Prognostic implications of the global leadership initiative on malnutrition criteria as a routine assessment modality for malnutrition in hospitalized patients at a university hospital

Naoharu Mori; Keisuke Maeda; Yasushi Fujimoto; Tomoyuki Nonogaki; Yuria Ishida; Rie Ohta; Akio Shimizu; Junko Ueshima; Ayano Nagano; Ryoji Fukushima

doi:10.1016/j.clnu.2022.12.008

Prognostic implications of the global leadership initiative on malnutrition criteria as a routine assessment modality for malnutrition in hospitalized patients at a university hospital

Clin Nutr. 2023 Feb;42(2):166-172. doi: 10.1016/j.clnu.2022.12.008. Epub 2022 Dec 22.

Authors

Naoharu Mori¹, Keisuke Maeda², Yasushi Fujimoto³, Tomoyuki Nonogaki⁴, Yuria Ishida⁵, Rie Ohta⁶, Akio Shimizu⁷, Junko Ueshima⁸, Ayano Nagano⁹, Ryoji Fukushima¹⁰

Affiliations

¹ Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan. Electronic address: nmori@aichi-med-u.ac.jp.
² Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
³ Department of Otorhinolaryngology and Head and Neck Surgery, Aichi Medical University, Nagakute, Aichi, Japan.
⁴ Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan; Department of Pharmacy, Aichi Medical University Hospital, Nagakute, Aichi, Japan.
⁵ Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan; Department of Nutrition, Aichi Medical University Hospital, Nagakute, Aichi, Japan.
⁶ Department of Nutrition, Aichi Medical University Hospital, Nagakute, Aichi, Japan.
⁷ Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan; Department of Health Science, Faculty of Health and Human Development, University of Nagano, Nagano City, Nagano, Japan.
⁸ Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan; Department of Clinical Nutrition and Food Services, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan.
⁹ Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan; Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Japan.
¹⁰ Department of Surgery, Teikyo University School of Medicine/Health and Dietetics Teikyo Heisei University, Tokyo, Japan.

PMID: 36586218
DOI: 10.1016/j.clnu.2022.12.008

Abstract

Background & aims: Few studies have examined the association between mortality and malnutrition diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria for routine nutritional assessment; thus, this association is not well known. We aimed to clarify the association between GLIM-defined malnutrition and mortality in a large population of hospitalized patients.

Methods: In this retrospective cohort study, we enrolled adult patients admitted to Aichi Medical University Hospital between April 2019 and March 2021, who underwent nutritional assessment using the GLIM criteria. In November 2021, we collected the following data from electronic medical records: demographic, clinical, and laboratory data upon admission; nutritional data assessed using GLIM criteria; and data on final patient outcomes.

Results: In this study, we included 9372 hospitalized patients who were identified to be at risk by the validated nutritional screening tools (50.6% men, median age 75.0 [67.0-82.0] years, 69.2% patients aged ≥70 years). The number of patients with no, moderate, and severe GLIM-defined malnutrition was 4145 (44.2%), 2799 (29.9%), and 2428 (25.9%), respectively. Kaplan-Meier survival curve analysis showed a significant increase in mortality with worsening nutritional status (log-rank test, P < 0.001). After adjusting for age and sex, multivariable Cox regression analysis revealed that both moderate (Hazard ratio [HR] 2.0, 95% confidence interval [CI] 1.79-2.23, P < 0.001) and severe malnutrition (HR 3.06, 95% CI 2.74-3.40, P < 0.001) were independent risk factors for mortality. Moreover, multivariable analysis showed that four of the five GLIM sub-criteria (except low body mass index) were independently associated with prognosis.

Conclusion: Malnutrition and its severity, routinely assessed using the GLIM criteria, are associated with high mortality in hospitalized patients at nutritional risk. Further research is needed to evaluate the usefulness of the GLIM sub-criteria, including low body mass index, in these patients.

Keywords: Cachexia; Calf circumference; Disease related malnutrition; GLIM; Malnutrition; Nutritional assessment.

MeSH terms

Adult
Aged
Female
Hospitals, University
Humans
Leadership*
Male
Malnutrition* / diagnosis
Malnutrition* / epidemiology
Nutrition Assessment
Nutritional Status
Prognosis
Retrospective Studies