GLIM criteria for the evaluation of nutrition in palliative care patients, a comparison of MNA-SF and NRS-2002

Abstract

Introduction: A major cause of mortality and morbidity, malnutrition also increases the duration of hospital stay and costs. Therefore, the early diagnosis and detection of those patients at risk is important. Many malnutrition screening tests are available for the detection of those patients. The validity and reliability of the commonly used tests, Nutritional Risk Screening (NRS)-2002 and Mini Nutritional Assessment (MNA) have been proven in the diagnosis of malnutrition in hospitalized patients. A new malnutrition diagnostic criterion called the Global Leadership Initiative on Malnutrition (GLIM) was created by an initiative of the same name as these criteria in 2018. The aim of the present study is to evaluate the differences and superiority of MNA, NRS-2002 screening tests and GLIM criteria in patients hospitalized in palliative care with a diagnosis of malnutrition. Material and method: 148 patients who were hospitalized in palliative care due to clinical malnutrition were included in the study. MNA, NRS-2002 and GLIM screening tests filled out by dieticians for each patient within the first 48 hours of hospitalization. Within the framework of GLIM criteria, patients were recorded for weight loss from phenotypic criteria based on information obtained from their relatives (more than five percent in the last six months or ten percent or more over the last six months). Hand dynamometer and calf circumference measurements were made to show muscle loss. Hand grip power was measured three times in both hands using a Jamar Digital Hand Dynamometer and the highest value was recorded. Hand grip power cut-off value was accepted as <22 and <32 for women and men, respectively. Individuals with a calf circumference of <31 cm (the cut-off value) were considered to have muscle loss. Low Body Mass Index (BMI) was accepted as 20 kg/m2 for individuals under the age of 70 years, and <22 for individuals above the age of 70 years. Decreased food intake which is among the etiologic criteria was detected by calculating the mean daily consumed calories of a patient. Individuals with CRP>5 were accepted as inflammation positive. Result: Mean age in the total series was 72.98 with 70.4 in males and 75.5 in females including a total of 148 patients. Among the patients 50.67% (n=75) were males and 49.32% (n=73) were females. Malnutrition was found to be present in 141/148 (94.6%) patients according to the GLIM screening test. Malnutrition risk was present in 131/148 (87.9%) and 139/148 (93.2%) according to MNA-SF and NRS-2002, respectively. The results of GLIM criteria and the other two screening tests were compared. While the results of GLIM criteria and NRS-2002 test were similar, a significant difference was found between the GLIM test results and the results of MNA-SF. The reason of the difference was considered to be the fact that more patients were diagnosed as having malnutrition when GLIM and NRS-2002 tests were used, and the number was found to be smaller when MNA-SF was used. Conclusion: The GLIM screening test is considered to be an easy to use and sensitive test for the diagnosis of patients hospitalized in palliative care centers. GLIM test and NRS- 2002 were found to be similar for diagnosing malnutrition. Although the results of MNA and GLIM tests were close, a significant difference was found between them in the diagnosis of malnutrition

Keywords

• Palliative care
• Malnutrition
• Global Leadership Initiative on Malnutrition
• MNA-SF and NRS 2002
• Malnutrition Screening
• Nutrition assessment
• Diagnostic criteria

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