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Wang D, Yin J, Liao W, Feng X, Zhang F. GLIM criteria for definition of malnutrition in peritoneal dialysis: a new aspect of nutritional assessment. Ren Fail 2024; 46:2337290. [PMID: 38575339 PMCID: PMC10997366 DOI: 10.1080/0886022x.2024.2337290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Background: The aim of our study was to evaluate the effectiveness of Global Leadership Initiative on Malnutrition (GLIM) criteria in assessing malnutrition within the peritoneal dialysis (PD) population.Methods: We conducted a retrospective analysis involving 1057 PD patients across multiple institutions, characterized by an age of 56.1 ± 14.4 years, 464 (43.9%) female, and a median follow-up of 45 (25, 68) months. Malnutrition was diagnosed according to GLIM criteria. The endpoint event was overall mortality. The survival rate and hazard ratio (HR) of death between malnutrition and well-nourished were analyzed in all patients and various subgroups. Receiver operator characteristic curve and integrated discrimination improvement (IDI) were used to distinguish the efficacy of the nutritional tools prediction model.Results: According to the GLIM criteria, the prevalence of malnutrition among the study population was 34.9%. The adjusted HR of overall mortality was 2.91 (2.39 - 3.54, p < 0.001) for malnutrition versus well-nourished. In sensitivity analyses, the HR remained robust except the cardiovascular disease subgroup. The area under the curve of GLIM predicting 5-year mortality was 0.65 (0.62-0.68, p < 0.001). As a complex model for forecast the long-term mortality, the performance of adjusted factors combined with GLIM was poorer than combined malnutrition inflammation score (MIS) (IDI >0, p < 0.001), but fitter than combined geriatric nutritional risk index (GNRI) (IDI <0, p < 0.001).Conclusions: The GLIM criteria provide a viable tool for nutritional assessment in patients with PD, and malnutrition defined according to the GLIM can predict prognosis with an acceptable performance.
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Affiliation(s)
- Dao Wang
- Department of Nephrology, Pingxiang People’s Hospital, Pingxiang, China
| | - Jun Yin
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen Liao
- Department of Nephrology, Pingxiang People’s Hospital, Pingxiang, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang First People’s Hospital, Jiujiang, China
| | - Fengping Zhang
- Department of Nephrology, Jiujiang First People’s Hospital, Jiujiang, China
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El Alami El Hassani N, Akrichi MA, Bajit H, Alem C. Investigation of accordance between nutritional assessment tools, and bio-electrical impedance-derived phase angle, with the global leadership initiative on malnutrition criteria in hemodialysis patients. Clin Nutr ESPEN 2024; 62:260-269. [PMID: 38865238 DOI: 10.1016/j.clnesp.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/22/2024] [Accepted: 05/31/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Malnutrition (MN) is a major health concern for patients with chronic kidney disease (CKD) who receive maintenance hemodialysis (MHD). These patients are particularly vulnerable to MN due to their compromised health status, which in turn increases the risk of morbidity and mortality. However, there is limited evidence on the use of reliable and effective tools for assessing MN in this population. This lack of sufficient data highlights the crucial need to assess MN within these patients, considering the significant mortality risk it poses. The first aim of this study was to compare the concurrent validity of three nutritional methods: the 7-point Subjective Global Assessment (7p-SGA), the Nutritional Risk Index (NRI), and the Nutritional Risk Screening from 2002 (NRS-2002) with the Global Leadership Initiative on Malnutrition (GLIM) criteria in MHD patients. The second aim was to investigate the advantage of the bio-electrical impedance-derived phase angle (PhA) in predicting MN. METHODS one hundred sixty-eight outpatients (31% women) with a mean age of 56.9 ± 14.7 years and a median dialysis vintage of 48 months were included in this retrospective study. Nutritional scores, anthropometric measurements, biological markers, and body composition parameters were collected. RESULTS According to GLIM standards, MN was identified in 80% of these patients. Using logistic regression (LR) analysis, all nutritional scores were significantly associated with GLIM criteria, with optimal sensitivity (94.4%) and specificity (85.7%) for 7p-SGA and NRI, respectively. For discriminating the nutritional risk, the GLIM criteria demonstrated a good agreement with 7p-SGA (Kappa concordance coefficient (κ) = 0.677, p-value<0.001) with a good level of accuracy (Area Under the Curve (AUC) = 0.841; 95% Confidence Interval (CI) = 0.705-0.977; p-value <0.001) when compared to the NRI and NRS-2002 (κ = 0.522, p-value<0.001 and κ = 0.411, p-value = 0.006, respectively). An excellent accuracy was found between PhA and the GLIM-defined MN, with an optimal cut-off value of 5.5° for males and 4.5° for females. The LR showed that arm circumference is the parameter that most influences the decrease of PhA (odds ratio 2.710, 95% CI = 1.597-4.597, p-value <0.001). CONCLUSION Based on the results of the present study, 7p-SGA is the most sensitive score in identifying MN diagnosed by GLIM criteria. Nonetheless, NRI exhibits greater specificity. PhA is a valuable marker for MN in MHD patients.
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Affiliation(s)
- Nadia El Alami El Hassani
- Team of Biochemistry of Natural Resources, Faculty of Sciences and Techniques, Moulay Ismaïl University, Errachidia, Morocco.
| | | | - Habiba Bajit
- Team of Biochemistry of Natural Resources, Faculty of Sciences and Techniques, Moulay Ismaïl University, Errachidia, Morocco; Department of Pharmacology, Faculty of Medicine, University of Granada, Spain
| | - Chakib Alem
- Team of Biochemistry of Natural Resources, Faculty of Sciences and Techniques, Moulay Ismaïl University, Errachidia, Morocco
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3
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Kojima S, Usui N, Uehata A, Inatsu A, Tsubaki A. Associations between bioelectrical impedance analysis-derived phase angle, protein-energy wasting and all-cause mortality in older patients undergoing haemodialysis. Nephrology (Carlton) 2024. [PMID: 38858748 DOI: 10.1111/nep.14333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/03/2024] [Accepted: 05/31/2024] [Indexed: 06/12/2024]
Abstract
AIM Protein-energy wasting (PEW) is a common syndrome in patients undergoing haemodialysis (HD) and is associated with poor prognosis. Bioelectrical impedance analysis (BIA)-derived phase angle (PA) is useful for predicting PEW, but sex and age need to be considered. We aimed to reveal sex-specific cut-off values of PA predicting PEW in HD patients aged ≥65. METHODS This two-centre retrospective cohort study included patients on HD who underwent BIA. PEW was detected using the International Society of Renal Nutrition and Metabolism (ISRNM) criteria as a reference. The PA was measured using a multifrequency bioimpedance device. Sex-specific cut-off values of PA predicting PEW were detected by receiver-operator characteristic analysis. We investigated the association between PEW determined using sex-specific cut-off values for PA and all-cause mortality. RESULTS This study included 274 patients undergoing HD, with a median age of 75 (70-80) years, mean PA of 3.8 ± 1.1° and PEW of 43%. Over a median follow-up duration of 1095 (400-1095) days, 111 patients died. Cut-off values of PA predicting PEW were as follows: female, 3.00° (sensitivity, 87.3%; specificity, 77.5%), and male, 3.84° (sensitivity, 77.6%; specificity, 71.4%). The kappa coefficient between sex-specific cut-off values of the PA and ISRNM criteria had a moderate coincidence level of 0.55. PEW detected by PA was independently associated with all-cause mortality (hazard ratio: 2.40; 95% confidence interval: 1.51-3.85; p < .001). CONCLUSIONS Sex-specific cut-off values for PA in older HD patients may be useful as a screening tool for predicting PEW and mortality.
