Association of Global Leadership Initiative on Malnutrition with survival outcomes in patients with cancer: A systematic review and meta-analysis

Abstract

Background & aims: The Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. This tool used the phenotypic and etiologic criteria to diagnose the malnutrition in adults. This meta-analysis aimed to examine the association between malnutrition defined by the GLIM and survival outcomes in patients with cancer.

Methods: Two independent authors comprehensively searched the articles indexed in PubMed, Web of Science, Embase databases until June 25, 2022. Only cohort studies evaluating the association of malnutrition defined by the GLIM with survival outcomes in cancer patients were included. The fully adjusted hazard ratio (HR) with 95% confidence intervals (CI) was pooled for the malnutrition versus the those without.

Results: Twelve article reporting on 11 studies including 6799 cancer patients were identified. Four articles were grouped to have moderate risk of bias and 8 articles were deemed to have a low risk of bias. The prevalence of malnutrition defined by the GLIM ranged from 11.9% to 87.9%. Meta-analysis indicated that malnutrition defined by the GLIM was associated with poor overall survival (HR 1.90; 95% CI 1.58-2.29) and disease-free survival (HR 1.51; 95% CI 1.27-1.79), respectively. Subgroup analysis showed that the pooled HR was 1.49 (95% CI 1.32-1.68) for moderate malnutrition and 1.68 (95% CI 1.42-1.99) for severe malnutrition.

Conclusions: Malnutrition defined by the GLIM is significantly associated with reduced overall survival and disease-free survival in patients with cancer. Detection of nutritional status using GLIM has potential to improve survival stratification in these patients.

Keywords: Cancer; Disease-free survival; Global leadership initiative on malnutrition; Meta-analysis; Overall survival.