Nutritional support therapy after GLIM criteria may neglect the benefit of reducing infection complications compared with NRS2002: Reanalysis of a cohort study

Xu, Jing; Zhang, Xian Na; Zhu, Jiang; Bin, Jie; Wang, Yang; Li, Wei; Kondrup, Jens; Nolan, Marie T.; Andrews, Martha; Kang, Wei; Ye, Xin; Yu, Kang; Zhu, Meng; Lü, Qian

doi:10.1016/j.nut.2020.110802

Cited by 20 publications

(24 citation statements)

References 19 publications

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“…As a result, the patient would be classified as high malnutrition risk even without weight loss, low BMI, or reduced muscle mass, if he or she was ≥ 70 years old, which leads to poor consistency with GLIM criteria. A similar result was observed by Xu et al in surgical patients that more than half of patients with malnutrition risk screened by NRS2002 did not meet the GLIM criteria for malnutrition ( 25 ). In the previous studies, MUST was found to have a high sensitivity and specificity and excellent diagnostic accuracy for the identification of malnutrition in patients with geriatric gastrointestinal cancer and patients with colorectal cancer ( 13 , 26 ).…”

Section: Discussionsupporting

confidence: 80%

Comparison of the Suitability Between NRS2002 and MUST as the First-Step Screening Tool for GLIM Criteria in Hospitalized Patients With GIST

et al. 2022

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ObjectiveThe Global Leader Initiative on Malnutrition (GLIM) criteria have been recommended for malnutrition diagnosis recently, for which the first step is malnutrition risk screening with any validated tool. This study aims to investigate the incidence of malnutrition risk in gastrointestinal stromal tumor (GIST) inpatients and compare the suitability of Nutritional Risk Screening 2002 (NRS2002) and Malnutrition Universal Screening Tool (MUST) as the first-step screening tool for GLIM criteria.MethodsWe retrospectively analyzed the clinical data of GIST inpatients in our hospital from January 2015 to December 2019. NRS2002 and MUST were used to screen malnutrition risk at the time of admission. The diagnostic consistency of these two tools with GLIM criteria for malnutrition was analyzed, and the predictive performance of both tools for the length of hospital stay and the occurrence of complications was also evaluated in surgical and non-surgical inpatients.ResultsA total of 269 GIST inpatients were included in this study, of which 45.7 and 40.9% were at malnutrition risk determined by NRS2002 and MUST, respectively. In non-surgical inpatients, NRS2002 and MUST had similar diagnostic consistency with GLIM criteria in sensitivity (93.0 vs. 97.7%), specificity (81.1 vs. 81.1%), and Kappa value (K = 0.75 vs. 0.80), and high nutritional risk classified by NRS2002 and malnutrition identified by GLIM criteria were found to be associated with the length of hospital stay. In surgical inpatients, MUST had better diagnostic consistency with GLIM criteria in sensitivity (86.1 vs. 53.5%) and Kappa value (K = 0.61 vs. 0.30) than NRS2002, but no factors were found associated with the length of postoperative hospital stay or the occurrence of complications.ConclusionThe malnutrition risk is common in GIST inpatients. NRS2002 is more suitable than MUST for the first-step risk screening of the GLIM scheme in non-surgical inpatients, considering its better performance in screening malnutrition risk and predicting clinical outcomes. MUST was found to have good diagnostic consistency with GLIM criteria for malnutrition in both non-surgical and surgical GIST inpatients, and further studies need to be conducted to investigate its predictive performance on clinical outcomes.

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Section: Discussionsupporting

confidence: 80%

Comparison of the Suitability Between NRS2002 and MUST as the First-Step Screening Tool for GLIM Criteria in Hospitalized Patients With GIST

et al. 2022

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“…Therefore, elucidating the appropriate indications for nutritional therapy is particularly critical. Previous evidence suggested that nutritional support improved the clinical outcomes of patients with NRS2002 scores higher than 3 ( 45 ). Our study considered that patients who were overlooked by the NRS 2002 would also benefit from nutritional therapy, further illustrating that the GLIM criteria may be more suitable in patients with CD.…”

Section: Discussionmentioning

confidence: 98%

The GLIM Criteria Represent a More Appropriate Tool for Nutritional Assessment in Patients With Crohn's Disease

Peng

et al. 2022

Front. Nutr.

