Prevalence and prognostic implications of malnutrition as defined by GLIM criteria in elderly patients with heart failure

Hirose, Susumu; Matsue, Yuya; Kamiya, Kentaro; Kagiyama, Nobuyuki; Hiki, Masaru; Dotare, Taishi; Sunayama, Tsutomu; Konishi, Masaaki; Saitô, Hiroshi; Saito, Kazuya; Ogasahara, Yuki; Maekawa, Emi; Kitai, Takeshi; Iwata, K.; Jujo, Kentaro; Wada, Hiroshi; Kasai, Takatoshi; Momomura, Shin‐ichi; Minamino, Tohru

doi:10.1016/j.clnu.2021.01.014

Cited by 61 publications

(49 citation statements)

References 29 publications

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“…The prevalence of malnutrition according to this study was 36%, similar to other studies, indicating that this syndrome continues to impose a significant burden on the health of older acutely unwell inpatients (2,40,41). Malnutrition continues to be an important and unsolved issue in older adults, especially during hospitalisation (42).…”

Section: Discussionsupporting

confidence: 85%

Use of the Patient-Generated Subjective Global Assessment to Identify Pre-Frailty and Frailty in Hospitalized Older Adults

Han

Sharma

Yaxley

et al. 2021

The Journal of nutrition, health and aging

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OBJECTIVES: The Scored Patient-Generated Subjective Global Assessment (PG-SGA) and Edmonton Frail Scale (EFS) are widely used in acute care settings to assess nutritional and frailty status, respectively. We aimed to determine whether the scored PG-SGA can identify pre-frailty and frailty status, to simultaneously evaluate malnutrition and frailty in clinical practice. DESIGN: Cross-sectional study. SETTINGS AND PARTICIPANTS: A convenience sample of 329 consecutive patients admitted to an acute medical unit in South Australia. MEASUREMENTS: Nutritional and frailty status were ascertained with scored PG-SGA and EFS, respectively. Optimal cut-off scores to identify pre-frailty and frailty were determined by calculating the Scored PG-SGA's sensitivity, specificity, positive and negative predictive values, Youden Index (YI), Liu index, Receiver Operator Curves (ROC) and Area Under Curve (AUC). Nutritional status and patient characteristics were analysed according to frailty categories. RESULTS: The optimal cut-off PG-SGA score as determined by the highest YI, to identify both pre-frailty and frailty was >3, with a sensitivity of 0.711 and specificity of 0.746. The AUC was 0.782 (95% CI 0.731-0.833). In this cohort, 64% of the patients were wellnourished, 26% were moderately malnourished and 10% were severely malnourished. Forty-three percent, 24% and 33% of the patients were classified as robust, pre-frail and frail, respectively. Bivariate analysis showed that those robust were significantly younger than those who were pre-frail (-2.8, 95% CI -5.5 to -0.1, p=0.036) or frail (-3.4, 95% CI -5.9 to -1.0, p=0.002). Robust patients had significantly lower Scored PG-SGA than those who were pre-frail (-2.5, 95%CI -3.8 to -1.1, p<0.001) or frail (-4.9, 95% CI -6.1 to -3.7, p<0.001). CONCLUSION: The Scored PG-SGA is moderately sensitive in identifying pre-frailty/frailty in older hospitalized adults and can be useful in identifying both conditions concurrently.

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Section: Discussionsupporting

confidence: 85%

Use of the Patient-Generated Subjective Global Assessment to Identify Pre-Frailty and Frailty in Hospitalized Older Adults

Han

Sharma

Yaxley

et al. 2021

The Journal of nutrition, health and aging

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“…The strengths of this study include the incorporation of GLIM criteria for malnutrition diagnosis, considering its capacity to predict clinical outcomes in other populations. [12][13][14] This systematization makes our study more easily comparable to future studies in different populations and contexts.…”

Section: Discussionmentioning

confidence: 97%

“…10 Malnutrition according to GLIM criteria was associated with mortality, survival prediction, and clinical outcomes in patients with cancer, chronic obstructive pulmonary disease, and heart failure. [11][12][13][14] Several studies have shown positive results using phase angle (PhA) as a nutrition and prognostic marker for malnutrition. 15,16 PhA is a raw indicator of the cell membrane integrity and functionality.…”

