Agreement between the GLIM criteria and PG-SGA in a mixed patient population at a nutrition outpatient clinic

Kristin S Rosnes; Christine Henriksen; Anne Høidalen; Ingvild Paur

doi:10.1016/j.clnu.2021.07.019

Agreement between the GLIM criteria and PG-SGA in a mixed patient population at a nutrition outpatient clinic

Clin Nutr. 2021 Aug;40(8):5030-5037. doi: 10.1016/j.clnu.2021.07.019. Epub 2021 Jul 24.

Authors

Kristin S Rosnes¹, Christine Henriksen², Anne Høidalen³, Ingvild Paur⁴

Affiliations

¹ Norwegian Advisory Unit on Disease-Related Undernutrition, Oslo, Norway; Department of Nutrition, Faculty of Medicine, University of Oslo, Norway.
² Department of Nutrition, Faculty of Medicine, University of Oslo, Norway. Electronic address: christine.henriksen@medisin.uio.no.
³ Division of Cancer Medicine, Department of Clinical Services, Section of Clinical Nutrition, Oslo University Hospital, Norway. Electronic address: ahoeid@ous-hf.no.
⁴ Norwegian Advisory Unit on Disease-Related Undernutrition, Oslo, Norway; Division of Cancer Medicine, Department of Clinical Services, Section of Clinical Nutrition, Oslo University Hospital, Norway. Electronic address: inpaur@ous-hf.no.

PMID: 34365037
DOI: 10.1016/j.clnu.2021.07.019

Abstract

Background & aims: The Global Leadership Initiative on Malnutrition (GLIM) criteria is a step-wise process including a screening tool of choice for risk assessment of malnutrition before assessment of diagnosis and grading of malnutrition severity. The agreement between GLIM and the established malnutrition assessment method Patient Generated-Subjective Global Assessment (PG-SGA) is uncertain. Also, several aspects of GLIM remain to be clearly defined. In this study, we compared diagnosis of malnutrition with the GLIM criteria to the PG-SGA, and explored the differences between the methods.

Methods: This cross-sectional study was conducted at the Nutrition Outpatient Clinic at Oslo University Hospital, Norway. Patients were included from September-December 2019. Nutritional Risk Screening 2002 (NRS-2002) was used as the screening tool in the GLIM process before diagnosing and grading the severity of malnutrition. Results are presented with and without the initial risk screening. The diagnostic results from the GLIM process were compared to the malnutrition diagnosis using the PG-SGA.

Results: In total, 144 patients, median age 58 years, participated in the study. The full GLIM process identified 36% of the patients as malnourished, while the PG-SGA identified 69% of the patients as malnourished. Comparison of GLIM and PG-SGA showed fair agreement, however the agreement was better when the NRS-2002 screening was excluded. Considering the PG-SGA a gold standard, GLIM had a sensitivity of 51% and a specificity of 98%. The introduction of new cut-off values for fat-free mass did not considerably alter the diagnosis of malnutrition within GLIM.

Conclusions: The GLIM criteria showed only fair agreement with the PG-SGA, however the agreement was better when the initial NRS-2002 screening was excluded. A joint consensus on how to perform the GLIM process is needed for comparisons of future studies, and before routine use in clinical practice.

Keywords: Agreement; GLIM criteria; Malnutrition; PG-SGA; Validation.

Publication types

Comparative Study

MeSH terms

Ambulatory Care Facilities
Cross-Sectional Studies
Female
Humans
Male
Malnutrition / diagnosis*
Mass Screening / methods*
Middle Aged
Norway
Nutrition Assessment*
Outpatients / statistics & numerical data*
Reference Values
Reproducibility of Results
Risk Assessment*
Sensitivity and Specificity