Background The Global Leadership Initiative on Malnutrition (GLIM) approach to diagnose malnutrition was published in 2018. An important next step is to use the GLIM criteria in clinical investigations to assess their validity and feasibility.Objective To compare the validity and feasibility of the GLIM criteria with Patient-Generated Subjective Global Assessment (PG-SGA) in hospitalized patients and to assess the association between malnutrition and 1-year mortality.Design Post hoc analysis of a prospective cohort study. Participants/setting Hospitalized patients (n ¼ 574) from the Departments of Gastroenterology, Gynecology, Urology, and Orthopedics at the Radboudumc academic facility in Nijmegen, The Netherlands, were enrolled from July 2015 through December 2016. Main outcome measuresThe GLIM criteria and PG-SGA were applied to identify malnourished patients. Mortality rates were collected from electronic patient records. Feasibility was assessed by evaluating the amount of and reasons for missing data.Statistical analyses performed Concurrent validity was evaluated by assessing the sensitivity, specificity, and Cohen's kappa coefficient for the GLIM criteria compared with PG-SGA. Cox regression analysis was used for the association between the GLIM criteria and PG-SGA and mortality. ResultsOf 574 patients, 160 (28%) were classified as malnourished according to the GLIM criteria and 172 (30.0%) according to PG-SGA (k ¼ 0.22, low agreement). When compared with PG-SGA, the GLIM criteria had a sensitivity of 43% and a specificity of 79%. Mortality of malnourished patients was more than two times higher than for nonmalnourished patients according to the GLIM criteria (hazard ratio [HR], 2.68; confidence interval [CI], 1.33-5.41). Data on muscle mass was missing in 454 of 574 (79%) patients because of practical problems with the assessment using bioimpedance analysis (BIA).Conclusions Agreement between GLIM criteria and PG-SGA was low when diagnosing malnutrition, indicating that the two methods do not identify the same patients. This is supported by the GLIM criteria showing predictive power for 1-year mortality in hospitalized patients in contrast to PG-SGA. The assessment of muscle mass using BIA was difficult to perform in this clinical population.

Implementation of a high-frequency food service can improve protein intake at mealtimes during the day and might be a strategy to increase the number of patients with adequate protein intake.

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Background The preoperative period likely provides an important opportunity to improve postoperative recovery, as suggested by the finding that low nutrition status is a predictor of increased postoperative complications and longer length of stay (LOS). It was investigated whether a home‐delivered, protein‐rich meal service improves protein intake relative to requirements within 3 weeks prior to surgery compared to usual care (UC). Methods This randomized controlled trial included adults (n = 126) with planned surgery performed at the orthopedics, urology, gynecology, or general surgery departments. The intervention group received 6 protein‐rich dishes per day for 3 weeks, and the control group sustained their usual diet. Dietary intake, nutrition status, hand grip strength, physical performance, and quality of life were assessed at baseline and after 3 weeks. Patient satisfaction was reported after 3 weeks, and data on complications and LOS were reported 30 days after surgery. Results Protein intake relative to requirements significantly improved by 16%, and energy intake relative to requirements increased by 19% for the meal service, as compared with UC. The intervention group experienced significantly less stress with preparing meals and were more satisfied with the presentation of the meals than the control group. No significant effects of the intervention were detected on other secondary outcomes. Conclusion The home‐delivered, protein‐rich meal service was successfully implemented before surgery and improved protein and energy intake relative to requirements within 3 weeks while patient satisfaction maintained. The preoperative period serves as a window of opportunity to prepare patients before hospitalization.

Background: Malnutrition at admission is associated with complication-related readmission and prolonged hospital stay. This underscores the importance of an adequate intake -more particular, protein intake -to prevent further deterioration and treat malnutrition during hospitalization. Our objective was to assess whether protein intake relative to requirements at the first day of full oral intake is associated with complications and hospital length of stay (LOS) in medical and surgical patients. Methods: This was a post hoc analysis of a prospective cohort study in patients on the wards of gastroenterology, orthopedics, urology, and gynecology. Protein intake was measured by subtracting the weight of each dish at the end of each mealtime from the weight at serving time. Complications and LOS were reported using patients' medical records. Results: In total, complications were observed in 92 of 637 (14.4%) patients, with a median LOS of 5 days (3.0-7.0). An absolute increase of 10% protein intake relative to requirements reduced the relative complication risk by 10% (odds ratio, 0.900; 95% CI, 0.83-0.97; P < .05). Also, LOS was shortened by 0.23 days for each increase of 10% in protein intake relative to requirements (95% CI, -0.3 to -0.2; P < .05). Conclusion: Protein intake relative to requirements at the first day of full-oral intake is associated with the risk of complications and hospital LOS. This analysis bolsters the evidence for the importance of any hospital meal service that increases protein intake.