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Phenotyping in clinical nutrition

Global leadership initiative in malnutrition (GLIM) criteria using hand-grip strength adequately predicts postoperative complications and long-term survival in patients underwent radical gastrectomy for gastric cancer

European Journal of Clinical Nutrition volume 76, pages 1323–1331 (2022)Cite this article

Subjects

Abstract

Background

The present study aims to investigate whether malnutrition defined by the Global Leadership Initiative in Malnutrition (GLIM) criteria using hand-grip strength (HGS) adequately predict postoperative complications and long-term survival in patients underwent radical gastrectomy for gastric cancer in a similar manner to GLIM-defined malnutrition using skeletal muscle index (SMI).

Methods

Patients who underwent radical gastrectomy for gastric cancer from August 2014 to June 2019 were included in this study. Clinical data were prospectively collected. Malnutrition was diagnosed based on the two-step approach following the GLIM criteria. Skeletal muscle mass was assessed using SMI based on abdominal computed tomography (CT) scans, or assessed using HGS.

Results

A total of 1359 patients were included in this study, in which 36.2% of the patients were at risk of malnutrition (Nutritional Risk Screening 2002 scores ≥3). The incidence of malnutrition was 28.2% and 27.5% using SMI and HGS, respectively. There was a high agreement between the two criteria of malnutrition (kappa = 0.863, P < 0.001). Both of the two criteria of malnutrition were independently associated with postoperative complications (SMI-GLIM, P = 0.041; HGS-GLIM, P = 0.023), overall survival (P < 0.001, both), and disease-free survival (P < 0.001, both), with similar odds ratio or hazard ratio after adjusting for the same confounding variables. HGS-GLIM malnutrition (P = 0.046) but not SMI-GLIM malnutrition (P = 0.270) was associated with a higher incidence of severe complications.

Conclusions

GLIM criteria using HGS is a useful tool to diagnose malnutrition and has a similar or even better predictive value for postoperative complications and long-term survival after radical gastrectomy for gastric cancer compared with GLIM criteria using SMI.

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Fig. 1: Survival curves of patients with and without malnutrition based on the two GLIM criteria.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This study was supported by the Radiology Imaging Center of the First Affiliated Hospital of Wenzhou Medical University.

Funding

This study was funded by the National Natural Science Foundation of China (No. 82100951), the Natural Science Foundation of Zhejiang Province (LQ21H070003), the Wenzhou Municipal Science and Technology Bureau (2020Y1330), and the Youth Program of Science and Technology Innovation Foundation of Wenzhou Medical University (KYYW201921).

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Author notes

  1. These authors contributed equally: Dong-Dong Huang, Ding-Ye Yu.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

    Dong-Dong Huang, Wen-Bin Wang, Hao-Nan Song, Xin Luo, Xiao-Lei Chen, Zhen Yu & Jing-Yi Yan

  2. Department of General Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    Ding-Ye Yu

  3. First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China

    Gao-Feng Wu

  4. Department of Gastrointestinal Surgery, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China

    Zhen Yu

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Contributions

HDD was responsible for conception and design of the study, analysis of the data and writing of the paper. YDY was responsible for the analysis and interpretation of data. WWB was responsible for analysis of the data. SHN was responsible for acquisition of data. XL was responsible for acquisition of data. WGF was responsible for analysis of the data. CXL was responsible for conception and design of the study. YZ was responsible for the analysis and interpretation of data. YJY was responsible for conception and design of the study and the final approval of the version to be submitted.

Corresponding authors

Correspondence to Zhen Yu or Jing-Yi Yan.

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Competing interests

The authors declare no competing interests.

Ethics approval

The study was performed in accordance with the Declaration of Helsinki and has been approved by the Ethical Review Board of The First Affiliated Hospital of Wenzhou Medical University and registered in China Clinical Trial Registry (NO. ChiCTR1800019717).

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Huang, DD., Yu, DY., Wang, WB. et al. Global leadership initiative in malnutrition (GLIM) criteria using hand-grip strength adequately predicts postoperative complications and long-term survival in patients underwent radical gastrectomy for gastric cancer. Eur J Clin Nutr 76, 1323–1331 (2022). https://doi.org/10.1038/s41430-022-01109-2

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