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Nutrition in acute and chronic diseases

Application of the GLIM criteria in patients with intestinal insufficiency and intestinal failure at nutritional risk on admission

European Journal of Clinical Nutrition volume 76, pages 1003–1009 (2022)Cite this article

Subjects

Abstract

Background

The role of the Global Leadership Initiative on Malnutrition (GLIM) criteria requires further validation. This study was aimed to evaluate the application of the GLIM criteria in patients with intestinal insufficiency and intestinal failure at nutritional risk on admission.

Methods

Three hundred and twenty eligible patients with intestinal insufficiency and intestinal failure at nutritional risk admitted to the clinical nutrition center in Jinling hospital from January 1, 2015 to January 1, 2020 were retrospectively identified from a database. GLIM and the European Society for Clinical Nutrition and Metabolism (ESPEN) criteria were used to diagnose malnutrition. Kappa test was conducted to determine consistency between the two diagnostic methods. Paired chi-square test (McNemar test) was used to compare the positive rate of the two diagnostic methods in diagnosing malnutrition. GLIM criteria were used as the reference standard, the receiver operating characteristic curve was used to estimate the diagnostic efficacy of phenotypic criteria (BMI, FFMI, ASMI and SMI) in malnutrition. The consistency to diagnose malnutrition between ESPEN and GLIM criteria was recorded, meanwhile the consistency and efficacy of GLIM phenotypic criteria to diagnose malnutrition were also recorded.

Results

The malnutrition rate of GLIM diagnosis (93.4%) was higher than that of ESPEN diagnosis (80.9%), and the kappa value of the consistency test was 0.459. Combined with etiologic criteria (reduced food intake or assimilation), the incidence of malnutrition diagnosed by fat-free mass index (FFMI) (79.7%) was higher than body mass index (BMI) (70.6%), appendicular skeletal muscle index (ASMI) (55.6%), and skeletal muscle index (SMI) (53.1%) (McNemar test: p < 0.01), and the kappa values of consistency test were 0.561, 0.458, and 0.435, respectively. FFMI and BMI (p = 0.574) and SMI (p = 0.319) showed no statistically significant differences [except ASMI (p < 0.001)] in area under the curve for malnutrition diagnosis.

Conclusion

GLIM criteria showed a higher malnutrition rate than ESPEN criteria. The incidence of malnutrition diagnosed by FFMI was higher than other phenotypic criteria such as BMI, ASMI and SMI among patients with intestinal insufficiency and intestinal failure. The FFMI threshold needs to be combined with different situations to develop different recommendations.

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Fig. 1: Receiver operating characteristic (ROC) curve for diagnosing malnutrition according to the GLIM criteria.
Fig. 2: Bivariate linear correlation analysis between FFMI and BMI, ASMI, SMI.

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Acknowledgements

We thank Ruting Shen, Sitong Liu for aiding data collection. This project was supported by the National Science and Technology Research Funding for Public Welfare Medical Projects (201502022).

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Author notes

  1. These authors contributed equally: Hao Liu, Xuejin Gao.

Authors and Affiliations

  1. Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China

    Hao Liu, Xuejin Gao, Li Zhang, Yupeng Zhang & Xinying Wang

  2. The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China

    Hao Liu & Xinying Wang

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  1. Hao Liu
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Contributions

Conceived and designed the study: HL, XW, and XG. Performed the study: HL, LZ, XG, YZ, and XW. Analyzed the data: HL. Wrote the manuscript: HL. Reviewed the manuscript: LZ, XG, YZ, and XW. All authors approved the final version of the manuscript.

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Correspondence to Xinying Wang.

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Liu, H., Gao, X., Zhang, L. et al. Application of the GLIM criteria in patients with intestinal insufficiency and intestinal failure at nutritional risk on admission. Eur J Clin Nutr 76, 1003–1009 (2022). https://doi.org/10.1038/s41430-022-01084-8

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  • DOI: https://doi.org/10.1038/s41430-022-01084-8

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