagogastric cancer between 2019-2020 were identified from a prospectively maintained regional database. Data were retrieved regarding involuntary weight loss, body mass index, CT body composition analyses and neutrophil-lymphocyte-ratio at the time of clinical staging. This allowed comparison based on Fearon, Martin and GLIM classifications. The primary outcome of interest was overall survival. Results Overall, 465 patients (66.9% male, median 71 years) were diagnosed with oesophageal (72.0%) or gastric cancer (28.0%). Greater proportions of advanced stage disease were associated with Fearon (p=0.019), Martin (p=0.004) and GLIM (p&amp;lt;0.001) defined cachexia. Patients who met the GLIM criteria were also older and had poorer ECOG performance status (both p&amp;lt;0001). Each cachexia classifier was associated with worsened overall survival (all p&amp;lt;0.001). Following adjustment for clinicopathological confounders, Fearon (aHR: 1.54 (95%CI:1.24-1.92) and GLIM defined cachexia (aHR: 1.74 (95%CI:1.40-2.17) were both adversely associated with overall survival. Grade 4 weight-loss, as per Martin et al., had the greatest prognostic effect (aHR: 2.11 (95%CI:1.52-2.93). Conclusion Cancer cachexia is strongly associated with poorer survival in oesophagogastric cancer. The GLIM criteria and high Martin et al. weight loss grade appear to have the greatest prognostic value.

SP4.10 - Comparison of the Global Leadership Initiative on Malnutrition (GLIM) Phenotypic Criteria in Patients with Oesophagogastric Cancer

Abstract Aim The Global Leadership Initiative on Malnutrition (GLIM) consensus proposed that patients should meet one of three phenotypic criteria for a diagnosis of malnutrition. This study examined the association between these criteria and survival in oesophagogastric cancer. Methods Consecutive patients newly diagnosed with oesophagogastric cancer were identified from a prospectively maintained regional database between 2019-2020. Data were collected regarding the GLIM phenotypical criteria: involuntary weight loss (≥5% in 6 months or ≥10% in &amp;gt;6 months), body mass index (&amp;lt;20kg/m2 (&amp;lt;70 years) or &amp;lt;22kg/m2 (&amp;gt;70 years)) and reduced muscle mass via body composition analysis. Cross-sectional area of skeletal muscle was measured at mid-L3 on staging CT imaging. This was normalised for height to create skeletal muscle index (SMI), with low SMI being defined as per Martin et al. The outcome of interest was overall survival. Results Overall, 465 patients (median 71 years, n=311 males) were identified. Weight loss (p=0.022), BMI (p&amp;lt;0.001) and SMI (p=0.005) cut-offs were all associated with reduced ECOG performance status. BMI and SMI were also associated with increased age. A higher proportion of patients with advanced stage malignancy met the weight loss threshold (p=0.001). Each phenotypical criterion was associated with worsened overall survival (all p&amp;lt;0.001). While all three were prognostic, following adjustment for confounders, low SMI (aHR:1.76 (95%CI:1.39-2.22)) was more strongly associated with poor survival than low BMI (aHR:1.57 (95%CI:1.18-2.08)) or weight loss (aHR:1.46 (95%CI:1.17-1.81)). Conclusion While each of the GLIM phenotypical criteria are adversely prognostic in oesophagogastric cancer, low SMI is most strongly associated with poor survival.

ThP4.9 - The role of preoperative nutritional assessment in postoperative outcomes of hepato-pancreato-biliary patients: A bicenter prospective observational study

Abstract Aims Preoperative nutritional status of patients who undergo surgery due to hepato-pancreato-biliary (HPB) cancer has been considered as a prognostic factor of their postoperative course. The aim of the present study was to investigate the association of preoperative nutritional assessment with the postoperative morbidity and mortality in such patients. Methods Patients undergoing surgery due to HPB cancer from March 2022 until March 2023 at two university surgical departments were included in the present study. Patients’ demographics and postoperative parameters, such as complications’ severity according to Clavien-Dindo classification and mortality, along with malignancy stage were reported. Preoperative nutritional assessment was conducted according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Controlling Nutritional Status (CONUT) score. The present study was registered in ClinicalTrials.gov (NCT05795374). Results The present study included 66 patients with a mean age of 63 ± 12 years old. The high risk of malnutrition according to the GLIM criteria was associated with major (Clavien-Dindo≥3) postoperative complications (74% vs 32%, p=0.026) and increased 30-day mortality (80% vs 23%, p=0.021). Moreover, malnutrition according to the CONUT tool was correlated to increased 30-day mortality (66% vs 45%, p=0.016). Conclusions Preoperative malnutrition seems to be associated with higher rates of postoperative mortality and major morbidity in patients undergoing surgery due to HPB cancer.