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BackgroundThe early recognition of malnutrition is essential for improving the prognosis of patients with Crohn's disease (CD). The Global Leadership Initiative on Malnutrition (GLIM) criteria represent a new consensus for the diagnosis of malnutrition but need to be validated in CD. The aims were to explore the related factors of malnutrition in CD and explore whether GLIM-positive patients who did not meet the Nutritional Risk Screening 2002 (NRS 2002) would benefit from nutritional treatment.MethodsThis study retrospectively enrolled patients with CD at the Gastroenterology Department of Xiangya Hospital Central South University between March 2020 and March 2021. After bioelectrical impedance analysis, all patients underwent nutritional screening and diagnosis using the NRS 2002 and GLIM criteria, respectively. Multivariable analysis was performed to evaluate risk factors related to malnutrition in patients with CD. A multivariable Cox hazard model was used to assess the association between nutritional therapy and prognostic outcomes.ResultsOf the 118 patients included, fifty were classified as having a high malnutrition risk according to the NRS 2002, while 76 were diagnosed with malnutrition by the GLIM criteria. Multivariate analysis showed that a high malnutrition risk was independently associated with the L4 phenotype [odds ratio (OR) (95% confidence interval (CI)) = 4.718 (1.108, 20.10), p = 0.036] and Crohn's Disease Activity Index (CDAI) [OR (95% CI) = 1.018 (1.007, 1.029), p = 0.002] based on the NRS 2002. The age at onset [OR (95% CI) = 0.828 (0.699, 0.980), p = 0.028] and CDAI [OR (95% CI) = 1.111 (1.034, 1.195), p = 0.004] were regarded as independent risk factors related to malnutrition, as determined by the GLIM criteria. Among 26 GLIM+/NRS− patients, significantly more patients who received nutritional support achieved 6-week remission than patients who did not (100 vs. 71.4%, p < 0.05). The 6-week remission risk in patients treated with nutrition therapy was more than 4-fold higher than those without nutritional therapy.ConclusionThe GLIM criteria could diagnose more malnourished patients with CD who are not positively screened by the NRS 2002, among whom nutritional support therapy would be beneficial for disease remission. The new criteria should be more appropriate for assessing the nutritional status of patients with CD.

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“…Within healthcare system outcomes, mortality was reported most frequently (n ¼ 33; 27%) [16,22,23,25,26,28e31, 34,37e42,44,45,53,55,57,60,61,65,67,68,73e75,80,83,85,89]. Other outcomes were hospitalization/readmissions/costs (n ¼ 11; 9%) [27,29,34,38,44,62,67,69,83,85,91], hospital and/or intensive care unit LOS (n ¼ 10; 8%) [27,34,44,53,65,67,77,83,91], complications (n ¼ 7; 6%) [53e55, 68,72,85], critical care admission (n ¼ 2; 2%) [42,67], and institutionalization (n ¼ 2; 2%) [16,29]. Patient outcomes included sarcopenia (n ¼ 6; 5%) [17,18,24,35,38,93], physical function (n ¼ 5; 4%) [38,57,75,80,93], quality of life (n ¼ 5; 4%) [56,59,64,74,75], falls/fractures (n ¼ 3; 2%) [29,38], frailty (n ¼ 2; 2%)…”

Section: Discussionmentioning

confidence: 99%

Utilization and validation of the Global Leadership Initiative on Malnutrition (GLIM): A scoping review

et al. 2022

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Nutritional support therapy after GLIM criteria may neglect the benefit of reducing infection complications compared with NRS2002: Reanalysis of a cohort study

Cited by 20 publications

References 19 publications

Comparison of the Suitability Between NRS2002 and MUST as the First-Step Screening Tool for GLIM Criteria in Hospitalized Patients With GIST

Comparison of the Suitability Between NRS2002 and MUST as the First-Step Screening Tool for GLIM Criteria in Hospitalized Patients With GIST

The GLIM Criteria Represent a More Appropriate Tool for Nutritional Assessment in Patients With Crohn's Disease

Utilization and validation of the Global Leadership Initiative on Malnutrition (GLIM): A scoping review

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