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Affiliation(s)
- Sho Kojima
- Department of Rehabilitation, Kisen Hospital, Tokyo, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Naoto Usui
- Department of Rehabilitation, Kisen Hospital, Tokyo, Japan
- Department of Nephrology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Akimi Uehata
- Division of Cardiology, Kisen Hospital, Tokyo, Japan
| | | | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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4
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Alonso-Peña M, Dierssen T, Marin MJ, Alonso-Molero J, Gómez-Acebo I, Santiuste I, Lazarus JV, Sanchez-Juan P, Peralta G, Crespo J, Lopez-Hoyos M. The Cantabria Cohort, a protocol for a population-based cohort in northern Spain. BMC Public Health 2023; 23:2429. [PMID: 38053113 PMCID: PMC10698930 DOI: 10.1186/s12889-023-17318-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/23/2023] [Indexed: 12/07/2023] Open
Abstract
Cantabria Cohort stems from a research and action initiative lead by researchers from Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital and University of Cantabria, supported by the regional Goverment. Its aim is to identify and follow up a cohort that would provide information to improve the understanding of the etiology and prognosis of different acute and chronic diseases. The Cantabria Cohort will recruit between 40,000-50,000 residents aged 40-69 years at baseline, representing 10-20% of the target population. Currently, more than 30,000 volunteers have been enrolled. All participants will be invited for a re-assessment every three years, while the overall duration is planned for twenty years. The repeated collection of biomaterials combined with broad information from participant questionnaires, medical examinations, actual health system records and other secondary public data sources is a major strength of its design, which will make it possible to address biological pathways of disease development, identify new factors involved in health and disease, design new strategies for disease prevention, and advance precision medicine. It is conceived to allow access to a large number of researchers worldwide to boost collaboration and medical research.
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Affiliation(s)
| | - Trinidad Dierssen
- Valdecilla Research Institute (IDIVAL), Santander, 39011, Spain
- Faculty of Medicine, University of Cantabria, Santander, 39011, Spain
| | | | - Jessica Alonso-Molero
- Valdecilla Research Institute (IDIVAL), Santander, 39011, Spain
- Faculty of Medicine, University of Cantabria, Santander, 39011, Spain
| | - Inés Gómez-Acebo
- Valdecilla Research Institute (IDIVAL), Santander, 39011, Spain
- Faculty of Medicine, University of Cantabria, Santander, 39011, Spain
| | - Inés Santiuste
- Valdecilla Research Institute (IDIVAL), Santander, 39011, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
- CUNY Graduate School of Public Health and Health Policy (CUNY SPH), New York, NY, USA
| | - Pascual Sanchez-Juan
- CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, 28220, Madrid, Spain
- Alzheimer's Centre Reina Sofia-CIEN Foundation-ISCIII, 28031, Madrid, Spain
| | - Galo Peralta
- Valdecilla Research Institute (IDIVAL), Santander, 39011, Spain
| | - Javier Crespo
- Valdecilla Research Institute (IDIVAL), Santander, 39011, Spain
- Faculty of Medicine, University of Cantabria, Santander, 39011, Spain
- Marques de Valdecilla University Hospital, Santander, 39008, Spain
| | - Marcos Lopez-Hoyos
- Valdecilla Research Institute (IDIVAL), Santander, 39011, Spain
- Faculty of Medicine, University of Cantabria, Santander, 39011, Spain
- Marques de Valdecilla University Hospital, Santander, 39008, Spain
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5
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Fonseca ALF, Santos BC, Anastácio LR, Pereira RG, Correia MITD, Lima AS, Mizubuti YGG, Ferreira SC, Ferreira LG. Global Leadership Initiative on Malnutrition criteria for the diagnosis of malnutrition and prediction of mortality in patients awaiting liver transplant: A validation study. Nutrition 2023; 114:112093. [PMID: 37437417 DOI: 10.1016/j.nut.2023.112093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/02/2023] [Accepted: 05/21/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES The Global Leadership Initiative on Malnutrition (GLIM) is a framework aiming to standardize malnutrition diagnosis. However, it still needs to be validated, in particular for patients with chronic liver disease. This study aimed to validate the GLIM criteria in patients with liver cirrhosis awaiting liver transplant (LTx). METHODS This was a retrospective observational study carried out with adult patients on the waiting list for LTx, consecutively evaluated between 2006 and 2021. The phenotypic criteria were unintentional weight loss, low body mass index, and reduced muscle mass (midarm muscle circumference [MAMC]). The etiologic criteria were high Model for End-Stage Liver Disease (MELD) and MELD adjusted for serum sodium (MELD-Na) scores, the Child-Pugh score, low serum albumin, and low food intake and/or assimilation. Forty-three GLIM combinations were tested. Sensitivity (SE), specificity (SP), positive and negative predictive values, and machine learning (ML) techniques were used. Survival analysis with Cox regression was carried out. RESULTS A total of 419 patients with advanced liver cirrhosis were included (median age, 52.0 y [46-59 y]; 69.2% male; 68.8% malnourished according to the Subjective Global Assessment [SGA]). The prevalence of malnutrition by the GLIM criteria ranged from 3.1% to 58.2%, and five combinations had SE or SP >80%. The MAMC as a phenotypic criterion with MELD and MELD-Na as etiologic criteria were predictors of mortality. The MAMC and the presence of any phenotypic criteria associated with liver disease parameters and low food intake or assimilation were associated with malnutrition prediction in ML analysis. CONCLUSIONS The MAMC and liver disease parameters were associated with malnutrition diagnosis by SGA and were also predictors of 1-y mortality in patients with liver cirrhosis awaiting LTx.
