Background Malnutrition is prevalent in lung cancer (LC) patients, yet there are no globally accepted criteria for diagnosing malnutrition. Recently, the Global Leadership Initiative on Malnutrition (GLIM) criteria were proposed. However, the role of these criteria in prospective LC cohorts remains unclear. Methods We performed a multicenter, observational cohort study including 1219 LC patients. Different anthropometric measures were compared for assessment of reduced muscle mass (RMM) in the GLIM criteria. Least absolute shrinkage and selection operator and multivariate Cox regressions were performed to analyze the association between the GLIM criteria and survival. Independent prognostic predictors were incorporated to develop a nomogram for individualized survival prediction, and decision curve was applied to assess the clinical significance of the nomogram. Results Patients in the stage II (severe) malnutrition group, diagnosed using combined calf circumference (CC) plus body weight–standardized handgrip strength (HGS/W) criteria, had the highest hazard ratio (HR, 2.07; 95%CI, 1.50–2.86) compared with other methods used to evaluate RMM. The GLIM criteria diagnosed malnutrition in 24% of cases (292 patients, using the CC and HGS/W criteria) and were effective for determining the nutrition status of LC patients. GLIM‐diagnosed malnutrition was an independent risk factor for survival, and malnutrition severity was monotonically associated with death hazards (P = .002). The GLIM nomogram showed good performance in predicting the survival of LC patients, and the decision‐curve analysis demonstrated that the nomogram was clinically useful. Conclusion These findings support the effectiveness of GLIM in diagnosing malnutrition and predicting survival among LC patients.

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The present study evaluated whether fat mass assessment using the triceps skinfold (TSF) thickness provides additional prognostic value to the GLIM framework in patients with lung cancer (LC). We performed an observational cohort study including 2672 LC patients at two institutions in China. Comprehensive demographic, disease and nutritional characteristics were collected. Malnutrition was retrospectively defined using the GLIM criteria, and optimal stratification was used to determine the best thresholds for the TSF. The associations of malnutrition and TSF categories with survival were estimated independently and jointly by calculating multivariable-adjusted hazard ratios (HRs). Malnutrition was identified in 808 (30.2%) patients, and the best TSF thresholds were 9.5 mm in men and 12 mm in women. Accordingly, 496 (18.6%) patients were identified as having a low TSF. Patients with concurrent malnutrition and a low TSF had a 54% (HR = 1.54, 95%CI = 1.25 to 1.88) greater death hazard compared with well-nourished individuals, which was also greater compared to malnourished patients with a normal TSF (HR = 1.23, 95%CI = 1.06 to 1.43) or malnourished patients without TSF assessment (HR = 1.31, 95%CI = 1.14 to 1.50). These associations were concentrated among those patients with adequate muscle mass (as indicated by the calf circumference). Additional fat mass assessment using the TSF enhances the prognostic value of the GLIM criteria. Using the population-derived thresholds for the TSF may provide significant prognostic value when used in combination with the GLIM criteria to guide strategies to optimize the long-term outcomes in patients with LC.

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