Prognostic Value of the ESPEN Consensus and Guidelines for Malnutrition: Prediction of Post‐Discharge Clinical Outcomes in Older Inpatients

Sánchez-Rodríguez, Dolores; Annweiler, Cédric; Ronquillo-Moreno, Natalia; Vázquez-Ibar, Olga; Escalada, Ferrán; Duran, Xavier; Muniesa, Josep M.; Marco, Ester

doi:10.1002/ncp.10088

Cited by 16 publications

(16 citation statements)

References 52 publications

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“…We used the European Society for Clinical Nutrition and Metabolism (ESPEN) diagnostic criteria for malnutrition (ESPEN criteria) to define malnutrition. The ESPEN criteria is a consensus‐based criteria developed by ESPEN, which report the predictive capacity for mortality/functional outcome . The criteria allow the following methods for determining malnutrition in patients at risk of malnutrition screened using a validated tool: (1) BMI <18.5 kg/m 2 and (2) unintentional body weight loss (>5%/3 months or >10% indefinitely) and low BMI (<20 kg/m 2 for individuals aged <70 years or <22 kg/m 2 for those aged ≥70 years) or low fat‐free mass index (<15 kg/m 2 for females; <17 kg/m 2 for males).…”

Section: Methodsmentioning

confidence: 99%

Impact of nutritional status, muscle mass and oral status on recovery of full oral intake among stroke patients receiving enteral nutrition: A retrospective cohort study

Nishioka¹,

Yamasaki

Ogawa³

et al. 2019

Nutrition & Dietetics

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Aim: To clarify the correlation between malnutrition, muscle mass and oral status, and swallowing function recovery in stroke patients receiving enteral nutrition. Methods: Patients with stroke and dysphagia receiving any amount of enteral nutrition in rehabilitation wards from 2012 to 2016 were eligible for inclusion in this retrospective study. On admission, body composition by bioimpedance analysis, malnutrition confirmed by the European Society for Clinical Nutrition and Metabolism criteria, oral status, functional independence measure and demographic data were collected. Characteristics were compared between "oral intake alone" and "artificial nutrition" groups based on the discharge status. Kaplan-Meier methods and the Cox proportional hazards model were used to determine explanatory factors for the probability of full oral intake. Results: Among 174 patients, 113 were analysed (55 women; median age, 77 years). Overall, 61% and 39% were classified as "oral intake alone" and "artificial nutrition," respectively. Days from onset to admission to rehabilitation wards and motor Functional Independence Measure were higher in the "oral intake alone" group. Kaplan-Meier analysis demonstrated that patients with lower muscle mass exhibited lower probability of full oral intake (P = .009). The Cox proportional hazards model suggested that lower muscle mass (hazard ratio, 0.493; 95% CI, 0.286-0.850) and poor oral hygiene (hazard ratio, 0.573; 95% CI, 0.333-0.987) were independently correlated with "oral intake alone" status. Malnutrition and other oral status are not related to achieving full oral intake.

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Section: Methodsmentioning

confidence: 99%

Impact of nutritional status, muscle mass and oral status on recovery of full oral intake among stroke patients receiving enteral nutrition: A retrospective cohort study

Nishioka¹,

Yamasaki

Ogawa³

et al. 2019

Nutrition & Dietetics

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“…Malnutrition is a major cause of adverse health consequences, such as impaired physical function [1], hospitalization [2], and mortality [3,4] in older people. One of the most prominent features of malnutrition is that it is a reversible disease, and a wide variety of effective therapeutic approaches are available and adaptable to the different etiologies and patient requirements [5,6].…”

Section: Introductionmentioning

confidence: 99%

Malnutrition as a Strong Predictor of the Onset of Sarcopenia

et al. 2019

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This study aims to explore the association between malnutrition diagnosed according to both the Global Leadership Initiative of Malnutrition (GLIM) and the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria and the onset of sarcopenia/severe sarcopenia, diagnosed according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criterion, in the sarcopenia and physical impairment with advancing age (SarcoPhAge) cohort during a four-year follow-up. Adjusted Cox-regression and Kaplan-Meier curves were performed. Among the 534 community-dwelling participants recruited in the SarcoPhAge study, 510 were free from sarcopenia at baseline, of whom 336 had complete data (186 women and 150 men, mean age of 72.5 ± 5.8 years) to apply the GLIM and ESPEN criteria. A significantly higher risk of developing sarcopenia/severe sarcopenia during the four-year follow-up based on the GLIM [sarcopenia: Adjusted hazard ratio (HR) = 3.23 (95% confidence interval (CI) 1.73–6.05); severe sarcopenia: Adjusted HR = 2.87 (95% CI 1.25–6.56)] and ESPEN [sarcopenia: Adjusted HR = 4.28 (95% CI 1.86–9.86); severe sarcopenia: Adjusted HR = 3.86 (95% CI 1.29–11.54)] criteria was observed. Kaplan-Meier curves confirmed this relationship (log rank p < 0.001 for all). These results highlighted the importance of malnutrition since it has been shown to be associated with an approximately fourfold higher risk of developing sarcopenia/severe sarcopenia during a four-year follow-up.