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Affiliation(s)
| | - Bárbara Chaves Santos
- Food Science Graduate Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Ramon Gonçalves Pereira
- Computer Science Graduate Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Agnaldo Soares Lima
- Surgery PostGraduate Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Lívia Garcia Ferreira
- Nutrition and Health Graduate Program, Universidade Federal de Lavras, Lavras, Brazil.
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Silva MZC, Cederholm T, Gonzalez MC, Lindholm B, Avesani CM. GLIM in chronic kidney disease: What do we need to know? Clin Nutr 2023; 42:937-943. [PMID: 37099985 DOI: 10.1016/j.clnu.2023.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 04/28/2023]
Abstract
The lack of consensus on diagnostic criteria for malnutrition has hampered developments in research and clinical practice pertaining to nutrition. This opinion paper describes the applicability and other aspects of using the Global Leadership Initiative on Malnutrition (GLIM) criteria for diagnosing malnutrition in patients with chronic kidney disease (CKD). We examine the purpose of GLIM, the particularities of CKD that can affect the nutritional and metabolic status and the diagnosis of malnutrition. In addition, we make an appraisal of previous studies that used GLIM in the context of CKD and discuss the value and relevance of using the GLIM criteria in patients with CKD.
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Affiliation(s)
- Maryanne Zilli Canedo Silva
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, Brazil.
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
| | | | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institute, Stockholm, Sweden.
| | - Carla Maria Avesani
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institute, Stockholm, Sweden.
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7
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Piccoli GB, Cederholm T, Avesani CM, Bakker SJL, Bellizzi V, Cuerda C, Cupisti A, Sabatino A, Schneider S, Torreggiani M, Fouque D, Carrero JJ, Barazzoni R. Nutritional status and the risk of malnutrition in older adults with chronic kidney disease - implications for low protein intake and nutritional care: A critical review endorsed by ERN-ERA and ESPEN. Clin Nutr 2023; 42:443-457. [PMID: 36857954 DOI: 10.1016/j.clnu.2023.01.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
Increased life expectancy is posing unprecedented challenges to healthcare systems worldwide. These include a sharp increase in the prevalence of chronic kidney disease (CKD) and of impaired nutritional status with malnutrition-protein-energy wasting (PEW) that portends worse clinical outcomes, including reduced survival. In older adults with CKD, a nutritional dilemma occurs when indications from geriatric nutritional guidelines to maintain the protein intake above 1.0 g/kg/day to prevent malnutrition need to be adapted to the indications from nephrology guidelines, to reduce protein intake in order to prevent or slow CKD progression and improve metabolic abnormalities. To address these issues, the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Renal Nutrition group of the European Renal Association (ERN-ERA) have prepared this conjoint critical review paper, whose objective is to summarize key concepts related to prevention and treatment of both CKD progression and impaired nutritional status using dietary approaches, and to provide guidance on how to define optimal protein and energy intake in older adults with differing severity of CKD. Overall, the authors support careful assessment to identify the most urgent clinical challenge and the consequent treatment priority. The presence of malnutrition-protein-energy wasting (PEW) suggests the need to avoid or postpone protein restriction, particularly in the presence of stable kidney function and considering the patient's preferences and quality of life. CKD progression and advanced CKD stage support prioritization of protein restriction in the presence of a good nutritional status. Individual risk-benefit assessment and appropriate nutritional monitoring should guide the decision-making process. Higher awareness of the challenges of nutritional care in older adult patients with CKD is needed to improve care and outcomes. Research is advocated to support evidence-based recommendations, which we still lack for this increasingly large patient subgroup.
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Affiliation(s)
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Uppsala University. Theme Inflammation & Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Carla Maria Avesani
- Department of Clinical Science, Technology and Intervention, Division of Renal Medicine and Baxter Novum, Karolinska Institute, Stockholm, Sweden
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Vincenzo Bellizzi
- Nephrology and Dialysis Division - Department of Medical Sciences, Hospital "Sant'Anna e San Sebastiano", Caserta, Italy
| | - Cristina Cuerda
- Departamento de Medicina, Universidad Complutense de Madrid, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Alice Sabatino
- UO Nefrologia, Azienda Ospedaliera- Universitaria Parma, Parma, Italy
| | - Stephane Schneider
- Gastroenterology and Nutrition, Nice University Hospital, Université Côte d'Azur, Nice, France
| | - Massimo Torreggiani
- Néphrologie et dialyse, Centre Hospitalier Le Mans, Avenue Rubillard, 72037, Le Mans, France
| | - Denis Fouque
- Renal Department, Lyon SUD Hospital, Hospices Civils de Lyon, Université de Lyon, Pierre Benite, France
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Division of Nephrology, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
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Wang X, Yang F, Zhu M, Cui H, Wei J, Li J, Chen W. Development and Assessment of Assisted Diagnosis Models Using Machine Learning for Identifying Elderly Patients With Malnutrition: Cohort Study. J Med Internet Res 2023; 25:e42435. [PMID: 36917167 PMCID: PMC10131894 DOI: 10.2196/42435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/05/2022] [Accepted: 01/10/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Older patients are at an increased risk of malnutrition due to many factors related to poor clinical outcomes. OBJECTIVE This study aims to develop an assisted diagnosis model using machine learning (ML) for identifying older patients with malnutrition and providing the focus of individualized treatment. METHODS We reanalyzed a multicenter, observational cohort study including 2660 older patients. Baseline malnutrition was defined using the global leadership initiative on malnutrition (GLIM) criteria, and the study population was randomly divided into a derivation group (2128/2660, 80%) and a validation group (532/2660, 20%). We applied 5 ML algorithms and further explored the relationship between features and the risk of malnutrition by using the Shapley additive explanations visualization method. RESULTS The proposed ML models were capable to identify older patients with malnutrition. In the external validation cohort, the top 3 models by the area under the receiver operating characteristic curve were light gradient boosting machine (92.1%), extreme gradient boosting (91.9%), and the random forest model (91.5%). Additionally, the analysis of the importance of features revealed that BMI, weight loss, and calf circumference were the strongest predictors to affect GLIM. A BMI of below 21 kg/m2 was associated with a higher risk of GLIM in older people. CONCLUSIONS We developed ML models for assisting diagnosis of malnutrition based on the GLIM criteria. The cutoff values of laboratory tests generated by Shapley additive explanations could provide references for the identification of malnutrition. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR-EPC-14005253; https://www.chictr.org.cn/showproj.aspx?proj=9542.
