Effect of GLIM-defined malnutrition on postoperative clinical outcomes in patients with colorectal cancer

Song, Hao-Nan; Wang, Wenbin; Luo, Xin; Huang, Dongdong; Ruan, Xiuhang; Xing, Chungen; Chen, Wei-Zhe; Dong, Qian-Tong; Chen, Xiaolei

doi:10.1093/jjco/hyab215

Cited by 30 publications

(33 citation statements)

References 35 publications

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“…According to previous studies, the prevalence of malnutrition in the gastrointestinal is about 30–50% ( 11 – 13 ). According to GLIM criteria, the prevalence of malnutrition was 28.27% in our study which is also consistent with previous studies ( 14 – 16 ). For the reason why our study population had a relatively lower incidence of malnutrition, we hypothesized that it might be due to the higher incidence of colorectal cancer and the almost lack of stage IV cancer patients in our study.…”

Section: Discussionsupporting

confidence: 93%

Comparison of three malnutrition risk screening tools in identifying malnutrition according to Global Leadership Initiative on Malnutrition criteria in gastrointestinal cancer

Huang

Chen

et al. 2022

Front. Nutr.

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BackgroundMalnutrition is common in patients with gastrointestinal cancer. The first step in the diagnosis of malnutrition is to evaluate the malnutrition risk by validated screening tools according to the Global Leadership Initiative on Malnutrition (GLIM). This study aimed to determine the best nutritional screening tool for identifying GLIM malnutrition and validate the performance of these tools in different age subgroups.Materials and methodsWe did a prospective cohort study of patients who were diagnosed with gastrointestinal cancer from February 2016 to November 2019. The sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and area under the receiver operating characteristic (ROC) curve (AUC) of three screening tools (Nutritional risk screening 2002 (NRS 2002), Geriatric Nutritional Risk Index (GNRI), MNA-SF) were calculated.ResultsA total of 488 patients were enrolled, and 138 patients (28.27%) were malnutrition according to the GLIM criteria. The consistency of NRS 2002, GNRI, and MNA-SF with GLIM-defined malnutrition was 74.8, 72.1, and 71.1%, respectively. In the subgroup analysis of young patients (<65 years), NRS 2002 exhibited the best discrimination with the AUC of 0.724 (95% CI, 0.567–0.882), the sensitivity of 64.3% (95% CI, 35.6–86.0), and the specificity of 80.6% (95% CI, 69.2–88.6). In patients older than 65 years, MNA-SF exhibited the best discrimination with the AUC of 0.764 (95% CI, 0.714–0.814), the sensitivity of 82.3% (95% CI, 74.1–88.3), and the specificity of 70.5% (95% CI, 64.7–75.7).ConclusionsNutritional risk screening 2002 (NRS 2002) is the best malnutrition screening tool in gastrointestinal cancer patients younger than 65 years, and MNA-SF is the best malnutrition screening tool in patients older than 65 years. It is necessary to select targeted nutritional screening tools according to the difference in age.

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Section: Discussionsupporting

confidence: 93%

Comparison of three malnutrition risk screening tools in identifying malnutrition according to Global Leadership Initiative on Malnutrition criteria in gastrointestinal cancer

Huang

Chen

et al. 2022

Front. Nutr.

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“…In this study, the prevalence of GLIM-defined malnutrition was 24.8%, and other nutritional tools classified 31.0-46.9% of patients with rectal cancer as malnourished. Recently, Song et al (3) reported that the prevalence of GLIM-defined malnutrition was 23.6% in patients with colorectal cancer, which is similar to the prevalence of GLIM-defined malnutrition in this study. Many previous studies have demonstrated that malnutrition is both a short and long-term risk factor.…”

Section: Discussionsupporting

confidence: 89%

“…In 2020, an estimated 1.9 million cases and 935,000 deaths will be attributed to colorectal cancer (including anal cancer), representing approximately one in 10 cancer cases and deaths ( 1 ). Patients with cancer often experience malnutrition, which is related with increased postoperative complications and mortality ( 2 , 3 ). Thus, the nutritional status of patients with cancer should be assessed, and nutritional interventions should be provided as necessary in the perioperative period.…”

