Malnutrition via GLIM Criteria in General Surgery Patients

Abstract

Purpose: The purposes are to determine malnutrition in elective general surgery patients via GLIM criteria, compare GLIM criteria with NRS2002 and to determine the effect of malnutrition on Length of Stay (LoS). Materials and Methods: Malnutrition was detected with NRS2002 and GLIM. GLIM was evaluated in two different ways as 1-NRS2002 (first four questions) was used as a preliminary malnutrition screening tool for GLIM and 2-All patients were evaluated with GLIM without a preliminary assessment. Reduced muscle mass in GLIM, was assessed using different anthropometric measurements and cut-off points. In total, 10 different GLIM models were constituted. Data were collected within 48 hours of admission. Agreement between malnutrition tools was determined via Kappa. Logistic regression models were established to present the effect of malnutrition on long LoS. p<0.05 was deemed significant. Results: Among participants(n=224) prevalence of malnutrition was 45.5% via NRS2002, 62.9-64.3% via GLIMpre-assess 81.7-88% via GLIMonly. NRS2002 and GLIMpre-assess had a very high agreement. After controlling for confounding variables, malnutrition increases the long LoS 3.6-fold via NRS2002 whereas, for GLIMpre-assessed, ORs were 3.9-4.2(p<0.001 for all). Conclusions: Malnutrition increased LoS. NRS2002 and GLIMpre-assess give similar results. MUAC or CC can be preferred to define reduced muscle mass. Broader studies should be conducted to determine which anthropometric measurement would better define reduced muscle mass for GLIM.

Keywords

• Malnutrition
• NRS2002
• GLIM criteria
• Length of Stay

References

1. 1. Cederholm, T., R. Barazzoni, P. Austin, P. Ballmer, G. Biolo, S.C. Bischoff, et al., ESPEN guidelines on definitions and terminology of clinical nutrition. Clinical nutrition, 2017. 36(1): p. 49-64.
2. 2. Cortes, R., M. Bennasar-Veny, E. Castro-Sanchez, S. Fresneda, J. de Pedro-Gomez, and A. Yanez, Nutrition screening tools for risk of malnutrition among hospitalized patients: A protocol for systematic review and meta analysis. Medicine (Baltimore), 2020. 99(43): p. e22601.
3. 3. Kondrup, J., S.P. Allison, M. Elia, B. Vellas, and M. Plauth, ESPEN guidelines for nutrition screening 2002. Clinical nutrition, 2003. 22(4): p. 415-421.
4. 4. Tobert, C.M., J.M. Hamilton-Reeves, L.A. Norian, C. Hung, N.A. Brooks, J.M. Holzbeierlein, et al., Emerging impact of malnutrition on surgical patients: literature review and potential implications for cystectomy in bladder cancer. The Journal of urology, 2017. 198(3): p. 511-519.
5. 5. Korfalı, G., H. Gündoğdu, S. Aydıntuğ, M. Bahar, T. Besler, A.R. Moral, et al., Nutritional risk of hospitalized patients in Turkey. Clinical Nutrition, 2009. 28(5): p. 533-537.
6. 6. Curtis, L.J., P. Bernier, K. Jeejeebhoy, J. Allard, D. Duerksen, L. Gramlich, et al., Costs of hospital malnutrition. Clinical Nutrition, 2017. 36(5): p. 1391-1396.
7. 7. Ruiz, A.J., G. Buitrago, N. Rodríguez, G. Gómez, S. Sulo, C. Gómez, et al., Clinical and economic outcomes associated with malnutrition in hospitalized patients. Clinical Nutrition, 2019. 38(3): p. 1310-1316.
8. 8. Tah, P.C., C.C. Kee, and H.A. Majid, Validity and Reliability of a Nutrition Screening Tool in Identifying Malnutrition Among Hospitalized Adult Patients. Nutr Clin Pract, 2020. 35(5): p. 942-950.