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Affiliation(s)
- Xue Wang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengchun Yang
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingwei Zhu
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Hongyuan Cui
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Junmin Wei
- Department of General Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jiao Li
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Chen
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Muñoz-Redondo E, Morgado-Pérez A, Pérez-Sáez MJ, Faura A, Sánchez-Rodríguez D, Tejero-Sánchez M, Meza-Valderrama D, Muns MD, Pascual J, Marco E. Low Phase Angle Values Are Associated with Malnutrition according to the Global Leadership Initiative on Malnutrition Criteria in Kidney Transplant Candidates: Preliminary Assessment of Diagnostic Accuracy in the FRAILMar Study. Nutrients 2023; 15:nu15051084. [PMID: 36904084 PMCID: PMC10005429 DOI: 10.3390/nu15051084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Malnutrition has a negative impact on patients with chronic diseases and its early identification is a priority. The primary objective of this diagnostic accuracy study was to assess the performance of the phase angle (PhA), a bioimpedance analysis (BIA)-derived parameter, for malnutrition screening using the Global Leadership Initiative for Malnutrition (GLIM) criteria as the reference standard in patients with advanced chronic kidney disease (CKD) waiting for kidney transplantation (KT); criteria associated with low PhA in this population were also analyzed. Sensitivity, specificity, accuracy, positive and negative likelihood ratios, predictive values, and area under the receiver operating characteristic curve were calculated for PhA (index test) and compared with GLIM criteria (reference standard). Of 63 patients (62.9 years old; 76.2% men), 22 (34.9%) had malnutrition. The PhA threshold with the highest accuracy was ≤4.85° (sensitivity 72.7%, specificity 65.9%, and positive and negative likelihood ratios 2.13 and 0.41, respectively). A PhA ≤ 4.85° was associated with a 3.5-fold higher malnutrition risk (OR = 3.53 (CI95% 1.0-12.1)). Considering the GLIM criteria as the reference standard, a PhA ≤ 4.85° showed only fair validity for detecting malnutrition, and thus cannot be recommended as a stand-alone screening tool in this population.
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Affiliation(s)
- Elena Muñoz-Redondo
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar–Hospital de l’Esperança), 08003 Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
- PhD Program in Medicine, Department of Medicine, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Andrea Morgado-Pérez
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar–Hospital de l’Esperança), 08003 Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
| | - María-José Pérez-Sáez
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain
- Kidney Disease Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Dr Aiguader Building (Mar Campus), 08003 Barcelona, Spain
| | - Anna Faura
- Nephrology Department, Hospital del Mar, 08003 Barcelona, Spain
| | - Dolores Sánchez-Rodríguez
- Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, 1020 Brussels, Belgium
- Geriatrics Department, Parc de Salut Mar (Centre Fòrum), 08019 Barcelona, Spain
- WHO Collaborating Centre for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, Université of Liège, Campus Sart Tilman, Quartier Hôpital, 4000 Liège, Belgium
| | - Marta Tejero-Sánchez
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar–Hospital de l’Esperança), 08003 Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
| | - Delky Meza-Valderrama
- Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
- Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation (INMFRE), Diagonal a la Universidad Tecnológica de Panamá, Panama City 0819, Panama
| | - María Dolors Muns
- Department of Endocrinology and Nutrition, Hospital del Mar, 08003 Barcelona, Spain
| | - Julio Pascual
- Nephrology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Ester Marco
- Physical Medicine and Rehabilitation Department, Parc de Salut Mar (Hospital del Mar–Hospital de l’Esperança), 08003 Barcelona, Spain
- Rehabilitation Research Group, Hospital del Mar Medical Research Group, 08003 Barcelona, Spain
- Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Dr Aiguader Building (Mar Campus), 08003 Barcelona, Spain
- Correspondence:
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10
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Song HC, Shin J, Hwang JH, Kim SH. Utility of the Global Leadership Initiative on Malnutrition criteria for the nutritional assessment of patients with end-stage renal disease receiving chronic hemodialysis. J Hum Nutr Diet 2023; 36:97-107. [PMID: 35441765 DOI: 10.1111/jhn.13019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/08/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Malnutrition is associated with adverse outcomes in patients on chronic haemodialysis. Thus, identifying accurate methods for diagnosing malnutrition is essential. The present retrospective study investigated the utility of the new Global Leadership Initiative on Malnutrition (GLIM) criteria in patients undergoing chronic haemodialysis. METHODS Phase angle and fat-free mass index (FFMI) were derived using bioelectrical impedance analysis. Malnutrition was determined when the subjects had at least one phenotypic criterion (weight loss, low body mass index [BMI] or FFMI). RESULTS This study included 103 patients undergoing chronic haemodialysis and 46 (44.7%) patients were diagnosed as malnourished. Malnutrition determined using the GLIM criteria was associated with increased risks of all-cause death (hazard ratio = 3.0, p = 0.044) and infection requiring hospitalisation (hazard ratio = 2.4, p = 0.015), independent of age, sex and comorbidities. However, malnutrition was not related to major adverse cardiovascular events (p = 0.908). We further evaluated the longitudinal changes in phenotypic parameters. Subjects with median levels of high-sensitivity C-reactive protein exceeding 5 mg L-1 exhibited decreased body weight and BMI (p = 0.015 and 0.016, respectively). In addition, body weight, BMI and FFMI were reduced in subjects with a median protein catabolic rate of < 1.0 mg kg-1 day-1 , even after adjustment for age, sex and comorbidities (p = 0.026, 0.053 and 0.039, respectively). CONCLUSIONS Malnutrition assessed using the GLIM criteria could be a useful predictor of mortality and infection in patients on chronic haemodialysis. To improve nutritional status, approaches for decreasing inflammation and increasing protein intake are needed.
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Affiliation(s)
- Hyun Chul Song
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jungho Shin
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jin Ho Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Su Hyun Kim
- Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
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Al Sabbah H, Assaf EA, Al-Jawaldeh A, AlSammach AS, Madi H, Khamis Al Ali N, Al Dhaheri AS, Cheikh Ismail L. Nutrition Situation Analysis in the UAE: A Review Study. Nutrients 2023; 15:nu15020363. [PMID: 36678240 PMCID: PMC9861891 DOI: 10.3390/nu15020363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/01/2023] [Accepted: 01/04/2023] [Indexed: 01/14/2023] Open
Abstract
This review study aimed to assess the nutrition situation in the UAE using published data from 2010 to 2022. It highlights the gaps and challenges that prevail in addressing the nutrition-related problems in the UAE and the opportunities that have been overlooked. The available literature indicates that the UAE is burdened with more than one form of nutrition-related problems, including being underweight, being overweight, obesity, micronutrient deficiencies, and nutrition-related chronic diseases. It is clear that data on micronutrient deficiencies, protein-energy malnutrition, obesity, diabetes, and other nutrition-related diseases among the UAE population are extremely scarce. The UAE has a high prevalence of obesity and diabetes; however, limited studies have been conducted to document this nutritional phenomenon. Few examples of published data are available assessing the burden of stunting, wasting, and being underweight among children under five years of age. Despite the importance of protein-energy malnutrition, no recent publications analyze its prevalence within the UAE population. Therefore, future studies must be conducted, focusing on malnutrition. Based on the literature, and bearing in mind the magnitude of the health issues due to the UAE population's nutrition negligence, there is an urgent need to assess the population's nutrient behaviors, to aid policy decision-makers in developing and implementing effective health policies and strategies.
