Data_Sheet_1_Validation of GLIM criteria on malnutrition in older Chinese inpatients.pdf

ObjectiveMalnutrition is a nutritional disorder and common syndrome that has a high incidence and is easily ignored in hospitalized older patients. It can lead to multiple poor prognoses, such as frailty. Early identification and correct evaluation of possible malnutrition and frailty are essential to improve clinical outcomes in older patients. Therefore, our objective was to explore the applicability and effectiveness of the Global Leadership Initiative on Malnutrition (GLIM) criteria for identifying malnutrition in older patients.
MethodsIn total, 223 participants aged ≥60 years were involved. Nutrition was evaluated using the Mini Nutritional Assessment-Full Form (MNA-FF) and GLIM criteria, which adopt a two-step procedure. The first step was to use three different methods for the screening of nutritional risk: the Nutrition Risk Screening 2002, the Mini Nutritional Assessment Short Form (MNA-SF), and the Malnutrition Universal Screening Tool. The second step was to link a combination of at least one phenotypical criterion and one etiological criterion to diagnose malnutrition. The Clinical Frailty Scale was used to assess frailty. Sensitivity, specificity, Youden index, kappa values, and positive and negative predictive values were used to evaluate the validity of the GLIM criteria. Logistic regression models were used to assess whether there was a correlation between malnutrition, as defined by the GLIM criteria, and frailty.
ResultsWe found that 32.3–49.8% of our patient sample were at risk of malnutrition based on the GLIM diagnosis and using the three different screening tools; 19.3–27.8% of the patients were malnourished. GLIM criteria with MNA-SF as a diagnostic validation and MNA-FF as a reference showed high consistency (K = 0.629; p < 0.001), sensitivity (90.5%), and specificity (86.4%). Logistic regression analysis showed that malnutrition, using MNA-SF with the GLIM criteria, was relevant for a higher likelihood of frailty (OR = 1.887; 95% CI 1.184–2.589).
ConclusionsThe incidence of GLIM-defined malnutrition was 19.3–27.8% using different screening tools. The consistency between the GLIM criteria using the MNA-SF and the MNA methods was high. Malnutrition, as diagnosed by the GLIM criteria with MNA-SF, was significantly correlated with frailty. GLIM criteria with MNA-SF may be a more reliable malnutrition assessment process in older inpatients.

研究目的：营养不良是一种营养紊乱性疾病，亦是一种高发且在住院老年患者中极易被忽视的常见综合征，可引发衰弱等多种不良预后。早期识别并准确评估潜在营养不良与衰弱状态，对改善老年患者的临床结局至关重要。因此本研究旨在探讨全球营养不良领导倡议（Global Leadership Initiative on Malnutrition, GLIM）标准在老年患者营养不良筛查中的适用性与有效性。方法：本研究共纳入223名年龄≥60岁的受试者。采用微型营养评定完整版（Mini Nutritional Assessment-Full Form, MNA-FF）与GLIM标准对营养状况进行评估，GLIM标准采用两步法流程：第一步通过三种不同方法开展营养风险筛查，分别为营养风险筛查2002（Nutrition Risk Screening 2002）、微型营养评定简版（Mini Nutritional Assessment Short Form, MNA-SF）以及营养不良通用筛查工具（Malnutrition Universal Screening Tool）；第二步结合至少1项表型标准与1项病因学标准以确诊营养不良。采用临床衰弱量表（Clinical Frailty Scale）评估受试者的衰弱状态。通过灵敏度、特异度、约登指数（Youden index）、Kappa值以及阳性、阴性预测值评价GLIM标准的有效性。采用Logistic回归模型分析GLIM标准定义的营养不良与衰弱之间的相关性。结果：基于GLIM诊断标准并联合三种不同筛查工具分析，本研究队列中32.3%~49.8%的患者存在营养不良风险，19.3%~27.8%的患者确诊为营养不良。以MNA-FF作为参照标准、MNA-SF用于诊断验证的GLIM标准展现出较高的一致性（K=0.629；p<0.001）、灵敏度（90.5%）与特异度（86.4%）。Logistic回归分析显示，采用MNA-SF联合GLIM标准定义的营养不良与衰弱发生风险升高显著相关（优势比OR=1.887；95%置信区间CI：1.184~2.589）。结论：采用不同筛查工具时，GLIM标准定义的营养不良发生率为19.3%~27.8%。采用MNA-SF的GLIM标准与MNA方法之间具有较高的一致性。通过GLIM标准联合MNA-SF确诊的营养不良与衰弱存在显著相关性。针对住院老年患者而言，采用MNA-SF的GLIM标准或可成为一种更为可靠的营养不良评估方案。