Global Leadership Research Articles

Severity of Inflammation Is Associated with Food Intake in Hospitalized Geriatric Patients-A Merged Data Analysis.

The extent to which inflammation impacts food intake remains unclear, serving as a key risk factor for malnutrition as defined by the Global Leadership Initiative on Malnutrition (GLIM). To address this, we analyzed a large, merged dataset of geriatric hospitalized patients across Europe. The study included 1650 consecutive patients aged ≥65 year from Germany, Italy, Finland, Denmark, and Poland. Nutritional intake was assessed using the first item of the Mini Nutritional Assessment Short Form; C-reactive protein (CRP) levels were measured using standard procedures. In total (age 79.6 ± 7.4 year, 1047 females), 23% exhibited moderate to severe inflammation, and 12% showed severe inflammation; 35% showed moderate reductions in food intake, and 28% were considered malnourished. Median CRP levels differed significantly between patients with severe, moderate, and no decrease in food intake. Among patients with a CRP level of 3.0-4.99 mg/dL, 19% experienced a severe decrease in food intake, while 66% experienced moderate to severe decreases. Regression analysis revealed that inflammation was the most prominent risk factor for low food intake and malnutrition, surpassing other factors such as age, gender, infection, and comorbidity. A CRP level of ≥3.0 mg/dL is associated with reduced food intake during last 3 months in two thirds of hospitalized geriatric patients and therefore indicative for a high risk of malnutrition.

Turkey and the Russian invasion of Ukraine: an interplay of bloc (de)formation, recognition and asymmetric interdependencies?

ABSTRACT This piece answers some of the issues (such as the potential emergence of new blocs, the role of interdependencies, and Western recognition) raised in Debating the War in Ukraine by examining Turkey’s role in the war in Ukraine. It argues that Turkey’s somewhat balanced policy in the war, trying to please both Ukraine and Russia, stems from three main considerations. First, Turkey’s economic and strategic asymmetric interdependency (in Syria) on Russia prevents Turkey from taking actions that might run against Russian interests in the war in Ukraine. Second, Turkey’s balanced attitude legitimizes Turkey’s position to undertake mediation efforts to end the war, fulfill the global leadership role envisioned by the JDP-led Turkey, and also has the potential to garner Turkey some Western recognition, which might not be domestically translated. Finally, the balanced attitude is also a well-poised strategy for Turkey to garner a stake in the post-war reconstruction of Ukraine.

Association between GLIM-defined malnutrition and hospitalizations in kidney transplant candidates: A post hoc analysis of a cohort study.

Malnutrition is frequent in patients with chronic kidney disease (CKD) and has a negative impact on morbidity, mortality, and quality of life. The objective of this study was to assess the value of the Global Leadership Initiative for Malnutrition (GLIM) criteria to predict hospitalizations and mortality in candidates to kidney transplant during their first year on the waiting list. This was a post hoc analysis of 368 patients with advanced CKD. The main study variables were malnutrition, according to the GLIM criteria; number of hospital admissions during the first year on the waiting list; and mortality at the end of follow-up. Kaplan-Meier survival curves and binary logistic regression were performed, adjusting for age, frailty status, handgrip strength, and Charlson Index as potential confounders. The prevalence of malnutrition was 32.6%. Malnutrition was associated with increased risk of hospitalizations during the first year on the waiting list (odds ratio [OR] = 3.33 [95% CI = 1.34-8.26]), which persisted after adjustment for age and frailty status (adjusted OR = 3.61 [95% CI = 1.38-10.7]), age and handgrip strength (adjusted OR = 3.39 [95% CI = 1.3-8.85]), and age and Charlson Index (adjusted OR = 3.25 [95% CI = 1.29-8.13]). Malnutrition according to the GLIM criteria was highly prevalent in patients with CKD and was associated with a threefold increased risk of hospitalizations during the first year on the waiting list; these associations remained significant after adjusting for age, frailty status, handgrip strength, and comorbidities.

Developing a Pipeline of African Global Surgery Scholars.