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Affiliation(s)
- Haleama Al Sabbah
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Dubai P.O. Box 144534, United Arab Emirates
- Correspondence: ; Tel.: +971-56-950-1179
| | - Enas A. Assaf
- Faculty of Nursing, Applied Science Private University, Amman 11931, Jordan
| | - Ayoub Al-Jawaldeh
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo 11516, Egypt
| | - Afra Salah AlSammach
- Health Promotion Department, Ministry of Health, Dubai 20224, United Arab Emirates
| | - Haifa Madi
- Health Promotion Department, Ministry of Health, Dubai 20224, United Arab Emirates
| | - Nouf Khamis Al Ali
- Health Promotion Department, Ministry of Health, Dubai 20224, United Arab Emirates
| | - Ayesha S. Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
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12
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Patient and Staff Perceptions on Using Bioelectrical Impedance Analysis in an Outpatient Haemodialysis Setting: A Qualitative Descriptive Study. Healthcare (Basel) 2022; 10:healthcare10071205. [PMID: 35885732 PMCID: PMC9320163 DOI: 10.3390/healthcare10071205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/10/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Bioelectrical impedance analysis (BIA) is an objective hydration and body composition assessment method recommended for use in haemodialysis patients. Limited research exists on the acceptability and utility of BIA in clinical practice. This qualitative study explored patient and staff acceptability and perceived value of BIA in an outpatient haemodialysis setting at a tertiary public hospital in Queensland, Australia. Participants included five patients receiving outpatient haemodialysis and 12 multidisciplinary clinical staff providing care to these patients. Semi-structured interviews were employed and data were analysed thematically. Patients were satisfied with the BIA measurement process and most thought the BIA data would be useful for monitoring changes in their nutrition status. Clinical staff valued BIA data for improving fluid management, assessing nutrition status and supporting patient care. Staff recommended targeting BIA use to patient groups who would benefit the most to improve its uptake in the haemodialysis setting. Conclusions: BIA use in the outpatient haemodialysis setting is acceptable and provides valuable objective data to support health-related behaviour changes in patients and enhance clinical practice. Implementation of BIA should be tailored to the local context and staff should be supported in its use.
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Huo Z, Chong F, Yin L, Lu Z, Liu J, Xu H. Accuracy of the GLIM criteria for diagnosing malnutrition: A systematic review and meta-analysis. Clin Nutr 2022; 41:1208-1217. [DOI: 10.1016/j.clnu.2022.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 01/04/2023]
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14
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Correia MIT, Tappenden KA, Malone A, Prado CM, Evans DC, Sauer AC, Hegazi R, Gramlich L. Utilization and validation of the Global Leadership Initiative on Malnutrition (GLIM): A scoping review. Clin Nutr 2022; 41:687-697. [DOI: 10.1016/j.clnu.2022.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/05/2022] [Accepted: 01/20/2022] [Indexed: 12/27/2022]
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15
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Song HN, Wang WB, Luo X, Huang DD, Ruan XJ, Xing CG, Chen WZ, Dong QT, Chen XL. Effect of GLIM-defined malnutrition on postoperative clinical outcomes in patients with colorectal cancer. Jpn J Clin Oncol 2022; 52:466-474. [PMID: 35062024 DOI: 10.1093/jjco/hyab215] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/30/2021] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Malnutrition is common in colorectal cancer patients. Malnutrition is recognized as a risk factor for adverse postoperative outcomes, yet there are no consistent diagnostic criteria for it. Thus, the Global Leadership Initiative on Malnutrition published new universal criteria. We aimed to investigate the prevalence of malnutrition with the application of Global Leadership Initiative on Malnutrition criteria, and explore the correlations between Global Leadership Initiative on Malnutrition-defined malnutrition and postoperative clinical outcomes in colorectal cancer patients.
Methods
We included a cohort of 918 patients who underwent radical resection surgery for colorectal cancer from July 2014 to October 2019. Malnutrition was diagnosed based on the Global Leadership Initiative on Malnutrition criteria. The associations between nutritional status and postoperative clinical outcomes were analyzed by the Kaplan–Meier method, logistic and Cox regression analyses.
Results
Among the included patients, 23.6% were diagnosed as malnutrition based on Global Leadership Initiative on Malnutrition criteria. Global Leadership Initiative on Malnutrition-defined malnutrition was associated with total postoperative complications [odds ratio: 1.497 (1.042–2.152), P = 0.029]. Further, Global Leadership Initiative on Malnutrition-diagnosed malnutrition was an independent risk factor for overall survival [hazard ratio: 1.647 (1.048–2.587), P = 0.030] and disease-free survival [hazard ratio: 1.690 (1.169–2.441), P = 0.005].
Conclusions
The Global Leadership Initiative on Malnutrition criteria is effective to assess malnutrition. Preoperative malnutrition is associated with postoperative complications, overall survival and disease-free survival in colorectal cancer patients after radical resection surgery.
