Assessment Criteria to Diagnose Malnutrition (Undernutrition and Overnutrition) in Hemodialysis Patients

Abstract

Objective: This study aimed to determine if adapted Global Leadership Initiative on Malnutrition (GLIM) criteria can diagnose overnutrition, in addition to undernutrition, in hemodialysis patients. Additionally, it compared the adapted GLIM criteria with the subjective global assessment (SGA) for diagnosing undernutrition.

Methods: A cross-sectional, descriptive study design with an analytical component was utilized. An interviewer-administered questionnaire was completed with 116 adult participants from 2 public renal units in Cape Town. Data collection included demographic, medical, and anthropometric information, incorporating the established SGA tool and the adapted GLIM criteria.

Results: Of the participants, 58% were female, with a mean age of 41.04 years (SD 10.6). The primary causes of renal failure were hypertension (38%) and glomerular disease (33%). The median weight was 64.74 kg (IQR 16.4), and the mean body mass index (BMI) was 25.44 kg/m² (SD 4.66). The prevalence of obesity was 20%, and undernutrition was 4% by BMI. Participants from Groote Schuur Hospital had a higher mean BMI (26.40, SD 4.9) than those from Tygerberg Hospital (P = .0033). Abdominal obesity prevalence was 51%, with a mean waist circumference of 87.06 cm (SD 11.37). Using SGA parameters, undernutrition prevalence was 26%, with all classified as SGA-B, compared to 22% by adapted GLIM. Adapted GLIM classified 69.83% as malnourished (overnutrition 47% and undernutrition 22%). For undernutrition, the adapted GLIM had a sensitivity of 75% (CI 64.04, 85.96), specificity of 77.78% (CI 67.26, 88.3), positive predictive value of 69.23% (CI 57.55, 80.91), and negative predictive value of 82.35% (CI 72.71, 92.00). Among those diagnosed with overnutrition by adapted GLIM, 89% were classified as well-nourished by SGA.

Conclusion: The adapted GLIM criteria effectively assessed overnutrition as well as undernutrition in hemodialysis patients. It identified a significant proportion of patients misclassified as well-nourished by SGA who were actually overnourished. The adapted GLIM showed good sensitivity and specificity for diagnosing undernutrition in this population.

Keywords: Malnutrition; chronic kidney disease (CKD); global leadership initiative on malnutrition (GLIM); overnutrition; protein energy wasting (PEW); subjective global assessment (SGA); undernutrition.