Section: Introductionmentioning

confidence: 99%

The geriatric nutritional risk index is an effective tool to detect GLIM-defined malnutrition in rectal cancer patients

et al. 2022

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BackgroundThis study aimed to investigate the value of the Geriatric Nutritional Risk Index (GNRI), prognostic nutritional index (PNI), and advanced lung cancer inflammation index (ALI) scores in detecting malnutrition in patients with rectal cancer; the Global Leadership Initiative on Malnutrition (GLIM) was used as the reference criterion.Materials and methodsThis study included patients with rectal cancer who underwent proctectomy. GNRI, PNI, and ALI were calculated to detect the GLIM-defined malnutrition using the Receiver operating characteristic (ROC) curves. Univariate and multivariate logistic regression analyses were used to evaluate the association between the nutritional tools and postoperative complications. Kaplan-Meier survival curves, log-rank tests, and univariate and multivariate Cox regression analyses were used to clarify the relationship between nutritional tools and overall survival (OS).ResultsThis study enrolled 636 patients with rectal cancer. The GNRI demonstrated the highest sensitivity (77.8%), pretty specificity (69.0%), and the largest AUC (0.734). The GNRI showed good property in predicting major postoperative complications. All three nutritional tools were independent predictors of OS.ConclusionThe GNRI can be used as a promising alternative to the GLIM and is optimal in perioperative management of patients with rectal cancer.

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“…SGA has been used previously in patients with colorectal cancer, finding a prevalence between 35 and 40% [ 11 , 30 ]. A Japanese study found a prevalence of preoperative malnutrition of 23.6%, which was associated with postoperative complications, overall survival, and disease-free survival in colorectal cancer patients after radical resection surgery [ 31 ]. These findings were also corroborated by the results from a large population database from the United States [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Poor Physical Performance Is Associated with Postoperative Complications and Mortality in Preoperative Patients with Colorectal Cancer

et al. 2022

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Introduction: Poor physical performance has been shown to be a good predictor of complications in some pathologies. The objective of our study was to evaluate, in patients with colorectal neoplasia prior to surgery, physical performance and its relationship with postoperative complications and in-hospital mortality, at 1 month and at 6 months. Methods: We conducted a prospective study on patients with preoperative colorectal neoplasia, between October 2018 and July 2021. Physical performance was evaluated using the Short Physical Performance Battery (SPPB) test and hand grip strength (HGS). For a decrease in physical performance, SPPB < 10 points or HGS below the EWGSOP2 cut-off points was considered. Nutritional status was evaluated using subjective global assessment (SGA). The prevalence of postoperative complications and mortality during admission, at 1 month, and at 6 months was evaluated. Results: A total of 296 patients, mean age 60.4 ± 12.8 years, 59.3% male, were evaluated. The mean BMI was 27.6 ± 5.1 kg/m2. The mean total SPPB score was 10.57 ± 2.07 points. A total of 69 patients presented a low SPPB score (23.3%). Hand grip strength showed a mean value of 33.1 ± 8.5 kg/m2 for men and 20.7 ± 4.3 kg/m2 for women. A total of 58 patients presented low HGS (19.6%). SGA found 40.2% (119) of patients with normal nourishment, 32.4% (96) with moderate malnutrition, and 27.4% (81) with severe malnutrition. Postoperative complications were more frequent in patients with a low SPPB score (60.3% vs. 38.6%; p = 0.002) and low HGS (64.9% vs. 39.3%, p = 0.001). A low SPPB test score (OR 2.57, 95% CI 1.37–4.79, p = 0.003) and low HGS (OR 2.69, 95% CI 1.37–5.29, p = 0.004) were associated with a higher risk of postoperative complications after adjusting for tumor stage and age. Patients with a low SPPB score presented an increase in in-hospital mortality (8.7% vs. 0.9%; p = 0.021), at 1 month (8.7% vs. 1.3%; p = 0.002) and at 6 months (13.1% vs. 2.2%, p < 0.001). Patients with low HGS presented an increase in mortality at 6 months (10.5% vs. 3.3%; p = 0.022). Conclusions: The decrease in physical performance, evaluated by the SPPB test or hand grip strength, was elevated in patients with colorectal cancer prior to surgery and was related to an increase in postoperative complications and mortality.

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Effect of GLIM-defined malnutrition on postoperative clinical outcomes in patients with colorectal cancer

Cited by 30 publications

References 35 publications

Comparison of three malnutrition risk screening tools in identifying malnutrition according to Global Leadership Initiative on Malnutrition criteria in gastrointestinal cancer

Comparison of three malnutrition risk screening tools in identifying malnutrition according to Global Leadership Initiative on Malnutrition criteria in gastrointestinal cancer

The geriatric nutritional risk index is an effective tool to detect GLIM-defined malnutrition in rectal cancer patients

Poor Physical Performance Is Associated with Postoperative Complications and Mortality in Preoperative Patients with Colorectal Cancer

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