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Affiliation(s)
- Hao-Nan Song
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Wen-Bin Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xin Luo
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Dong-Dong Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xiao-Jiao Ruan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Chun-Gen Xing
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Wei-Zhe Chen
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, Tongji University School of Medicine, Shanghai, China
| | - Qian-Tong Dong
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xiao-Lei Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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Wang Y, Jiang H, Zhu MW, Deng HF, Wang L, Wang X, Yang GY, Wei JM, Chen W. Establishing a new BMI cut-off value for malnutrition diagnosis using the global leadership initiative on malnutrition (GLIM) tool in Chinese older adults. JPEN J Parenter Enteral Nutr 2021; 46:1071-1079. [PMID: 34716718 DOI: 10.1002/jpen.2296] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The average body weight of the Chinese population is rising rapidly over the past two decades and the old 2001 body mass index (BMI) cut-off value for malnutrition may underestimate malnutrition diagnosis. We explored the BMI cut-off value for malnutrition diagnosis based on national BMI data over the past 30 years and applied it to the Global Leadership Initiative on Malnutrition (GLIM) criteria when investigating malnutrition in hospitalized older adult patients. METHODS To explore the BMI cut-off value for malnutrition, we established a linear stepwise model to predict the annual increasing BMI trend based on data from the national BMI dataset (1990-2009). The new cut-off value was applied to a large-scale dataset from a cross-sectional study pertaining to older hospitalized patients (≥65) recruited from 30 large hospitals in China. RESULTS The average BMI increased from 21.8 to 23 kg/m2 in two decades. Using the linear model, we calculated that the net BMI increase will be 1.49 kg/m2 from 2009 to 2019. We subsequently proposed that the BMI cut-off value for malnutrition should rise to 20 kg/m2 . This cut-off value was applied to the validation dataset, containing 8,725 patients, and the GLIM-determined malnutrition rate was 24.58% (using the NRS-2002) and 23.32% (using the MNA-SF). The results significantly differed from those obtained using the 2001 Chinese BMI criteria (p<0.001). CONCLUSION The GLIM tool has good applicability in Asian populations, especially in Chinese older adult patients. The BMI cut-off value for malnutrition should be adjusted to 20 kg/m2 for Chinese adults. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yu Wang
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Ming-Wei Zhu
- National Geriatrics Center, Beijing Hospital, Beijing, China
| | - Hong-Fei Deng
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Lu Wang
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Xue Wang
- Department of Clinical Nutrition, Department of Health Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guang-Yu Yang
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Jun-Min Wei
- National Geriatrics Center, Beijing Hospital, Beijing, China
| | - Wei Chen
- Department of Clinical Nutrition, Department of Health Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Avesani CM, Sabatino A, Guerra A, Rodrigues J, Carrero JJ, Rossi GM, Garibotto G, Stenvinkel P, Fiaccadori E, Lindholm B. A Comparative Analysis of Nutritional Assessment Using Global Leadership Initiative on Malnutrition Versus Subjective Global Assessment and Malnutrition Inflammation Score in Maintenance Hemodialysis Patients. J Ren Nutr 2021; 32:476-482. [PMID: 34330567 DOI: 10.1053/j.jrn.2021.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/10/2021] [Accepted: 06/19/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Malnutrition is a prevalent condition in maintenance hemodialysis (MHD) patients. This study aimed to evaluate the performance of the recently developed GLIM (Global Leadership Initiative on Malnutrition) in MHD by assessing the agreement, accuracy, sensitivity, specificity, and survival prediction of GLIM when compared to 7-point subjective global assessment (7p-SGA) and malnutrition inflammation score (MIS). DESIGN AND METHODS We investigated 2 cohorts: MHDltaly (121 adults from Italy; 67 ± 16 years, 65% men, body mass index 25 ± 5 kg/m2) and MHDBrazil (169 elderly [age > 60 years] from Brazil; 71 ± 7 years, 66% men, body mass index 25 ± 4 kg/m2), followed for all-cause mortality for median 40 and 17 months, respectively. We applied the 2-step approach from GLIM: (1) screening and (2) confirming malnutrition by phenotypic and etiologic criteria. For 7p-SGA and MIS, a score ≤5 and ≥8, respectively, defined malnutrition. RESULTS Malnutrition was present in 38.8% by GLIM, 25.6% by 7p-SGA, and 29.7% by MIS in the MHDItaly cohort, and in 47.9% by GLIM, 59.8% by 7p-SGA, and 49.7% by MIS in the MHDBrazil cohort. Cohen's kappa coefficient (κ) showed only "fair" agreement between GLIM and SGA (MHDItaly: κ = 0.26, P = .003; MHDBrazil: κ = 0.22, P = .003) and between GLIM and MIS (MHDItaly: κ = 0.33, P < .001; MHDBrazil: κ = 0.25, P = .001). Cox regression analysis showed that all 3 methods were able to predict mortality in crude analysis; however in the adjusted model, the association seemed more consistent and stronger in magnitude for 7p-SGA and MIS. CONCLUSION In MHD patients, GLIM showed low agreement, sensitivity, and accuracy in identifying malnourished subjects by either 7p-SGA or MIS. Considering the specific wasting characteristics that predominate in MHD, the well-established 7p-SGA and MIS methods may be more useful in this clinical setting.
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Affiliation(s)
- Carla Maria Avesani
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institute, Stockholm, Sweden; Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil.
| | - Alice Sabatino
- Division of Nephrology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandro Guerra
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Juliana Rodrigues
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Juan Jesus Carrero
- Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, Stockholm, Sweden
| | - Giovanni Maria Rossi
- Division of Nephrology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Giacomo Garibotto
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Peter Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institute, Stockholm, Sweden
| | - Enrico Fiaccadori
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Technology and Intervention, Karolinska Institute, Stockholm, Sweden
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Cohen-Cesla T, Azar A, Hamad RA, Shapiro G, Stav K, Efrati S, Beberashvili I. Usual nutritional scores have acceptable sensitivity and specificity for diagnosing malnutrition compared to GLIM criteria in hemodialysis patients. Nutr Res 2021; 92:129-138. [PMID: 34304058 DOI: 10.1016/j.nutres.2021.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/31/2022]
Abstract
Diagnosing malnutrition by the recently published Global Leadership Initiative on Malnutrition (GLIM) criteria requires using modern techniques for body composition measurements. We hypothesized that the prevalence of malnutrition identified by usual nutritional scores and according to GLIM criteria may be close to each other due to the number of components shared between them. Our aim was to compare the concurrent validity of four nutritional scores, malnutrition-inflammation score (MIS), objective score of nutrition on dialysis, geriatric nutritional index (GNRI), and nutritional risk index against the GLIM criteria for malnutrition in maintenance hemodialysis patients. This prospective observational study was performed on 318 maintenance hemodialysis outpatients (37% women) with a mean age of 68.7 ± 13.1 years and a median dialysis vintage of 21 months. According to the GLIM criteria, 45.9% of these patients were diagnosed with malnutrition. Nutritional scores, dietary intake and body composition parameters were measured. All nutritional scores showed a strong association with malnutrition in multivariable logistic regression models. In discriminating the nutritional risk, the ROC AUC was largest for GNRI (0.70, 95% CI: 0.65-0.75; P< .001). Nutritional risk index and MIS showed high specificity but lower sensitivity compared to GNRI and objective score of nutrition on dialysis. Compared to MIS, GNRI had better concurrent validity (higher sensitivity and acceptable specificity) but was inferior to MIS in terms of relation to certain etiologic and phenotypic components of the GLIM criteria (specifically, to dietary intake and decrease in dry weight). In summary, of the nutritional scores tested, GNRI is the most sensitive score in identifying malnutrition diagnosed by GLIM criteria, but MIS is more specific and better in predicting the individual components of the GLIM criteria.
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Affiliation(s)
- Tamar Cohen-Cesla
- Internal Department D, Yitzhak Shamir Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ada Azar
- Nutrition Department, Yitzhak Shamir Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ramzia Abu Hamad
- Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Gregory Shapiro
- Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Kobi Stav
- Urology Department, Yitzhak Shamir Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Shai Efrati
- Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Ilia Beberashvili
- Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Israel.
