Accuracy of the Global Leadership Initiative on Malnutrition to identify malnutrition in hospitalized patients

ABSTRACT Objective: The Global Leadership Initiative on Malnutrition, introduced as a useful method in the diagnosis of malnutrition, is supported by little evidence in hospitalized individuals. Therefore, we reviewed this method with two objectives: 1) to compare the diagnostic accuracy of the Global Leadership Initiative on Malnutrition criteria with the Patient-Generated Subjective Global Assessment; 2) to determine the prevalence of malnutrition and its associated factors. Methods: Cross-sectional study, conducted with individuals hospitalized between April 2019 and July 2021. Sociodemographic, clinical and anthropometric information was investigated. Global Leadership Initiative on Malnutrition was the index test and Patient-Generated Subjective Global Assessment the standard reference to assess malnutrition. For diagnostic accuracy, measurements of sensitivity, specificity, area under the curve and kappa agreement were considered. Results: A total of 105 individuals participated (age 65.9±9.9 years). The prevalence of malnutrition in the total sample was 48.6% and 67.6% according to the Global Leadership Initiative on Malnutrition and Patient-Generated Subjective Global Assessment criteria, respectively. An association was observed between malnutrition and the variables that stand behind hospitalization, metabolic stress and anthropometric indicators (p&lt;0.05). The comparison showed sensitivity and specificity values for the Global Leadership Initiative on Malnutrition criteria of 67.6% (95% CI: 56.1-77.3) and 91.2% (95% CI: 77.0-96.9) (total sample) and 71.7% (95% CI: 58.4-82.0) and 95.5% (95% CI: 78.2-99.2) (elderly), respectively. An agreement of 49% was observed, raising to 55% when the elderly were assessed separately. Conclusion: The Global Leadership Initiative on Malnutrition criteria presented adequate sensitivity conditions and specificity to diagnose malnutrition, moderate agreement with the reference standard and good applicability in hospitalized patients’ clinical practice. Prevalence of malnutrition was high, regardless of the method used, and was associated with the reason for hospitalization, metabolic stress and anthropometric indicators.摘要 目的：全球营养不良领导倡议（Global Leadership Initiative on Malnutrition）作为一种实用的营养不良诊断工具，目前在住院人群中的支持性研究证据较为匮乏。为此本研究开展该项综述，旨在达成两大研究目标：1）对比全球营养不良领导倡议诊断标准与患者自评主观全面评定（Patient-Generated Subjective Global Assessment）的诊断准确性；2）明确营养不良的患病率及其相关影响因素。 方法：本研究为横断面研究，研究对象为2019年4月至2021年7月期间收治的住院患者。研究收集了受试者的社会人口学特征、临床资料及人体测量学相关信息。以全球营养不良领导倡议作为指标检测方法，以患者自评主观全面评定作为营养不良评估的金标准。在诊断准确性分析中，纳入了灵敏度、特异度、曲线下面积及Kappa一致性检验等评价指标。 结果：本研究共纳入105名受试者，平均年龄为65.9±9.9岁。依据全球营养不良领导倡议与患者自评主观全面评定标准，总样本的营养不良患病率分别为48.6%与67.6%。研究发现营养不良与住院诱因、代谢应激及人体测量学指标存在显著关联（p<0.05）。对比分析显示，全球营养不良领导倡议诊断标准的灵敏度与特异度在总样本中分别为67.6%（95% CI: 56.1-77.3）与91.2%（95% CI: 77.0-96.9），在老年亚组中分别为71.7%（95% CI: 58.4-82.0）与95.5%（95% CI: 78.2-99.2）。总体一致性为49%，单独评估老年亚组时一致性提升至55%。 结论：全球营养不良领导倡议诊断标准具备良好的灵敏度与特异度，可用于营养不良的临床诊断；其与金标准的一致性处于中等水平，在住院患者的临床实践中具有较好的应用价值。无论采用何种评估方法，营养不良的患病率均处于较高水平，且与住院诱因、代谢应激及人体测量学指标显著相关。