Global surgery is developing as new discipline in many countries. Global surgery primarily aims to improve access to quality surgery in low-and-middle Income countries (LMICs). Thus, ensuring appropriate LMIC representation and leadership in global surgery research, projects, and innovations, is essential. There is a paucity of pathways for students and young clinicians in LMICs to attain training in and exposure to global surgery research and projects. If equity in global surgery leadership and scholarship is truly desired, steps need to be taken to ensure that more students and young clinicians in LMICs are exposed to global surgery as an academic discipline and are offered pathways to practice and leadership. This paper explores ways of ensuring this through increased exposure, increased training and increased funding.

THE GLIM CRITERIA TO IDENTIFY MALNUTRITION IN PATIENTS IN HOSPITAL SETTINGS: A SYSTEMATIC REVIEW.

Malnutrition is recognized as one of the main public health problems in hospitals. Therefore, the Global Leadership Initiative on Malnutrition (GLIM) has established a global consensus on the criteria for diagnosing malnutrition in adults in hospital settings. This study aimed to identify the ability of the GLIM criteria as a tool to identify malnutrition in hospital settings patients and to compare the prevalence of malnutrition identified by GLIM criteria with other screening and/or nutritional assessment methods. This was a systematic review. Searches were performed using MEDLINE/PubMed, Scopus, and Virtual Health Library, based on established descriptors. The included studies were observational and used screening and/or nutritional assessment tools to compare the prevalence of malnutrition and predictive capacity identified by GLIM criteria in in hospital settings patients aged >18 years. Twelve studies were included in this systematic review. A total of 4066 individuals with different pathologies and clinical conditions participated in the included studies. The prevalence of malnutrition, according to the GLIM criteria, ranged from 16% to 80%. In four studies, the prevalence of malnutrition based on GLIM was higher than that of the other indicators. Six studies evaluated the predictive ability and identified satisfactory sensitivity and specificity. Four studies found low to high agreement between GLIM and the other methods. The GLIM criteria can identify malnutrition and find a high prevalence and severity of malnutrition in the hospital setting, proving to be a sensitive and specific instrument, with good agreement between screening and nutritional assessment methods. This article is protected by copyright. All rights reserved.

The Global Leadership Mentoring Community: An evaluation of its impact on nursing leadership.

To evaluate a year-long mentorship program, pairing nurses from different regions across the world to support their global leadership capability, and identifying additional consequences of their participation. Investment in developing nurse leaders continues as a strategic global imperative. Building on the first cohort's recommendations, this second program illustrates continued progress. Using the logic model of program evaluation, this non-empirical paper uses data collected from anonymized questionnaires and participants' stories to help improve the program, illustrating innovative practices to develop the confidence and competence of emerging and established nurse leaders globally. The value of mentorship was recognized, and there were gains for both mentors and mentees in the development of leadership confidence and competence. Through engagement and collaboration with the whole community, participants were encouraged to understand their own and others' cultures avoiding assumptions and stereotypes. This evaluation illustrates that in addition to helping improve future programs, mentorship has enabled the growth of individuals' skill sets and the confidence to reach out to peers across the world to understand the meaning of global health and to make a meaningful contribution to the challenges they face. Nurse managers should be encouraged to develop and formalize a mentoring culture to benefit the leadership competence and well-being of their workforce. Every nurse has a responsibility to invest in nursing leadership for themselves and others. Mentorship can assist nurse leaders to build workforce capability to lead and contribute to the policy agenda locally, nationally, and internationally. Starting early and at the individual level, global mentorship programs can develop leadership expertise to help nurses find their voice and strengthen their confidence and competence to lead and therefore build the strategic leaders of the future.

Global leadership in paediatric and congenital cardiac care: education and empowerment to improve outcomes in low- and middle-income countries - an interview with Krishna Kumar, MD, DM FAHA.

