Influence of Malnutrition According to the GLIM Criteria on the Clinical Outcomes of Hospitalized Patients With Cancer

Abstract

Background: Malnutrition is prevalent among patients with cancer. The Global Leadership Initiative on Malnutrition (GLIM) released new universal criteria for diagnosing malnutrition in 2019. The objectives of this study were to assess the prevalence of malnutrition in patients with cancer using the GLIM criteria, explore the correlation between the GLIM criteria, and clinical outcomes, and compare the GLIM criteria with subjective global assessment (SGA). Methods: This retrospective analysis was conducted on 2,388 patients with cancer enrolled in a multicenter study. Nutritional risk was screened using the Nutritional Risk Screening-2002, and the nutritional status was assessed using SGA and GLIM criteria. Chi-square analysis and Wilcoxon rank sum test, stratified by age 65 years, were used to evaluate the effect of GLIM-defined malnutrition on clinical outcomes. Logistic regression analysis was used to analyze the nutritional status and complications, and the interrater reliability was measured using a kappa test. Results: The prevalence of malnutrition defined by the GLIM criteria was 38.9% (929/2,388). GLIM-defined malnutrition was significantly associated with in-hospital mortality (P = 0.001) and length of hospital stays (P = 0.001). Multivariate logistic regression analysis showed GLIM-defined malnutrition significantly increased complications (odds ratio [OR] 1.716, 95% CI 1.227-2.400, P = 0.002). The GLIM criteria had a "moderate agreement" (kappa = 0.426) compared with the SGA. Conclusions: The prevalence of malnutrition in hospitalized patients with cancer is high, and malnourishment in patients with cancer is associated with poorer clinical outcomes. The use of the GLIM criteria in assessing the nutritional status of inpatients with cancer is recommended and can be used as the basis for nutritional interventions.

Keywords: GLIM criteria; cancer patients; clinical outcome; malnutrition; subjective global assessment.

Figure 1

Univariate analysis of demographic characteristics, nutritional status, and GLIM criteria associated with complications. SGA, subjective global assessment; GLIM, Global Leadership Initiative on Malnutrition; BMI, body mass index; OR, odds ratio. *p < 0.05.

Figure 2

The receiver operating characteristic (ROC) curve was used to assess the difference between patients with malnutrition and without malnutrition, measured by Global Leadership Initiative on Malnutrition (GLIM) criteria and subjective global assessment (SGA). The analysis was grouped by disease type, with (A) for all cancer patients, (B) for patients with colorectal cancer, (C) for patients with gastric cancer, and (D) for patients with lung cancer. AUC, area under the curve.