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Zhou H, Yao W, Pan D, Sun G. Predicational ability of phase angle on protein energy wasting in kidney disease patients with renal replacement therapy: A cross-sectional study. Food Sci Nutr 2021; 9:3573-3579. [PMID: 34262718 PMCID: PMC8269568 DOI: 10.1002/fsn3.2310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To investigate the ability of phase angle (PA) and body composition for predicting protein energy wasting (PEW) in renal replacement therapy (RRT) patients. METHODS Renal replacement therapy (RRT) patients were enrolled in this study. Body composition was measured by direct segmental multi-frequency biolectrical impedance analysis method (DSM-BIA); phase angle (PA), fat-free mass (FFM), fat mass (FM), mid-arm circumference (MAC), WC (waist circumference), and ECW/TBW (extracellular water/total body water) were obtained. Biochemicals (serum albumin, triglyceride, and cholesterol) were tested. PEW patients were classified according to ISRNM (The International Society of Renal Nutrition and Metabolism) criteria. Cutoff value of PA and related variables was calculated by ROC analysis. The ability of body composition variables as indicators to predict PEW was evaluated. RESULTS Sixty-four patients were enrolled in this study. Thirty-three patients (52.6%) were males, and forty (62.5%) patients were diagnosed with PEW. The ROC curve showed that the optimal cutoff values of PA, FFMI (fat-free mass index), MAC, WC, and BMI for PEW risk were 4.45°, 16.71, 29.7 cm, 86.4 cm, and 21.1 kg/m2, respectively. These indicators showed significant association with PEW; meanwhile, the PA and MAC can be used as the predictors for PEW with OR 6.333 (95% CI, 1.956-20.505) and 3.267 (95% CI, 1.136-9.394), respectively. Both groups have a lower BUN/Cr ratio (<20). CONCLUSION In the RRT patients, over than 60% patients were diagnosed with PEW. PA, MAC, and other body composition can be used as the independent indicators for predicting PEW in renal replacement therapy kidney disease patients.
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Affiliation(s)
- Haiteng Zhou
- Key Laboratory of Environmental Medicine and Engineering Ministry of EducationDepartment of Nutrition and Food HygieneSchool of Public HealthSoutheast UniversityNanjingChina
| | | | - Da Pan
- Key Laboratory of Environmental Medicine and Engineering Ministry of EducationDepartment of Nutrition and Food HygieneSchool of Public HealthSoutheast UniversityNanjingChina
| | - Guiju Sun
- Key Laboratory of Environmental Medicine and Engineering Ministry of EducationDepartment of Nutrition and Food HygieneSchool of Public HealthSoutheast UniversityNanjingChina
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20
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Li Q, Zhang X, Tang M, Song M, Zhang Q, Zhang K, Ruan G, Zhang X, Ge Y, Yang M, Liu Y, Xu H, Song C, Wang Z, Shi H. Different muscle mass indices of the Global Leadership Initiative on Malnutrition in diagnosing malnutrition and predicting survival of patients with gastric cancer. Nutrition 2021; 89:111286. [PMID: 34090215 DOI: 10.1016/j.nut.2021.111286] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/05/2021] [Accepted: 04/11/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Malnutrition is common and related to negative prognosis in patients with gastric cancer (GC). The Global Leadership Initiative on Malnutrition (GLIM), a novel consensus for the diagnosis of malnutrition, was proposed recently. However, the roles of GLIM in diagnosing malnutrition and predicting overall survival (OS) in patients with GC have been unclear. METHOD We conducted a multicenter, observational cohort study including 877 hospitalized patients with GC 2013 through 2018. Different anthropometric measurements were compared to assess reduced muscle mass. Kaplan-Meier curves and multivariate Cox regression were used to analyze the relationship between GLIM-defined malnutrition and the OS of patients with GC. Independent prognostic variables were incorporated to develop a nomogram for individualized survival prediction. The calibration curve was used to determine the predictive accuracy and discriminatory capacity of the nomogram. In addition, 219 patients with GC were enrolled for external validation. RESULTS A total of 464 (53%) patients with GC were diagnosed with malnutrition. Patients diagnosed with severe malnutrition based on either midarm circumference or body weight-standardized hand grip strength had a shorter median survival time (16.7 mo; interquartile range, 8.4-32.7 mo) and a higher hazard ratio (HR, 1.49; 95% CI, 1.15-1.92; P = 0.002). Severe malnutrition was an independent risk factor for OS (HR, 1.32; 95% CI, 1.02-1.71; P = 0.038). The GLIM nomogram showed good performance in predicting 3-y survival in patients with GC. CONCLUSIONS Our findings support the effectiveness of GLIM in diagnosing malnutrition and predicting OS in patients with GC.
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Affiliation(s)
- Qinqin Li
- Institute of Biopharmaceutical, Liaocheng University, Liaocheng, China; Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Oncology, Capital Medical University, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Xi Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Oncology, Capital Medical University, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Meng Tang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Oncology, Capital Medical University, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Mengmeng Song
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Oncology, Capital Medical University, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Qi Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Oncology, Capital Medical University, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Kangping Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Oncology, Capital Medical University, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Guotian Ruan
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Oncology, Capital Medical University, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Xiaowei Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Oncology, Capital Medical University, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Yizhong Ge
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Oncology, Capital Medical University, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Ming Yang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Oncology, Capital Medical University, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China
| | - Yuying Liu
- Institute of Biopharmaceutical, Liaocheng University, Liaocheng, China
| | - Hongxia Xu
- Department of Clinical Nutrition, Daping Hospital, Army Medical University, Chongqing, China
| | - Chunhua Song
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhengping Wang
- Institute of Biopharmaceutical, Liaocheng University, Liaocheng, China; Liaocheng High-tech Biotechnology Co., Ltd., Liaocheng, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; Department of Oncology, Capital Medical University, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.