Dr Krishna Kumar is the focus of our sixth in a series of interviews in Cardiology in the Young entitled, "Global Leadership in Paediatric and Congenital Cardiac Care." Dr Kumar was born in Raurkela, India. He attended medical school at Maulana Azad Medical College in New Delhi, graduating in 1984. Dr Kumar then went on to complete internal medicine, emergency medicine, and adult cardiology training at All India Institute of Medical Sciences in 1988, 1989, and 1990, respectively. He then pursued paediatric cardiology training at Harvard Medical School in Boston, MA, USA. Dr Kumar began his clinical position as a paediatric cardiologist at Amrita Institute of Medical Sciences in Kochi, Kerala, India.During his impressive career, Dr Kumar has made significant contributions to educational advancement, research and innovation, public health advocacy, and clinical care. Dr Kumar is credited for distinguishing paediatric cardiology as a distinct subspecialty in India. He was a founding member of the Pediatric Cardiology Society of India and the original editor of the society's academic journal. Recognising the deficit of paediatric cardiology-trained physicians in low- and middle-income countries, Dr Kumar helped establish formal structured training programmes for paediatric cardiology in India. More recently, he established the Children's HeartLink Fellowships in paediatric cardiac sciences at Amrita Institute of Medical Sciences in Kochi and Institut Jantung Negara in Malaysia. Through educational programmes, Dr Kumar has taught countless caregivers and paediatricians, in India and neighbouring countries, the early identification and management of children with CHD. Dr Kumar has established a premier paediatric heart programme at Amrita Institute of Medical Sciences. As department Chief, he emphasises the importance of teamwork, advocacy, and continuous quality improvement. He has developed numerous low-cost strategies for the management of CHD. He has established large community-based studies on rheumatic heart disease and CHD in South India. Dr Kumar's focus on advocacy and policy change in India has made a substantial impact on early identification and treatment of CHD in the subcontinent. He has made a global impact on the care of paediatric cardiology patients through his educational programmes, research and innovation, large-scale research registries, and advocacy for public health policy changes. He is an incredibly humble and generous leader, and his patients and community are the source of his unending motivation.

Investigation on the 3-Step Procedure of Nutritional Screening, Evaluation, and GLIM Diagnosis for Elderly Inpatients

This study investigated a 3-step procedure of nutritional risk screening, evaluation, and Global Leadership Initiative on Malnutrition (GLIM) diagnosis for Chinese elderly inpatients. Nutritional risk screening was performed as the first step using the Nutritional Risk Screening 2002 (NRS2002). Nutritional status evaluation was performed as the second step using the Mini-Nutritional Assessment Short Form (MNA-SF). Malnutrition diagnosis was performed as the third step using the GLIM criteria. The consistency of these tools and the validity of the GLIM criteria were proven. Fewer patients met the GLIM criteria compared with the NRS2002. Good correlations between malnutrition and frailty or sarcopenia were discovered.

China's Path towards Global Green Governance on Rare Earth Elements: Challenges and Opportunities

In light of surging demands for critical minerals and its rising profile as a global provider, China can no longer dismiss the negative ecological externalities resulting from its unregulated, near-monopoly production of rare earth elements (REE) since the 1970s. REE, consisting of 17 elements with naturally enhanced chemical properties, is critical for manufacturing future green infrastructures and technologies. However, the extraction and refining processes are resource-intensive and toxic to the immediate environment, further exacerbated by improper radioactive waste management, underfunded land restoration, and illegal mining. By extension, China’s supply supremacy came at the cost of socio-ecological deprivation disproportionately experienced by the local community compared to the beneficiary beyond borders. This study aims to assess the challenges and opportunities for China as they seek global leadership in green governance through its post-reform sustainable development model guided by Ecological Civilization (EC) principle. Using narrative analysis methods, we seek to assess the intersection among three threads: the historical account of China’s REE global dominance, their elite-based approach to governance, and the unmitigated socio-ecological impacts on the local community; regarding EC and its derivatives. While domestic consolidation is strategically integral to China’s EC-guided development agenda, it poses dormant risks of supply volatility for international markets, and innovative secondary production becomes the new source of competitive edge for supply diversification and norm-making power.