Section: Introductionmentioning

confidence: 99%

Phase angle as predictor of malnutrition in people living with HIV/AIDS

et al. 2021

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Background: Phase angle (PhA), measured by bioelectrical impedance analysis (BIA) has been studied as an indicator of survival in people living with HIV (PLWH). However, it remains unclear whether PhA is associated with malnutrition or low CD4+ T-cell counts.Objective: In this study, we assessed the discriminative capacity of PhA for malnutrition detection using Global Leadership Initiative on Malnutrition (GLIM) criteria in PLWH, aiming to propose cutoff points for this population.Methods: This retrospective observational study included 427 adult PLWH (13% female). Participants were classified according to malnutrition status by using GLIM criteria. Body composition was assessed by using BIA. CD4+ T-cell counts were determined by flow cytometry.Results: According to GLIM criteria, 30% of the participants were malnourished. Multivariate regression analysis showed that PhA (adjusted odds ratio [OR], 0.10; 95% CI, 0.05-0.18; P < 0.001), fat-mass percentage (adjusted OR, 0.86; 95% CI, 0.82-0.90; P < 0.001), and male sex (adjusted OR, 0.26; 95% CI, 0.09-0.76; P = 0.013) were independently associated with malnutrition. A PhA cutoff of 5.45 • in men and 4.95 • in women may predict malnutrition with sensitivity and specificity >70%. Conclusion:PhA could be a valid, useful, and simple predictor of malnutrition in PLWH.

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“…Given that previous results might be affected by the study population and sample sizes, there is no international consensus on the most adequate screening tool or feasible combinations for predicting mortality thus far. Two studies have assessed nutritional status using the GLIM criteria after it was proposed and have shown its predictive efficacy in patients with cardiovascular diseases, including HF 8,19 . They evaluated the Malnutrition Universal Screening Tool or the geriatric nutritional risk index as a first‐stage screening tool for the risk of malnutrition at hospital discharge.…”

Section: Discussionmentioning

confidence: 99%

“…showed that malnutrition, defined by the GLIM criteria, had an additive prognostic predictive ability to a known definition of malnutrition, the geriatric nutritional risk index, in elderly patients with HF. 8 This study showed that 42.4% of hospitalized patients were malnourished according to the GLIM criteria. Furthermore, malnutrition, defined by the GLIM criteria, was a significant and independent factor for increasing mortality.…”

Section: Introductionmentioning

confidence: 87%

Combined prognostic value of malnutrition using GLIM criteria and renal insufficiency in elderly heart failure

et al. 2021

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Aims We aimed to investigate the prognostic impact of malnutrition, defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria, stratified by renal function in hospitalized patients with acute decompensated heart failure (HF). Methods and results In this retrospective study, 314 patients who were hospitalized for acute decompensated HF from August 2019 to October 2020 were enrolled. We evaluated malnutrition using the GLIM criteria during the time of admission. The primary outcome was 90‐day all‐cause mortality. The median patient age was 82 years, and 90‐day mortality was 14.0%. In total, 76 (24.2%) patients were malnourished according to the GLIM criteria. Malnutrition defined by the GLIM criteria [adjusted hazard ratio (HR) 1.41, 95% confidence interval (CI) 1.02–1.91, P = 0.036] and renal insufficiency [adjusted HR 2.59, 95% CI 1.07–6.28, P = 0.035 for estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 vs. ≥60 mL/min/1.73 m2] were identified as independent predictors of 90‐day mortality after adjustment for age, systolic blood pressure, and serum sodium level. In the combined setting of both variables, patients with malnutrition and eGFR < 30 mL/min/1.73 m2 had a markedly higher risk of 90‐day mortality compared with those without malnutrition and eGFR ≥ 60 mL/min/1.73 m2 (adjusted HR 3.92, 95% CI 1.10–13.9, P = 0.035). Adding both eGFR and malnutrition, defined by the GLIM criteria, to the baseline model with established risk factors improved both net reclassification and integrated discrimination greater than that of the baseline model (0.606, P < 0.001 and 0.050, P = 0.002, respectively), even when compared with the model with malnutrition by the GLIM alone (0.463, P = 0.002 and 0.034, P < 0.001, respectively). Conclusions Nutrition screening using the GLIM criteria stratified by renal function could clearly predict 90‐day mortality in hospitalized patients with acute decompensated HF.

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Prevalence and prognostic implications of malnutrition as defined by GLIM criteria in elderly patients with heart failure

Cited by 61 publications

References 29 publications

Use of the Patient-Generated Subjective Global Assessment to Identify Pre-Frailty and Frailty in Hospitalized Older Adults

Use of the Patient-Generated Subjective Global Assessment to Identify Pre-Frailty and Frailty in Hospitalized Older Adults

Phase angle as predictor of malnutrition in people living with HIV/AIDS

Combined prognostic value of malnutrition using GLIM criteria and renal insufficiency in elderly heart failure

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