Evaluation of the Validity and Feasibility of the GLIM Criteria Compared with PG-SGA to Diagnose Malnutrition in Relation to One-Year Mortality in Hospitalized Patients.

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Publisher: Elsevier Science Publishers
Document Type: Clinical report
Length: 453 words

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Keywords Malnutrition; GLIM criteria; PG-SGA; Mortality; Validity Abstract Background The Global Leadership Initiative on Malnutrition (GLIM) approach to diagnose malnutrition was published in 2018. An important next step is to use the GLIM criteria in clinical investigations to assess their validity and feasibility. Objective To compare the validity and feasibility of the GLIM criteria with Patient-Generated Subjective Global Assessment (PG-SGA) in hospitalized patients and to assess the association between malnutrition and 1-year mortality. Design Post hoc analysis of a prospective cohort study. Participants/setting Hospitalized patients (n = 574) from the Departments of Gastroenterology, Gynecology, Urology, and Orthopedics at the Radboudumc academic facility in Nijmegen, The Netherlands, were enrolled from July 2015 through December 2016. Main outcome measures The GLIM criteria and PG-SGA were applied to identify malnourished patients. Mortality rates were collected from electronic patient records. Feasibility was assessed by evaluating the amount of and reasons for missing data. Statistical analyses performed Concurrent validity was evaluated by assessing the sensitivity, specificity, and Cohen's kappa coefficient for the GLIM criteria compared with PG-SGA. Cox regression analysis was used for the association between the GLIM criteria and PG-SGA and mortality. Results Of 574 patients, 160 (28%) were classified as malnourished according to the GLIM criteria and 172 (30.0%) according to PG-SGA ([kappa] = 0.22, low agreement). When compared with PG-SGA, the GLIM criteria had a sensitivity of 43% and a specificity of 79%. Mortality of malnourished patients was more than two times higher than for non-malnourished patients according to the GLIM criteria (hazard ratio [HR], 2.68; confidence interval [CI], 1.33-5.41). Data on muscle mass was missing in 454 of 574 (79%) patients because of practical problems with the assessment using bioimpedance analysis (BIA). Conclusions Agreement between GLIM criteria and PG-SGA was low when diagnosing malnutrition, indicating that the two methods do not identify the same patients. This is supported by the GLIM criteria showing predictive power for 1-year mortality in hospitalized patients in contrast to PG-SGA. The assessment of muscle mass using BIA was difficult to perform in this clinical population. * Address correspondence to: Vera IJmker-Hemink, MSc, Department of Gastroenterology and Hepatology--Dietetics and Intestinal Failure, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands. Article History: Received 2 December 2020; Accepted 22 July 2021 (footnote) STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors. (footnote) FUNDING/SUPPORT The study was funded by the FoodforCare Foundation. (footnote) AUTHOR CONTRIBUTIONS VIJ, SH, and MB designed the structure of the article; VIJ and SH wrote the first draft. All authors reviewed and commented on subsequent drafts of the manuscript). Byline: Vera IJmker-Hemink, MSc [Vera.IJmkerHemink@radboudumc.nl] (*), Samantha Heerschop, MSc, Geert Wanten, MD, PhD, Manon van den Berg, PhD

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Gale Document Number: GALE|A694141993