New dilemmas of the «just war» theory

Referring to the classical tenets of the “just war” theory, the author also analyses its modern versions. While the research the author arrives at the conclusion that some political scientists have modernized the theory of “a just war” according to the modern times. For instance, due to the existence of new actors on the international arena, there were created a new version, which allows to include non-state actors for the analysis (which consequently led to abolition of such principles as legitimacy of authorities, “last resort” criteria and also led to the implementation of the preventive actions) as well as the principles just post bellum. It is interesting to note that some political scientists associate the theory of “a just war” with the issue of global leadership of the USA. Throughout the history the participants and the aims of the wars have undergone serious changes, so that nowadays they do not sound “just” (for example, theory of punitive war). Analyzing in detail the postulates of the theory of “just war”, the author turns to historical events - the “Arab Spring”, the confrontation between the USA and the USSR, modern information wars. The author arrives at the conclusion that the use of the theory of “just war” for the analysis of modern events remains relevant, however, requires the introduction of new postulates in the norms of the theory, in particular, the addition of the principles of jus ad bellum and jus post bellum.

The Relationship Between GLIM Criteria and Recovery Times in the Leukemia Treatment Process

Fatma YILMAZ1, Merih Reis ARAS1, Hacer Berna AFACAN OZTURK1, Umit Yavuz MALKAN2, Ayse Arslan KAPUCI3, Ahmet Kursad GUNES1, Murat ALBAYRAK1 1Ankara Etlik State Hospital, Department of Hematology, Ankara 2Hacettepe University Faculty of Medicine, Department of Hematology, Ankara 3Hacettepe University Faculty of Medicine, Department of Hematology, Ankara Keywords: GLIM criteria, Leukemias, Malnutrition, Recovery time Malnutrition is an important point in patients with hematological malignancies, especially in patients with leukemia who have the potential to enter into prolonged neutropenia. There is no generally accepted approach algorithm with a common consensus in determining the risk of malnutrition. The GLIM criteria, developed by a common consensus of major global nutrition societies (Global Leadership Initiative on Malnutrition), are one of the most frequently used approaches recently. Method A total of 50 patients with a diagnosis of leukemia (AML, ALL) were included in the study. NRS-2002 and then GLIM criteria were used to determine the nutritional status of the patients. The study parameters were evaluated by dividing the patients into two groups as malnourished and non-malnourished. Comparing the malnourished group to the non-malnourished group; while platelet, albumin, and prealbumin values and anthropometric measurements were found to be statistically significantly low, infection incidence rate, fever duration and rate, the need for multiple and longer courses of antibiotics and antifungal usage rate were found to be statistically significantly high (p< 0.005). Adequate nutritional level of the patient does not affect the neutrophil and platelet recovery time, but infection incidence rate and rate of fever within the same period of neutropenia statistically significantly reduces the need for antibiotics and antifungals. In patients with a diagnosis of leukemia who have long hospital stays, it is important to ensure adequate calorie intake with regular dietitian follow-up, to obtain a balanced calorie intake from macronutrients, and to add micronutrient support.

Cross-cultural boundary spanning activities in a global team: Insights from an ethnographic case study

How can global team leaders effectively span boundaries between highly diverse and distant team members, manage cross-cultural conflict, and foster team performance? Global team leadership continues to face persistent challenges, and while the boundary spanning literature has identified relevant characteristics, traits, competencies, and skills of effective boundary spanners, it says little about boundary spanning activities. This paper proposes new contributions to this question through an ethnographic case study of a highly successful global R&D project team. Over the course of the 2-year project, three conflict situations were resolved through cross-cultural boundary spanning activities. From an ethnographic perspective, the dynamics at work are described in detail. To better understand these dynamics, the paper draws on loosely coupled systems theory by asking how structural and cultural coupling can facilitate boundary spanning activities. In doing so, the paper extends the theory of boundary spanning and global team leadership and connects boundary spanning with loosely coupled systems theory. The contributions relate to four main propositions: effective global team leaders span intra-team boundaries through coupling activities; task-related “structural coupling” and relationship-related “cultural coupling” are interdependent; effective boundary spanning combines tight structural and loose cultural coupling; and boundary spanning objects and agents enhance coupling activities.

