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. 2022 Nov 22:9:1030619.
doi: 10.3389/fnut.2022.1030619. eCollection 2022.

GLIM in diagnosing malnutrition and predicting outcome in ambulatory patients with head and neck cancer

Helena Kristiina Orell  1   2 , Anne Katariina Pohju  1 , Pia Osterlund  3   4   5   6 , Ursula Sonja Schwab  2   7 , Paula Ravasco  8   9 , Antti Mäkitie  10   11   12
Affiliations

GLIM in diagnosing malnutrition and predicting outcome in ambulatory patients with head and neck cancer

Helena Kristiina Orell et al. Front Nutr. .

Abstract

Aim: This study aimed to determine the prevalence of malnutrition in a head and neck cancer (HNC) population according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and to assess its relation to survival. The secondary aim was to compare GLIM criteria to Patient-Generated Subjective Global Assessment (PG-SGA) and Nutritional Risk Screening 2002 (NRS 2002) methods.

Methods: The assessment was performed in a series of 65 curative patients with newly diagnosed HNC in a nutrition intervention study. Malnutrition was defined as PG-SGA classes BC and nutritional risk as NRS 2002 score ≥3 and was retrospectively diagnosed with GLIM criteria in prospectively collected data at diagnosis. Sensitivity, specificity, and kappa (κ) were analyzed. Predictive accuracy was assessed by calculating the area under curve (AUC) b y receiver operating characteristic (ROC) analysis. Kaplan-Meier and Cox regression analyses were used to evaluate association between malnutrition and overall survival (OS), and disease-free survival (DFS).

Results: GLIM-defined malnutrition was present in 37% (24/65) of patients. The GLIM showed 77% sensitivity and 84% specificity with agreement of κ = 0.60 and accuracy of AUC = 0.80 (p < 0.001) with PG-SGA and slightly higher sensitivity (83%) with NRS 2002 (κ = 0.58). Patients with GLIM-defined malnutrition had shorter OS (56 vs. 72 months, HR 2.26, 95% CI 1.07-4.77, p = 0.034) and DFS (37 vs. 66 months, HR 2.01, 95% CI 0.99-4.09, p = 0.054), than well-nourished patients. The adjusted HR was 2.53 (95% CI 1.14-5.47, p = 0.023) for OS and 2.10 (95% CI 0.98-4.48, p = 0.056) for DFS in patients with GLIM-defined malnutrition.

Conclusion: A substantial proportion of HNC patients were diagnosed with malnutrition according to the GLIM criteria and this showed a moderate agreement with NRS 2002- and PG-SGA-defined malnutrition. Even though the GLIM criteria had strong association with OS, its diagnostic value was poor. Therefore, the GLIM criteria seem potential for malnutrition diagnostics and outcome prediction in the HNC patient population. Furthermore, NRS 2002 score ≥3 indicates high nutritional risk in this patient group.

Keywords: Patient-Generated Subjective Global Assessment; head and neck cancer; malnutrition; nutrition status; nutrition status assessment; nutritional risk; nutritional risk screening 2002; survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Receiver operating characteristic curve (ROC) for GLIM-diagnosed malnutrition as a measure of malnutrition according to patient-subjective global assessment (PG-SGA) group BC. The area under the curve (AUC) is 0.805 (95% CI 0.68–0.93, p < 0.001).
Figure 2
Figure 2
Results of the Kaplan–Meier overall survival analysis and hazard ratio for head and neck cancer patients stratified by GLIM–defined nutrition status. Hazard ratio adjusted to age, gender, stage, and smoking.
Figure 3
Figure 3
Results of the Kaplan–Meier disease-free survival analysis and hazard ratio for head and neck cancer patients stratified by GLIM–defined malnutrition. Hazard ratio adjusted to age, gender, stage, and smoking.
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