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“…The phenotypic criteria are the three anthropometric measures that composed the previous internationally acknowledged definition of malnutrition, which was the ESPEN consensus, 1 launched in 2015. [11][12][13] The ESPEN consensus was the first effort of the largest societies on clinical nutrition and metabolism to obtain an international consensus, and it was found to be related with a 4.4-fold higher mortality risk in community-dwelling older people 11 and 2.7-fold higher risk in the hospitalized diabetic older population 14 ; however, the GLIM criteria are recent and have not yet been tested in a lot of studies.…”

Section: Introductionmentioning

confidence: 99%

“…The GLIM criteria have a three‐step diagnostic structure: (i) screening by any validated screening tool; (ii) diagnosis, which requires at least one phenotypic criterion [unintentional weight loss, low body mass index (BMI), and reduced muscle mass] AND at least one aetiologic criterion (reduced food intake or assimilation and disease burden or inflammatory conditions); and (iii) severity grading. The phenotypic criteria are the three anthropometric measures that composed the previous internationally acknowledged definition of malnutrition, which was the ESPEN consensus, 1 launched in 2015 11–13 . The ESPEN consensus was the first effort of the largest societies on clinical nutrition and metabolism to obtain an international consensus, and it was found to be related with a 4.4‐fold higher mortality risk in community‐dwelling older people 11 and 2.7‐fold higher risk in the hospitalized diabetic older population 14 ; however, the GLIM criteria are recent and have not yet been tested in a lot of studies.…”

Section: Introductionmentioning

confidence: 99%

Mortality in malnourished older adults diagnosed by ESPEN and GLIM criteria in the SarcoPhAge study

Sánchez-Rodríguez

Locquet

Reginster

et al. 2020

J cachexia sarcopenia muscle

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Background The Global Leadership Initiative on Malnutrition (GLIM) criteria have been recently launched by consensus of the major nutrition societies. GLIM criteria are partly constructed on the previous definition of malnutrition developed by the European Society of Clinical Nutrition and Metabolism (ESPEN). We aimed to assess malnutrition according to the ESPEN and GLIM criteria at baseline and to determine the corresponding risk of mortality during a 4-year follow-up in community-dwelling older adults from the SarcoPhAge (Sarcopenia and Physical Impairment with advancing Age) study. The relationship between malnutrition and incidence of 4-year adverse health consequences (institutionalization, hospitalization, falls, and fractures) was assessed. Methods This prospective population-based cohort was part of SarcoPhAge, which included 534 older adults in Belgium, followed up from 2013 to 2019. Community-dwelling healthy volunteers ≥65 years old were recruited. Mortality and adverse health consequences were collected annually by interview or phone call. Baseline malnutrition was defined according to the GLIM and ESPEN criteria. Agreement between the two definitions was reported by Cohen's kappa coefficient. Adjusted Cox regression and Kaplan-Meier survival curves were performed for malnutrition. Logistic regression was used for the other outcomes. Results From 534 subjects in SarcoPhAge, the records for 411 participants (73.2 ± 6.05 years old; 55.7% women) had all the variables needed to apply the GLIM criteria. Prevalence of baseline malnutrition was 23.4% for GLIM and 7% for ESPEN criteria (k = 0.30, low agreement). The adjusted Cox regression showed a significant increased mortality risk according to malnutrition status as defined by the GLIM [adjusted hazard ratio = 4.41 (95% confidence interval: 2.17-8.97)] and ESPEN [adjusted hazard ratio = 2.76 (95% confidence interval: 1.16-6.58)] criteria. Survival curves differed significantly between malnourished and non-malnourished groups, regardless of the definition used (log rank P < 0.001 for both). No association was found between baseline malnutrition according to these two criteria and 4-year risk of institutionalization, hospitalization, falls, or fractures (all P > 0.05). Conclusions Malnutrition according to the GLIM criteria was associated with a 4.4-fold higher mortality risk, double that of the ESPEN criteria, during a 4-year follow-up. No association was found between malnutrition according to these two criteria and incidence of other health adverse consequences. GLIM criteria anticipate mortality and might guide interventions, with important implications for clinical practice and research.

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Prognostic Value of the ESPEN Consensus and Guidelines for Malnutrition: Prediction of Post‐Discharge Clinical Outcomes in Older Inpatients

Abstract: Further research is needed on the potential value of the ESPEN consensus and guidelines for malnutrition to identify older patients at risk of worse functional status, institutionalization, readmissions, and mortality at 3-month follow-up postdischarge.

Cited by 16 publications

References 52 publications

Impact of nutritional status, muscle mass and oral status on recovery of full oral intake among stroke patients receiving enteral nutrition: A retrospective cohort study

Impact of nutritional status, muscle mass and oral status on recovery of full oral intake among stroke patients receiving enteral nutrition: A retrospective cohort study

Malnutrition as a Strong Predictor of the Onset of Sarcopenia

Mortality in malnourished older adults diagnosed by ESPEN and GLIM criteria in the SarcoPhAge study

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