Caught in the crossfire: Fears of Chinese–American scientists

The US global leadership in science and technology has greatly benefitted from immigrants from other countries, most notably from China in the recent decades. However, feeling the pressure of potential federal investigations since the 2018 launch of the China Initiative, scientists of Chinese descent in the United States now face higher incentives to leave the United States and lower incentives to apply for federal grants. Analyzing data pertaining to institutional affiliations of more than 200 million scientific papers, we find a steady increase in the return migration of scientists of Chinese descent from the United States to China. We also conducted a survey of scientists of Chinese descent employed by US universities in tenured or tenure-track positions (n = 1,304), with results revealing general feelings of fear and anxiety that lead them to consider leaving the United States and/or stop applying for federal grants. If the situation is not corrected, American science will likely suffer the loss of scientific talent to China and other countries.

Innovative Clusters of Global Trade Leadership

The formation of a new global system and systemic global interdependence has generated new competitiveness factors for market participants, determining their appropriate strategic behavior to ensure a highly competitive position and leadership. Therefore, the purpose of the study is to identify the countries of intellectual leaders in the global market and the factors that influence the positions that countries achieve in terms of leadership. The following research methods were used: multifactor regression models, cluster analysis, and comparative analysis. Based on the authors’ methodology for assessing countries’ intellectual leadership, the clustering of countries in the global economy is determined. The evaluation algorithm was based on three levels: 1) resources, 2) the intermediate results of intellectual activity, and 3) the final results of overall progress.
 Using a multifactor regression model and cluster analysis, four clusters of countries were identified according to key indicators of intellectual leadership. For each cluster, the specialization of the two countries in terms of merchandise exports was analyzed: cluster 1 – the United States and Germany; cluster 2 – Israel and Italy; cluster 3 – Brazil and Ukraine; cluster 4 – China and South Korea. Each country is assigned an index of economic complexity, and the change in position of each country within a cluster over ten years is noted.
 An important goal is to understand the determinants of the leadership of countries in each geographic region.
 The analysis is based on the cluster analysis carried out in previous publications. The clustering of countries was carried out based on the dynamics of macroeconomic indicators over the past 15 years.

MALNUTRITION AT HOSPITAL ADMISSION AND ITS ASSOCIATED FACTORS IN INTERNAL MEDICINE INPATIENTS

ABSTRACTBackground: Malnutrition at hospital admission may adversely affect patients' clinical outcomes. The Global Leadership Initiative on Malnutrition (GLIM) recently set a standard of measurable criteria to diagnose malnutrition. Objectives: This study aimed to determine the proportion and risk factors of malnutrition at hospital admission.Materials and Methods: A cross-sectional observational study was conducted in the internal medicine ward of the National General Central Hospital, Dr. Cipto Mangunkusmo (RSCM), Jakarta, from January to May 2022. Subjects aged 18 and above were recruited for this study. Malnutrition at hospital admission was defined according to the GLIM criteria. Then, the data were analyzed using multiple logistic regression to determine malnutrition risk factors, presented by odds ratios (OR) and 95% confidence intervals (CI).Results: A total of 231 subjects were enrolled in the study. Among them, 85.3% were malnourished according to the GLIM criteria. In addition, subjects with a severe to total dependency on functional status (OR 9.406, 95%CI: 3.147–28.109), inadequate energy intake (OR 2.718, 95%CI: 1.197–6.172), and multimorbidity (OR 2.337, 95%CI: 1.045–5.228), were significantly associated with malnutrition at hospital admission cases. Conclusion: According to the GLIM criteria, the proportion of malnutrition at hospital admission is high. The risk factors of malnutrition at hospital admission include low functional status, inadequate energy intake, and multimorbidity.Keywords : Malnutrition; Nutritional status; Nutrition assessment; Hospital admission; Internal medicine, Inpatients

Malnutrition and visceral obesity predicted adverse short-term and long-term outcomes in patients undergoing proctectomy for rectal cancer

