Correlation Between Components of Malnutrition Diagnosed by Global Leadership Initiative on Malnutrition Criteria and the Clinical Outcomes in Gastric Cancer Patients: A Propensity Score Matching Analysis

Abstract

ObjectiveMalnutrition is recognized as a risk factor for poor outcome in patients with gastric cancer (GC). In 2018, the Global Leadership Initiative on Malnutrition (GLIM) published standardized criteria for the diagnosis of malnutrition. Our aim was to investigate whether any of the components of the GLIM diagnostic criteria were related to worse clinical outcomes in patients with GC.MethodsThis study analyzed patients with GC who underwent radical gastrectomy in our hospital between 2014 and 2019. A preoperative nutritional assessment was performed for each patient. Matching was based on the presence of three GLIM components: high weight loss (WL), low body mass index (BMI), and low skeletal muscle index (SMI).ResultsThe analysis included 1,188 patients, including 241 (20.3%) with high WL, 156 (13.1%) with low BMI, and 355 (29.9%) with low SMI. Before matching, patients who met the GLIM component criteria were mostly associated with older age, low nutritional reserves, and late tumor progression. After matching, the clinical characteristics of the three cohorts were balanced. In the matched queue, the survival prognosis of the high WL group was worse than that of the non-WL group, and the postoperative complication rate was higher in the low SMI group than in the normal SMI group (P <0.05). In addition, the clinical outcomes in the low and normal BMI groups were similar (P >0.05).ConclusionOf the GLIM criteria, high WL and low SMI may be associated with poor clinical outcomes in patients with GC, while a low BMI may not be associated with outcome.

Malnutrition diagnosed by the Global Leadership Initiative on Malnutrition criteria predicting survival and clinical outcomes of patients with cancer: A systematic review and meta-analysis

“…Applying our inclusion and exclusion criteria resulted in the further exclusion of eighteen publications. Finally, 15 cohort studies (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) were pooled into the current analysis (Figure 1). Because Huang (18), Xu (28) and Song (29) reported different outcomes of interest or enrolled patients with different cancer types, they were all included in the present study even though they originated from a same cohort.…”

“…Finally, 15 cohort studies ( 16 – 30 ) were pooled into the current analysis ( Figure 1 ). Because Huang ( 18 ), Xu ( 28 ) and Song ( 29 ) reported different outcomes of interest or enrolled patients with different cancer types, they were all included in the present study even though they originated from a same cohort.…”

“…Four articles ( 16 , 20 , 23 , 30 ) were designed as prospective, while eleven ( 17 – 19 , 21 , 22 , 24 – 29 ) were retrospective. Four articles ( 31 – 34 ) enrolled patients with all types of cancer, three ( 18 , 27 , 28 ) enrolled patients with gastric cancer, three ( 19 , 20 , 26 ) enrolled patients with esophageal cancer, one ( 16 ) enrolled patients with gastric/pancreatic/hepatic/colorectal cancer, one ( 30 ) enrolled patients with gastric/pancreatic/biliary/colorectal cancer. The remaining three articles included patients diagnosed with hematologic cancer ( 17 ), pancreatic cancer ( 25 ), or colorectal cancer ( 29 ), respectively.…”

“…However, Maeda et al from Japan proposed that the preferred BMI cutoff value for younger adults should fall to 17.0 kg/m 2 , while value for older adults to 17.8 kg/m 2 ( 40 ). We noticed that three articles from Asia adopted this range ( 27 , 28 , 30 ) ( Supplementary Table 2 ), and subgroup analysis revealed a reduced heterogeneity in both subgroups chose different cut-off values ( Supplementary Table 6 ). Therefore, in-depth investigations on this topic, which enroll patients with one certain type of cancer, are needed to encourage high-quality meta-analysis that focuses on the effect of GLIM-defined malnutrition on specific type of cancer in the future.…”

Adipose Tissue Quantification Improves the Prognostic Value of GLIM Criteria in Advanced Gastric Cancer Patients

“…Based on the GLIM criteria, malnutrition is found to be quite common in patients with gastric cancer, showing incidence rates between 36.3 and 69.2% [ 6 , 8 , 9 ]. In addition, among patients with gastric cancer, those who were malnourished before treatment showed significantly worse prognoses than those with no malnutrition [ 6 , 9 , 10 ].…”