9. 9. Cederholm, T., G. Jensen, M. Correia, M. Gonzalez, R. Fukushima, T. Higashiguchi, et al., GLIM criteria for the diagnosis of malnutrition–a consensus report from the global clinical nutrition community. Journal of cachexia, sarcopenia and muscle, 2019. 10(1): p. 207-217.
10. 10. de van der Schueren, M.A.E., H. Keller, G. Consortium, T. Cederholm, R. Barazzoni, C. Compher, et al., Global Leadership Initiative on Malnutrition (GLIM): Guidance on validation of the operational criteria for the diagnosis of protein-energy malnutrition in adults. Clin Nutr, 2020. 39(9): p. 2872-2880.
11. 11. Cederholm, T. and G.L. Jensen, To create a consensus on malnutrition diagnostic criteria: a report from the Global Leadership Initiative on Malnutrition (GLIM) meeting at the ESPEN Congress 2016. Journal of Parenteral and Enteral Nutrition, 2017. 41(3): p. 311-314.
12. 12. Hersberger, L., L. Bargetzi, A. Bargetzi, P. Tribolet, R. Fehr, V. Baechli, et al., Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial. Clinical Nutrition, 2020. 39(9): p. 2720-2729.
13. 13. Gur, A.S., K. Atahan, I. Aladag, E. Durak, A. Cokmez, E. Tarcan, et al., The efficacy of Nutrition Risk Screening-2002 (NRS-2002) to decide on the nutritional support in general surgery patients. Bratisl Lek Listy, 2009. 110(5): p. 290-292.
14. 14. Contreras-Bolivar, V., F.J. Sanchez-Torralvo, M. Ruiz-Vico, I. Gonzalez-Almendros, M. Barrios, S. Padin, et al., GLIM Criteria Using Hand Grip Strength Adequately Predict Six-Month Mortality in Cancer Inpatients. Nutrients, 2019. 11(9).
15. 15. Sanchez-Rodriguez, D., M. Locquet, O. Bruyere, L. Lengele, E. Cavalier, J.Y. Reginster, et al., Prediction of 5-year mortality risk by malnutrition according to the GLIM format using seven pragmatic approaches to define the criterion of loss of muscle mass. Clin Nutr, 2020.
16. 16. Cederholm, T. and R. Barazzoni, A year with the GLIM diagnosis of malnutrition - does it work for older persons? Curr Opin Clin Nutr Metab Care, 2021. 24(1): p. 4-9.
17. 17. Vellas, B., H. Villars, G. Abellan, M. Soto, Y. Rolland, Y. Guigoz, et al., Overview of the MNA®-Its history and challenges. Journal of Nutrition Health and Aging, 2006. 10(6): p. 456.
18. 18. Kumar, P., N. Sareen, S. Agrawal, N. Kathuria, S. Yadav, and V. Sethi, Screening Maternal Acute Malnutrition Using Adult Mid-Upper Arm Circumference in Resource-Poor Settings. Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine, 2018. 43(2): p. 132-134.
19. 19. Van Tonder, E., L. Mace, L. Steenkamp, R. Tydeman-Edwards, K. Gerber, and D. Friskin, Mid-upper arm circumference (MUAC) as a feasible tool in detecting adult malnutrition. South African Journal of Clinical Nutrition, 2019. 32(4): p. 93-98.
20. 20. Gottschall, C., M. Tarnowski, P. Machado, D. Raupp, A. Marcadenti, E.I. Rabito, et al., Predictive and concurrent validity of the Malnutrition Universal Screening Tool using mid-upper arm circumference instead of body mass index. Journal of Human Nutrition and Dietetics, 2019. 32(6): p. 775-780.
21. 21. Thorup, L., S.A. Hamann, P. Kallestrup, V.E. Hjortdal, A. Tripathee, D. Neupane, et al., Mid-upper arm circumference as an indicator of underweight in adults: a cross-sectional study from Nepal. BMC Public Health, 2020. 20(1): p. 1187.
22. 22. Martínez-Camblor, P. and J.C. Pardo-Fernández, The Youden Index in the Generalized Receiver Operating Characteristic Curve Context. The International Journal of Biostatistics, 2019. 15(1): p. 20180060.
23. 23. Fryar, C.D., Q. Gu, C.L. Ogden, and K.M. Flegal, Anthropometric reference data for children and adults; United States, 2011-2014. 2016.
24. 24. Simsek, H., R. Meseri, S. Sahin, A. Kilavuz, D.H. Bicakli, M. Uyar, et al., Prevalence of sarcopenia and related factors in community-dwelling elderly individuals. Saudi medical journal, 2019. 40(6): p. 568-574.
