Reference body mass index values and the prevalence of malnutrition according to the Global Leadership Initiative on Malnutrition criteria

Abstract

Background & aims: The Global Leadership Initiative on Malnutrition (GLIM) released new criteria for diagnosing and grading malnutrition. This study aimed to investigate the optimal reference values of body mass index (BMI) for discriminating severe malnutrition according to the GLIM criteria, as well as the prevalence of GLIM-defined malnutrition in the clinical setting. Methods: This study included 6783 patients aged 40 years, who were admitted to an academic hospital. Of the 1987 patients who presented with low BMI in period 1, optimal BMI cut-off values were determined using receiver operating characteristic analyses against in-hospital mortality in younger (aged <70 years) and older age groups. Next, 4796 patients from period 2 were screened using a validated nutritional screening tool. Patients had their nutritional condition assessed after screenings were analyzed using the GLIM criteria, which included body weight changes, BMI, reduced muscle mass, nutritional intake, and disease burden. Additionally, patients diagnosed with malnutrition were classified as having moderate or severe malnutrition, according to the obtained BMI values from the period 1 data. Results: The optimal cut-off BMI values were 17.0 kg/m 2 for younger patients and 17.8 kg/m 2 for older patients. Patients at risk of malnutrition included 14.5% and 42.0% of admitted younger and older patients in period 2, respectively. GLIM-defined malnutrition was diagnosed in 18.0% of all patients (10.6% and 25.7% in younger and older patients, respectively). After adapting the BMI cut-off values according to the period 1 results, 9.0% and 9.0% of all patients were diagnosed as having moderate and severe malnutrition, respectively. Patients with GLIM-defined malnutrition showed significantly higher inhospital mortality compared to those without malnutrition. Conclusions: The Asian reference values of BMI to grade malnutrition severity according to the GLIM criteria, as well as the prevalence of GLIM-defined malnutrition were determined. These reference values will contribute to implementing the GLIM criteria in Asian populations.

Mortality in malnourished older adults diagnosed by ESPEN and GLIM criteria in the SarcoPhAge study

“…Results of the present study showed a 4-times higher prevalence of malnutrition when using GLIM instead of ESPEN criteria. This prevalence is similar to the 18% for adults older than 40 and 25.7% in the individuals older than 70 years reported in a cross-sectional study in community-dwelling Japanese older people, 31 which is, to authors' knowledge, the only study where GLIM criteria have been applied; therefore, further research would be needed to compare our findings. The authors consider that the close relationship found between malnutrition and mortality might be explained by the evidence-based close relationship between any of the five criteria that compose the new definition, which were selected due to their strong relationship with mortality, as described by Cederholm et al 32 The nature of the link between malnutrition and mortality is mediated by oxidative stress, altered micronutrient balance, catabolic changes, and inflammation (present in the definition as aetiologic criteria), and this damage in intracellular homeostasis leads to tissue dysfunction, organ failure, altered body composition, and weight loss (phenotypic criteria).…”

Malnutrition at Admission Predicts In-Hospital Falls in Hospitalized Older Adults

“…Although both these conditions are known to be associated with falls among older adults [41], this information was not recorded in the hospital's medical recording system, thereby preventing us from linking these conditions with the rest of the collected data. Third, BMI values that determine malnutrition may differ between Europeans and the Japanese [12]. Although many studies have reported ESPEN-defined malnutrition to be associated with malnutrition among Asian populations, a malnutrition diagnosis valid for the population under study would be better.…”

“…Malnutrition may result in an extended hospital stay, increased frequency of re-admission, increased mortality [10], and failure to return home [11]. Malnutrition is present in approximately 25% of hospitalized older adult patients in acute care [12]. Aging individuals are susceptible to malnutrition [12].…”

“…Malnutrition is present in approximately 25% of hospitalized older adult patients in acute care [12]. Aging individuals are susceptible to malnutrition [12]. In addition, patients admitted to acute care hospitals may develop malnutrition due to inflammation caused by acute or chronic illness [13], decreased activity [8], or decreased nutrition intake [14].…”

Determining the optimal value of the Geriatric Nutritional Risk Index to screen older patients with malnutrition risk: A study at a university hospital in Japan

“…Second, we only used the ESPEN criteria in diagnosing malnutrition, although the latest diagnostic criteria from GLIM had been published. 2,26 Although many clinical studies in Japanese individuals have reported an association of ESPEN criterion malnutrition with clinical outcomes, no report has examined whether the cut-offs for BMI and lean body mass index, components of the ESPEN criterion malnutrition diagnosis, are optimal cut-offs for Japanese people. [27][28][29] GLIM-defined malnutrition requires the presence of phenotypic and etiologic criteria, whereas ESPEN-defined malnutrition does not involve etiologic factors.…”