Comparison of the GLIM criteria with specific screening tool for diagnosing malnutrition in hospitalized patients with cirrhosis: A descriptive cross‐sectional study

Abstract

Background The Global Leadership Initiative on Malnutrition (GLIM) has been built to diagnose malnutrition; however, its validity among patients with cirrhosis remains enigmatic. We aimed to investigate the prevalence of malnutrition according to GLIM criteria and compare the differences by using a specific screening tool. Methods We conducted a descriptive cross‐sectional study analyzing hospitalized patients. The Royal Free Hospital‐Nutritional Prioritizing Tool (RFH‐NPT) was chosen as the screening tool. Estimated prevalence was shown with and without the initial screening process. Diverse combinations of phenotypic and etiologic criteria and distinct body mass index (BMI) cutoffs were applied to detect frequency of malnourished patients with cirrhosis. Results Overall, 363 patients were recruited (median age, 64 years; 51.2% female). The prevalence of malnutrition according to GLIM criteria with and without RFH‐NPT screening was 33.3% and 36.4%, respectively. Low BMI and inflammation represented the most prevalent combination resulting in a malnutrition diagnosis (42.4%), followed by low BMI and reduced food intake (39.4%). By contrast, the least prevalence was found when combining reduced muscle mass with inflammation to diagnose malnutrition. Furthermore, the frequency of malnourished and well‐nourished participants was not statistically different when using divergent BMI reference values across the study population. Conclusions GLIM criteria may serve a specific proxy to diagnose malnutrition, along with RFH‐NPT screening. Relevant investigation is required to report on the applied combination of phenotypic/etiologic criteria, taking into consideration the marked impact of different models. More attempts are warranted to delineate the prognostic role of GLIM criteria in the context of cirrhosis.

Accumulating awareness on the clinical significance and relevance of frailty in cirrhosis: Time to dig deeper into mechanistic basis!

“…Timely nutritional screening and appropriate nutrition therapy represent the cornerstones to relieve symptoms, delay disease progression and prevent dismal prognosis in the context of cirrhosis 91,92 . Branched‐chain amino acids (BCAAs) are essential to protein synthesis, ammonia detoxification and energy source for the skeletal muscles 93 .…”

“…Timely nutritional screening and appropriate nutrition therapy represent the cornerstones to relieve symptoms, delay disease progression and prevent dismal prognosis in the context of cirrhosis. 91,92 Branched-chain amino acids (BCAAs) are essential to protein synthesis, ammonia detoxification and energy source for the skeletal muscles. 93 A pilot double-blind study implicated that BCAAs supplementation alongside physical activity for 12 weeks significantly improve the LFI in entire cohort, wherein some respondents even achieved resolution of baseline frailty.…”

The relationship between sarcopenia, multidimensional frailty, and malnutrition cluster and long‐term mortality in hospitalized patients with cirrhosis

“…As stated in the background, the GLIM scheme was implemented in a two-step manner. 2 First, any subject enrolled was screened for malnutrition risk by using the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) score, with scores ≥1 indicating malnourished risk. Second, the diagnosis of malnutrition was made in the circumstance that at least one etiologic criterion and one phenotypic criterion had been fulfilled.…”

“…Radiology‐defined modalities based on cross‐sectional images (e.g., computed tomography [CT] or magnetic resonance) are routinely used to measure muscle mass in these patients. The malnutrition diagnosis applied to cirrhotic patients varies considerably in terms of measuring toolkit and assessing metrics in the existing literature, and most recently, we have tried to harmonize its diagnosis by using the Global Leadership Initiative on Malnutrition (GLIM) criteria 2 . In turn, GLIM‐defined malnutrition was prevalent in the setting of hospitalized patients with cirrhosis and independently associated with poor outcomes pertaining to prolonged length of hospitalization and short‐term mortality 6 .…”

“…Accordingly, several studies have elaborated on their prevalence, predictive role, and prognosticating value among patients with cirrhosis at distinct stages. [2][3][4] However, there are scattered reports concerning the interrelationship between these disease-related conditions, and it is imperative to clarify this issue with the purpose of improving their recognition, management, treatment, and prevention.…”