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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

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.

Data availability

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

References

  1. Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr. 2017;36:623–50.

    Article  Google Scholar 

  2. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22:321–36.

    Article  Google Scholar 

  3. Braga M, Ljungqvist O, Soeters P, Fearon K, Weimann A, Bozzetti F. ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr. 2009;28:378–86.

    Article  CAS  Google Scholar 

  4. Cederholm T, Jensen GL, Correia M, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clin Nutr. 2019;38:1–9.

    Article  CAS  Google Scholar 

  5. Mitchell WK, Williams J, Atherton P, Larvin M, Lund J, Narici M. Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength; a quantitative review. Front Physiol. 2012;3:260.

    Article  Google Scholar 

  6. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  Google Scholar 

  7. Sato T, Aoyama T, Hayashi T, Segami K, Kawabe T, Fujikawa H, et al. Impact of preoperative hand grip strength on morbidity following gastric cancer surgery. Gastric Cancer. 2016;19:1008–15.

    Article  Google Scholar 

  8. Schaap LA, van Schoor NM, Lips P, Visser M. Associations of sarcopenia definitions, and their components, with the incidence of recurrent falling and fractures: the longitudinal aging study Amsterdam. J Gerontol A Biol Sci Med Sci. 2018;73:1199–204.

    Article  Google Scholar 

  9. Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15:95–101.

    Article  Google Scholar 

  10. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  CAS  Google Scholar 

  11. Zhuang CL, Huang DD, Pang WY, Zhou CJ, Wang SL, Lou N, et al. Sarcopenia is an independent predictor of severe postoperative complications and long-term survival after radical gastrectomy for gastric cancer: analysis from a large-scale cohort. Medicine. 2016;95:e3164.

    Article  Google Scholar 

  12. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31.

    Article  Google Scholar 

  13. Contreras-Bolívar V, Sánchez-Torralvo FJ, Ruiz-Vico M, González-Almendros I, Barrios M, Padín S, et al. GLIM criteria using hand grip strength adequately predict six-month mortality in cancer inpatients. Nutrients. 2019;11:2043.

    Article  Google Scholar 

  14. Lee B, Han HS, Yoon YS, Cho JY, Lee JS. Impact of preoperative malnutrition, based on albumin level and body mass index, on operative outcomes in patients with pancreatic head cancer. J Hepatobiliary Pancreat Sci. 2021;28:1069–75.

    Article  Google Scholar 

  15. Takahashi M, Sowa T, Tokumasu H, Gomyoda T, Okada H, Ota S, et al. Comparison of three nutritional scoring systems for outcomes after complete resection of non-small cell lung cancer. J Thorac Cardiovasc Surg. 2021;162:1257–68.

    Article  Google Scholar 

  16. Huang DD, Cai HY, Chen XY, Dong WX, Wangchuk D, Yan JY, et al. Value of sarcopenia defined by the new EWGSOP2 consensus for the prediction of postoperative complications and long-term survival after radical gastrectomy for gastric cancer: a comparison with four common nutritional screening tools. J Cancer. 2020;11:5852–60.

    Article  CAS  Google Scholar 

  17. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing. 2010;39:412–23.

    Article  Google Scholar 

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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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Authors and Affiliations

Authors

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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