Different GLIM criteria combinations change prevalence of malnutrition in patients with intestinal insufficiency or intestinal failure

Abstract

Background & aim: Due to lack of global consensus in diagnosing malnutrition, Global Leadership Initiative on Malnutrition (GLIM) has suggested the GLIM criteria based on etiological and phenotypical criteria. The aim of this study was to investigate the prevalence of malnutrition in patients with intestinal insufficiency (INS) or intestinal failure (IF) based on the different GLIM criteria combinations to diagnose malnutrition. Furthermore, the aim was to investigate the severity of malnutrition in the two patient groups. Methods: A cross-sectional study with INS patients on enteral nutrition and IF patients on home parenteral nutrition. We recorded age, gender, weight, height, fat free mass index (FFMI) by bioelectrical impedance analysis, handgrip strength (HGS), arm muscle circumference (AMC) and biochemical parameters: plasma albumin (p-alb) and plasma C-reactive protein (p-CRP). Further, we calculated Glasgow prognostic score (GPS) and body mass index (BMI). Statistics: T-test, Chi-square test and simple logistic regression analysis. Significance level: p < 0.05. Results: In total 277 INS and IF patients were included (age 59.5 ± 15.2 years, male 43,7%, BMI 22.1 ± 4.3 kg/m2). Groups were comparable according to number, age and gender but more IF patients had decreased BMI, p-alb, HGS and FFMI and increased CRP and GPS 1 or 2. Prevalence of malnutrition using GPS 1 or 2 combined with BMI, FFMI or HGS was 22.6%, 23.4%, 26.3% for INS, respectively (p ¼ 0.756) and 40.7%, 40.0%, 59.3% for IF, respectively (p ¼ 0.001). Agreement between the criteria combinations were: 8.0% for INS and 25.7% for IF. Significantly more with IF was diagnosed with severe malnutrition as compared to no malnutrition (43 vs. 26, p ¼ 0.012, OR 2.1 [CI95% 1.2e3.8]), but only a tendency in the group with moderate malnutrition as compared to no malnutrition (27 vs. 22, p ¼ 0.180, OR 1.6 [CI95% 0.8e3.0]) Conclusion: We found both prevalence and severity of malnutrition to be higher in IF than INS patients. GLIM-criteria were able to identify approximately same prevalence of malnutrition in INS but not in IF, when combining GPS 1 or 2 with BMI, FFMI and HGS. However, the agreement was poor in both groups. Consequently, further validation of GLIM is needed -including association to clinical outcome in lack of a gold standard.

Prevalence of sarcopenia in patients with chronic intestinal failure—how are SARC‐F and the EWGSOP algorithm associated before and after a physical exercise intervention

“…Even though improvements were seen in physical function, no significant change was seen in overall EQ5D‐5L score or in the VAS‐score, as described in the previous publication 14 . We found no associations between BMI/sex or sarcopenia, and thus find that it is relevant to screen and assess those overweight, as also addressed by former studies 10,11,13,19 …”

“… 14 We found no associations between BMI/sex or sarcopenia, and thus find that it is relevant to screen and assess those overweight, as also addressed by former studies. 10 , 11 , 13 , 19 …”

“…Among other factors contributing to the deterioration of patients' quality of life are large amounts of ostomy output, lack of independency, reduced functional level, and fatigue 9 . This is reflected in the decreased muscle mass and muscle strength that has been shown in these patients and is independent of body mass index (BMI) 10‐13 . In these patients, it may, therefore, be relevant to monitor and measure sarcopenia from an early state of disease to provide sufficient advice on exercise and strength training as well as to keep track of elements that may decrease the individual's possibility to be physically active, such as the large stomal outputs.…”