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Health issues and nutrition in the elderly

AND-ASPEN and ESPEN consensus, and GLIM criteria for malnutrition identification in AECOPD patients: a longitudinal study comparing concurrent and predictive validity

European Journal of Clinical Nutrition volume 76, pages 685–692 (2022)Cite this article

Subjects

Abstract

Background/objectives

Malnutrition in chronic obstructive pulmonary disease (COPD) patients is prevalent and usually assessed by body mass index (BMI), which can lead to misdiagnosis. The subjective global assessment (SGA) is the reference method for this diagnose in hospitalized patients. In the last decade, new tools have emerged Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition [AND-ASPEN], European Society for Clinical Nutrition and Metabolism [ESPEN], and Global Leadership Initiative on Malnutrition [GLIM]). Therefore, this study aimed to assess the concurrent and predictive validity of these tools in acute exacerbated COPD (AECOPD) patients.

Subjects/methods

Prospective cohort study with hospitalized AECOPD patients. Malnutrition was diagnosed by SGA (reference method), AND-ASPEN, ESPEN, and GLIM consensus. Hospital length of stay (LOS) and mortality were the outcomes evaluated.

Results

In 241 patients (46.5% males; 68.3 ± 10.2 years), malnutrition was found in 50.0% by SGA, 54.4% by AND-ASPEN, 20.2% by ESPEN, and 47.8% by GLIM. AND-ASPEN had the best accuracy (AUC = 0.837; 95% CI 0.783–0.841) and concordance (kappa = 0.674) with SGA and it was an independent predictor of prolonged LOS (OR = 1.73; 95% CI 1.01–3.37). ESPEN consensus did not agree with SGA, but was associated with prolonged LOS (OR = 2.57 95% CI, 1.27–5.20). The GLIM had good concordance (kappa = 0.533) and accuracy with SGA (AUC = 0.768; 95% CI 0.701–0.835), but was not associated with outcomes.

Conclusions

The AND-ASPEN was the most accurate tool for diagnosing malnutrition in AECOPD patients and was an independent predictor of prolonged LOS.

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Acknowledgements

We thank Nossa Senhora da Conceição Hospital for supporting the conduct of this study and thank the patients for their participation. We also thank the researchers Paula Portal Teixeira and Kamila Valduga for their valuable assistance during this study. The corresponding author received a productivity scholarship (PQ2) from the Brazilian National Council for Scientific and Technological Development (CNPq).

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Authors and Affiliations

  1. Registered dietitian, Master student at Nutrition Science Postgraduation Program from Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil

    Bruna Espíndola de Araújo

  2. Nutrition student at Federal University of Health Sciences from Porto Alegre, Porto Alegre, RS, Brazil

    Veronnike Kowalski & Giovana Molon Leites

  3. Registered dietitian at the Nutrition and Dietetics Division of Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil

    Jaqueline da Silva Fink

  4. Registered dietitian, Professor at Nutrition Department and Nutrition Science Postgraduation Program from Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil

    Flávia Moraes Silva

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  1. Bruna Espíndola de Araújo
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Contributions

FMS and BEA contributed to study conception. BEA, VK and GLM contributed to data acquisition. FMS contributed to data analysis and interpretation. BEA and FMS drafted the paper. All authors critically revised the paper, provided final approval, and agreed to be accountable for all aspects of the work, ensuring its integrity and accuracy.

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Correspondence to Flávia Moraes Silva.

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de Araújo, B.E., Kowalski, V., Leites, G.M. et al. AND-ASPEN and ESPEN consensus, and GLIM criteria for malnutrition identification in AECOPD patients: a longitudinal study comparing concurrent and predictive validity. Eur J Clin Nutr 76, 685–692 (2022). https://doi.org/10.1038/s41430-021-01025-x

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