BackgroundTo the best of our knowledge, no previous studies have explored the relationship between visceral obesity and malnutrition. Therefore, this study has aimed to investigate the association between them in patients with rectal cancer.MethodsPatients with rectal cancer who underwent proctectomy were included. Malnutrition was defined according to the Global Leadership Initiative on Malnutrition (GLIM). Visceral obesity was measured using computed tomography (CT). The patients were classified into four groups according to the presence of malnutrition or visceral obesity. Univariate and multivariate logistic regression analyses were performed to evaluate risk factors for postoperative complications. Univariate and multivariate cox regression analyses were performed to evaluate the risk factors for overall survival (OS) and cancer-specific survival (CSS). Kaplan-Meier survival curves and log-rank tests were performed for the four groups.ResultsThis study enrolled 624 patients. 204 (32.7%) patients were included in the well-nourished non-visceral obesity (WN) group, 264 (42.3%) patients were included in the well-nourished visceral obesity (WO) group, 114 (18.3%) patients were included in the malnourished non-visceral obesity (MN) group, and 42 (6.7%) patients were included in the malnourished visceral obesity (MO) group. In the multivariate logistic regression analysis, the Charlson comorbidity index (CCI), MN, and MO were associated with postoperative complications. In the multivariate cox regression analysis, age, American Society of Anesthesiologists (ASA) score, tumor differentiation, tumor node metastasis (TNM), and MO were associated with worsened OS and CSS.ConclusionsThis study demonstrated that the combination of visceral obesity and malnutrition resulted in higher postoperative complication and mortality rates and was a good indicator of poor prognosis in patients with rectal cancer.

Nascent entrepreneurship in university students: the role of the context

ABSTRACT This paper offers evidence that the context might influence a university student’s start-up process differently, depending on the category of activities and regions. Specifically, it explores the influence of university and national contexts while considering the different categories of the start-up process. Our approach divides the start-up process into three categories (Business planning, Interaction with the external environment, and Financing), four context definitions (University, Industry-technological, Institutional-policy, and Cultural), and three regions (European Union, Latin America, and Asian-African). We drew on the primary dataset of the Global University Entrepreneurial Spirit Students’ Survey (GUESSS) project that contains 7,628 nascent entrepreneurs from 21 countries, which we complemented with a set of international indexes from the World Economic Forum’s Global Competitiveness Index, the Global Entrepreneurship Index, and the Global Leadership and Organizational Behavior Effectiveness project. Generally speaking, the University context positively influences the start-up activities of students in Europe and Asia-Africa. The Industry and technological context and the Institutional and policy context play a relevant role (sometimes positive or negative) depending on the activity and region. Finally, the Cultural context presents mixed results too, and its influence varies (positively and negatively) depending on the kind of start-up activities and the region.

#3947 COMPARISON OF CT SCAN AND BIOIMPEDANCE SPECTROSCOPY FOR FAT FREE MASS MEASUREMENTS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract Background and Aims Malnutrition and sarcopenia are highly prevalent in patients with chronic kidney disease (CKD). Since body mass index and body weight do not reflect body composition, measuring fat free mass (FFM) is essential. Bio-impedance spectroscopy (BIS) is frequently used for monitoring body composition in patients with CKD. Unfortunately, BIS derived lean tissue mass (LTMBIS) is not suitable for comparison with the Global Leadership Initiative on Malnutrition (GLIM) cut-off values for the diagnosis of malnutrition, or for calculating dietary protein requirements. Hypothetically, FFM could be derived from BIS data (FFMBIS). This study aims to compare FFMBIS and LTMBIS with computed tomography (CT) scan derived FFM (FFMCT). Secondarily, we aimed to explore the impact of using different methods on calculated daily protein requirements. Method CT scans of 60 patients with CKD stage 4-5 were analyzed at third lumbar vertebra (L3) level for muscle cross-sectional area, which was converted to FFMCT. Spearman rank correlation coefficient and 95% limits of agreement (LoA) were calculated to compare FFMBIS and LTMBIS with FFMCT. Dietary protein requirements were determined based on FFMCT, FFMBIS, and adjusted body weight. Deviations over 10% from FFMCT were considered clinically relevant. Results FFMCT correlated strongest with FFMBIS (r=0.78, p<0.001), in males (r=0.72, p<0.001), and in females (r=0.60, p<0.001). A mean difference of -0.54 kg was found between FFMBIS and FFMCT (LoA: -14.88 to 13.7 kg, p=0.544). Between LTMBIS and FFMCT a mean difference of -12.2 kg was apparent (LoA: -28.7 to 4.2 kg, p<0.001). Compared with FFMCT, the highest occurrence of accurate predicted protein requirements was found for FFMBIS. Mean difference between protein requirements according to FFMBIS and FFMCT was -0.7 ± 9.9 grams in males and -0.9 ± 10.9 grams in females. Conclusion FFMBIS seems a valid surrogate measure for the estimation of FFM as compared to FFMCT. As expected, large clinically relevant differences were observed in calculated protein requirements when comparing multiple methods, with FFMBIS having the best accuracy compared to FFMCT.