25. 25. Cruz-Jentoft, A.J., G. Bahat, J. Bauer, Y. Boirie, O. Bruyère, T. Cederholm, et al., Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing, 2019. 48(1): p. 16-31.
26. 26. Preedy, V.R., Handbook of anthropometry: physical measures of human form in health and disease. 2012: Springer Science & Business Media.
27. 27. Correia, M., M.I. Perman, and D.L. Waitzberg, Hospital malnutrition in Latin America: A systematic review. Clin Nutr, 2017. 36(4): p. 958-967.
28. 28. Sauer, A.C., S. Goates, A. Malone, K.M. Mogensen, G. Gewirtz, I. Sulz, et al., Prevalence of Malnutrition Risk and the Impact of Nutrition Risk on Hospital Outcomes: Results From nutritionDay in the U.S. JPEN J Parenter Enteral Nutr, 2019. 43(7): p. 918-926.
29. 29. Allard, J.P., H. Keller, L. Gramlich, K.N. Jeejeebhoy, M. Laporte, and D.R. Duerksen, GLIM criteria has fair sensitivity and specificity for diagnosing malnutrition when using SGA as comparator. Clinical Nutrition, 2020. 39(9): p. 2771-2777.
30. 30. Matsumoto, Y., K. Iwai, N. Namikawa, S. Matsuda, C. Wakano, H. Heya, et al., The relationship between existing nutritional indicators and Global Leadership Initiative on Malnutrition (GLIM) criteria: A one-institution cross-sectional analysis. Clinical Nutrition, 2020. 39(10): p. 3099-3104.
31. 31. Henrique, J.R., R.G. Pereira, R.S. Ferreira, H. Keller, M. de Van der Schueren, M.C. Gonzalez, et al., Pilot study GLIM criteria for categorization of a malnutrition diagnosis of patients undergoing elective gastrointestinal operations: A pilot study of applicability and validation. Nutrition, 2020. 79-80: p. 110961.
32. 32. Fiorindi, C., C. Luceri, G. Dragoni, G. Piemonte, S. Scaringi, F. Staderini, et al., GLIM Criteria for Malnutrition in Surgical IBD Patients: A Pilot Study. Nutrients, 2020. 12(8): p. 2222.
33. 33. Cederholm, T., G.L. Jensen, M. Correia, M.C. Gonzalez, R. Fukushima, T. Higashiguchi, et al., GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle, 2019. 10(1): p. 207-217.
34. 34. Keller, H., M.A.E. de van der Schueren, f.t.G. Consortium, G.L. Jensen, R. Barazzoni, C. Compher, et al., Global Leadership Initiative on Malnutrition (GLIM): Guidance on Validation of the Operational Criteria for the Diagnosis of Protein-Energy Malnutrition in Adults. Journal of Parenteral and Enteral Nutrition, 2020. 44(6): p. 992-1003.
35. 35. Zhang, Z., Z. Wan, Y. Zhu, L. Zhang, L. Zhang, and H. Wan, Prevalence of malnutrition comparing NRS2002, MUST, and PG-SGA with the GLIM criteria in adults with cancer: A multi-center study. Nutrition, 2020. 83: p. 111072.
36. 36. Jensen, G.L., T. Cederholm, M. Correia, M.C. Gonzalez, R. Fukushima, T. Higashiguchi, et al., GLIM Criteria for the Diagnosis of Malnutrition: A Consensus Report From the Global Clinical Nutrition Community. JPEN J Parenter Enteral Nutr, 2019. 43(1): p. 32-40.
37. 37. Yin, L., X. Lin, N. Li, M. Zhang, X. He, J. Liu, et al., Evaluation of the Global Leadership Initiative on Malnutrition Criteria Using Different Muscle Mass Indices for Diagnosing Malnutrition and Predicting Survival in Lung Cancer Patients. JPEN J Parenter Enteral Nutr, 2020.
38. 38. Lew, C.C.H., R. Yandell, R.J.L. Fraser, A.P. Chua, M.F.F. Chong, and M. Miller, Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review [Formula: see text]. JPEN J Parenter Enteral Nutr, 2017. 41(5): p. 744-758.
39. 39. Xu, J.-Y., M.-W. Zhu, H. Zhang, L. Li, P.-X. Tang, W. Chen, et al., A Cross-Sectional Study of Glim-Defined Malnutrition Based on New Validated Calf Circumference Cut-Off Values and Different Screening Tools in Hospitalised Patients over 70 Years Old. The journal of nutrition, health & aging, 2020. 24: p. 832-838.