GLIM Criteria for Malnutrition in Surgical IBD Patients: A Pilot Study

Abstract

Background: A gold standard method for malnutrition diagnosis is still lacking in Inflammatory Bowel Disease (IBD). Objective: The aims of this study are to determine the prevalence of malnutrition in IBD patients according with recently published Global Leadership Initiative on Malnutrition (GLIM) criteria, to detect the factors contributing to the onset of malnutrition, and to evaluate the most accurate predictor of malnutrition risk within the available nutritional screening tools. Methods: Fifty-three consecutive adult IBD patients [38 Crohn’s disease (CD) and 15 ulcerative colitis (UC)] had been assessed preoperatively by a multidisciplinary IBD team before undergoing elective surgery. Several malnutrition risk tools were tested, such as NRS-2002, MUST, MST, MIRT, and SaskIBD-NR. The statistical association of independent GLIM variables with baseline characteristics of patients was explored as well as the concordance with the European Society for Clinical Nutrition and Metabolism (ESPEN 2015) and the screening tools. Results: Twenty-two IBD patients (42%) were malnourished according to GLIM criteria, of which 13 were CD (34%) and 9 UC (60%). The etiological criteria of inflammation and reduction of food intake were present in 51% and 19% of our patients, respectively. The prevalence of GLIM phenotypic criteria was 28%, 28% and 34% for BMI, Free Fat Mass Index (FFMI) and unintended weight loss (UWL), respectively. The presence of ileostomy was statistically associated with a higher prevalence of BMI (p = 0.030), FFMI (p = 0.030) and UWL (p = 0.002) values lower than the GLIM criteria cut-offs, while secondary surgery is associated with a decrease in FFMI (p = 0.017) and UWL (p = 0.041). The sensitivity of the tested nutritional screening tools, compared with the GLIM prevalence of malnutrition, was not satisfactory (between 50 and 82%). Conclusions: GLIM has a higher rate of malnutrition detection than ESPEN 2015, as malnutrition in IBD seems linked to inflammation and secondary malabsorption even without a reduction of food intake. The sensitivity of the screening tools is lower than the specificity when compared with GLIM criteria for malnutrition diagnosis.

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

“…When using the three combinations 22%e26% of the patients with INS were malnourished, while 40%e59% were malnourished among the IF patients. Compared to other studies that used the GLIM criteria to identify malnutrition among patients with IBD [33] and patients undergoing gastrointestinal surgery [34,35], the proportion of malnourished patients were approximately the same.…”

“…However, there is a lack of global consensus in diagnosing malnutrition, which led The Global Leadership Initiative on Malnutrition (GLIM) to develop the GLIM criteria [32]. Recent studies have demonstrated that 10%e42% were malnourished using the GLIM criteria among patients with inflammatory bowel disease (IBD) [33] and patients in gastrointestinal surgery [34,35].…”

Nutrition Considerations in Inflammatory Bowel Disease

“…Similarly, in a small study evaluating the presence of malnutrition in patients with IBD undergoing surgery, 42% of patients were classified as having malnutrition by utilizing the GLIM criteria. Whereas both the NRS‐2002 and MUST screening tools had high specificity for a diagnosis of malnutrition against the GLIM criteria (90.3% and 96.8%, respectively), the sensitivity for malnutrition detection was higher by utilizing the NRS‐2002 screening method (81.8% vs MUST sensitivity: 63.6%) 21 …”

“…Whereas both the NRS-2002 and MUST screening tools had high specificity for a diagnosis of malnutrition against the GLIM criteria (90.3% and 96.8%, respectively), the sensitivity for malnutrition detection was higher by utilizing the NRS-2002 screening method (81.8% vs MUST sensitivity: 63.6%). 21 In summary, the newer comprehensive definitions of malnutrition put forward by the ESPEN and GLIM differ significantly on the prevalence of malnutrition when applied to the same population. Prevalence of malnutrition appears to be significantly lower using the ESPEN definition as compared with the GLIM definition, which has implications for screening accuracy, recognition of malnutrition, and risk stratification.…”

Relationship between Nutritional Screening Tools and GLIM in Complicated IBD Requiring Surgery

“…Recently, the Global Leadership Initiative on Malnutrition (GLIM) involved the major clinical nutrition Societies to reach a global consensus on the identification of accurate criteria for the diagnosis of malnutrition in clinical settings [6]. After the fully validation of GLIM, it seems necessary to adopt a malnutrition screening tool that includes phenotypical and etiological parameters [7].…”