Applying the Global Leadership Initiative on Malnutrition criteria in patients admitted with SARS-CoV-2 infection using computed tomography imaging.

Patients with low muscle mass and acute SARS-CoV-2 infection meet the Global Leadership Initiative on Malnutrition (GLIM) etiologic and phenotypic criteria to diagnose malnutrition, respectively. However, available cut-points to classify individuals with low muscle mass are not straightforward. Using computed tomography (CT) to determine low muscularity, we assessed the prevalence of malnutrition using the GLIM framework and associations with clinical outcomes. A retrospective cohort was conducted gathering patient data from various clinical resources. Patients admitted to the COVID-19 unit (March 2020 to June 2020) with appropriate/evaluable CT studies (chest or abdomen/pelvis) within the first 5 days of admission were considered eligible. Sex- and vertebral-specific skeletal muscle indices (SMI; cm2 /m2 ) from healthy controls were used to determine low muscle mass. Injury-adjusted SMI were derived, extrapolated from cancer cut-points and explored. Descriptive statistics and mediation analyses were completed. Patients (n = 141) were 58.2 years of age and racially diverse. Obesity (46%), diabetes (40%), and cardiovascular disease (68%) were prevalent. Using healthy controls and injury-adjusted SMI, malnutrition prevalence was 26% (n = 36/141) and 50% (n = 71/141), respectively. Mediation analyses demonstrated a significant reduction in the effect of malnutrition on outcomes in the presence of Acute Physiology and Chronic Health Evaluation II, supporting the mediating effects of severity of illness intensive care unit (ICU) admission, ICU length of stay, mechanical ventilation, complex respiratory support, discharge status (all P values = 0.03), and 28-day mortality (P = 0.04). Future studies involving the GLIM criteria should consider these collective findings in their design, analyses, and implementation.

Validity of the GLIM criteria using calf circumference in the prediction of in-hospital mortality in older surgical patients: A secondary analysis of a cohort study.

Malnutrition is a prevalent condition among older patients and is associated with worse clinical outcomes. Methods such as the Subjective Global Assessment (SGA), the Mini Nutritional Assessment Long Form (MNA-LF), and the Global Leadership Initiative on Malnutrition (GLIM) diagnose malnutrition early. This study aimed to evaluate the performance and validity of these instruments to predict the length of hospital stay (LOS) and in-hospital mortality in older surgical patients. This prospective cohort study was performed with hospitalized older surgical patients. In the first 48 hours of admission, general data were collected, and patients were evaluated by SGA, MNA-LF, and GLIM using calf circumference (CC) and mid-upper arm circumference (MUAC) as phenotypic criteria for nutritional diagnoses. Accuracy tests and regression analysis adjusted for sex, type of surgery, and the Charlson Comorbidity Index adjusted for age were performed to assess the criterion validity of instruments to predict LOS and mortality. 214 surgical patients (75.4 ± 6.6 years old; 57.3% men, and 71.1% admitted to elective surgery) were evaluated. Malnutrition was diagnosed in 39.7% (SGA), 63% (MNA-LF), 41.6% (GLIMCC ), and 32.1% (GLIMMUAC ) of patients. GLIMCC had the best accuracy (AUC = 0.70; 95%CI 0.63-0.79) and sensitivity (95.8%) to predict in-hospital mortality. In the adjusted analysis, malnutrition, according to SGA, MNA-LF, and GLIMCC , increased the risk of in-hospital mortality by 3.12 [95%CI (1.08-11.34)], 4.51 [95%CI (1.29-17.61), and 4.83 [95%CI (1.52-15.22)], respectively. GLIMCC had the best performance and satisfactory criterion validity to predict in-hospital mortality in older surgical patients. This article is protected by copyright. All rights reserved.