Optimal Assessment of Nutritional Status in Older Subjects with the Chronic Obstructive Pulmonary Disease—A Comparison of Three Screening Tools Used in the GLIM Diagnostic Algorithm

Abstract

Chronic obstructive pulmonary disease (COPD) is a recognized risk factor for malnutrition. The European Respiratory Society (ERS) statement included nutritional status assessment and dietary intervention as essential components of comprehensive management in subjects with COPD. According to the GLIM algorithm, the first step in diagnosing malnutrition is risk screening with a validated tool. Our study aimed to assess the diagnostic performance of three screening tools (MNA-SF, MUST, and NRS-2002) used in the GLIM algorithm in older patients with COPD. Additionally, we evaluated the agreement between these tools in the diagnostics of malnutrition. We performed a cross-sectional study of 124 patients aged at least 60 years with COPD diagnosed, based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD). We assessed the participants’ nutritional status with the three examined screening questionnaires (MNA-SF, MUST, and NRS-2002). Regardless of their results, we performed full malnutrition diagnostics following the GLIM algorithm in all subjects. The proportion of malnourished participants varied from 18.5% for the MUST questionnaire to 27.4% for the MNA-SF and 57.3% for the NRS-2002 score. Based on the GLIM criteria, malnutrition was diagnosed in 48 subjects (38.7%). All assessed questionnaires had an unsatisfactory sensitivity against the GLIM criteria for malnutrition: it was fair (58.3%) for the MNA-SF tool and poor for the MUST and NRS-2002 questionnaires (47.9% for both questionnaires). Considering the negative health consequences of malnutrition, a full diagnostic including GLIM etiologic and phenotypic criteria should be recommended in all elderly patients with COPD, regardless of the screening results.

Validity and feasibility of the global leadership initiative on malnutrition diagnostic concept in older people: a literature review from August 2021 to August 2022

“…Without prescreening, GLIM classified 39% patients as malnourished. The authors questioned the mandatory use of screening (at least for COPD patients) [43 ▪ ]. Malnutrition according to GLIM was observed in 38% of 63 Spanish patients with liver cirrhosis.…”

Prevalence of Malnutrition in a Group of Institutionalized Psychogeriatric Patients Using Different Diagnostic Criteria

“…The aim of this study was not to validate the GLIM criteria but to determine which criteria (or which variables) could help to better identify malnutrition in a sample of psychogeriatric patients with high cognitive impairment, frailty, and dependence. Some authors have questioned whether screening is mandatory before employing GLIM criteria [ 55 ]. In our case, since all except one of the subjects included in the study were categorized as malnourished or at risk of malnutrition according to the MNA, it was decided to apply the GLIM criteria to the entire group.…”

The Relationship between Nutritional Risk and the Most Common Chronic Diseases in Hospitalized Geriatric Population from Central Poland

“…Several medical conditions highlighted in previous reports were not selected as independent statistical determinants of malnutrition in our analysis. COPD is one of the risk factors for malnutrition among older subjects [ 67 ] and, based on some research, the prevalence of malnutrition according to NRS-2002 in COPD patients is as much as 57% [ 68 ]. NRS-2002 has been indicated as a tool for predicting 1 year mortality prognosis in patients with COPD [ 69 ].…”