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GLIM criteria for malnutrition diagnosis of hospitalized patients presents satisfactory criterion validity: A prospective cohort study. Clin Nutr 2021; 40:4366-4372. [PMID: 33487504 DOI: 10.1016/j.clnu.2021.01.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/25/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND & AIMS Malnutrition is prevalent among hospitalized patients, but there is no universally accepted consensus regarding its diagnosis. Recently, the Global Leadership Initiative on Malnutrition (GLIM) proposed a new framework for the malnutrition diagnosis and until this moment there is scarce evidence regarding its validity. This study aimed to evaluate the concurrent and predictive validity of GLIM criteria for malnutrition diagnosis in hospitalized patients. METHODS Prospective cohort study involving adult/elderly hospitalized patients. The malnutrition diagnoses according to Subjective Global Assessment (SGA) and GLIM criteria were performed within 48 h of admission. Patients were followed up until hospital discharge to assess the length of hospital stay (LOS) and in-hospital mortality. Six months post discharge; the patients were contacted to collect the outcomes readmission and death. Agreement and accuracy tests, Cox and Logistic regression analysis were performed for testing criterion validity. RESULTS 601 patients (55.7 ± 14.8 years, 51.3% men) were evaluated. Malnutrition was diagnosed in 33.9% and 41.6% of patients, by SGA and GLIM criteria, respectively. GLIM criteria presented a satisfactory accuracy, (AUC = 0.842; CI95% 0.807-0.877) with a sensitivity of 86.6%, and a specificity of 81.6%. The presence of malnutrition by GLIM criteria increased the chance of prolonged hospitalization by 1.76 (CI95% 1.23-2.52) times, and the risk of in-hospital deaths by 5.1 (CI95% 1.14-23.14) times. It was also associated with death within six months (RR = 3.96, CI95% 1.49-10.53). CONCLUSION GLIM criteria for malnutrition diagnosis presented satisfactory criterion validity and should be applied during clinical practice.
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22
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Yin L, Lin X, Liu J, Li N, He X, Zhang M, Guo J, Yang J, Deng L, Wang Y, Liang T, Wang C, Jiang H, Fu Z, Li S, Wang K, Guo Z, Ba Y, Li W, Song C, Cui J, Shi H, Xu H. Classification Tree-Based Machine Learning to Visualize and Validate a Decision Tool for Identifying Malnutrition in Cancer Patients. JPEN J Parenter Enteral Nutr 2021; 45:1736-1748. [PMID: 33415743 DOI: 10.1002/jpen.2070] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The newly proposed Global Leadership Initiative on Malnutrition (GLIM) framework is promising to gain global acceptance for diagnosing malnutrition. However, the role of machine learning in facilitating its application in clinical practice remains largely unknown. METHODS We performed a multicenter, observational cohort study including 3998 patients with cancer. Baseline malnutrition was defined using the GLIM criteria, and the study population was randomly divided into a derivation group (n = 2998) and a validation group (n = 1000). A classification and regression trees (CART) algorithm was used to develop a decision tree for classifying the severity of malnutrition in the derivation group. Model performance was evaluated in the validation group. RESULTS GLIM criteria diagnosed 588 patients (14.7%) with moderate malnutrition and 532 patients (13.3%) with severe malnutrition among the study population. The CART cross-validation identified 5 key predictors for the decision tree construction, including age, weight loss within 6 months, body mass index, calf circumference, and the Nutritional Risk Screening 2002 score. The decision tree showed high performance, with an area under the curve of 0.964 (κ = 0.898, P < .001, accuracy = 0.955) in the validation group. Subgroup analysis showed that the model had apparently good performance in different cancers. Among the 5 predictors constituting the tree, age contributed the least to the classification power. CONCLUSION Using the machine learning, we visualized and validated a decision tool based on the GLIM criteria that can be conveniently used to accelerate the pretreatment identification of malnutrition in patients with cancer.
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Affiliation(s)
- Liangyu Yin
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xin Lin
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Liu
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Na Li
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiumei He
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Mengyuan Zhang
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jing Guo
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jian Yang
- Department of Clinical Nutrition, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Deng
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, China
| | - Yizhuo Wang
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, China
| | - Tingting Liang
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, China
| | - Chang Wang
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, China
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Zhenming Fu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Suyi Li
- Department of Nutrition and Metabolism of Oncology, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Kunhua Wang
- Department of Gastrointestinal Surgery, Institute of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zengqing Guo
- Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China
| | - Yi Ba
- Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Wei Li
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, China
| | - Chunhua Song
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jiuwei Cui
- Cancer Center of the First Hospital of Jilin University, Changchun, Jilin, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hongxia Xu
- Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Phase angle is associated with length of hospital stay, readmissions, mortality, and falls in patients hospitalized in internal-medicine wards: A retrospective cohort study. Nutrition 2020; 85:111068. [PMID: 33545536 DOI: 10.1016/j.nut.2020.111068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the predictive value of bioimpedance phase angle (PA) on selected clinical outcomes in patients hospitalized in internal-medicine wards. METHODS This was a retrospective observational study of 168 patients admitted to the internalmedicine service (52.9% women, 47.1% men), with a mean (± SD) age of 73.9 ± 15.9 y. Anthropometric examination, laboratory tests, and bioelectrical impedance analysis were performed. Bioimpedance-derived PA was the study's parameter. Length of hospital stay, prospective all-cause hospital readmission, mortality, and falls were the clinical endpoints. RESULTS Across the four PA quartile groups, age was incrementally higher (P ≤ 0.001). Multivariate linear regression models showed that PA quartile 1 was significantly associated with length of hospital stay (β, SE) in both crude and adjusted models-respectively, β (SE) = 6.199 (1.625), P ≤ 0.001, and β = 2.193 (1.355), P = 0.033. Over a 9-mo follow-up period, the hazard ratios for readmission, in-hospital falls, and mortality were associated with the lowest phase angle (PA quartile 1 versus quartiles 2-4)-respectively, 2.07 (95% confidence interval [CI], 1.28-3.35), 2.36 (95% CI, 1.05-5.33), and 2.85 (95% CI, 1.01-7.39). Associations between narrow PA and outcomes continued to be significant after adjustments for various confounders. CONCLUSIONS In internal-medicine wards, bioimpedance-derived PA emerged as a predictor of length of hospital stay, hospital readmission, falls, and mortality. The present findings suggest that in the hospital setting, PA assessment could be useful in identifying patients at higher risk who need specific nutritional support.
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Henrique JR, Pereira RG, Ferreira RS, Keller H, de Van der Schueren M, Gonzalez MC, Meira W, Correia MITD. Pilot study GLIM criteria for categorization of a malnutrition diagnosis of patients undergoing elective gastrointestinal operations: A pilot study of applicability and validation. Nutrition 2020; 79-80:110961. [DOI: 10.1016/j.nut.2020.110961] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 01/07/2023]
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25
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Yin L, Lin X, Li N, Zhang M, He X, Liu J, Kang J, Chen X, Wang C, Wang X, Liang T, Liu X, Deng L, Li W, Song C, Cui J, Shi H, Xu H. Evaluation of the Global Leadership Initiative on Malnutrition Criteria Using Different Muscle Mass Indices for Diagnosing Malnutrition and Predicting Survival in Lung Cancer Patients. JPEN J Parenter Enteral Nutr 2020; 45:607-617. [PMID: 32386328 DOI: 10.1002/jpen.1873] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/21/2020] [Accepted: 05/04/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Liangyu Yin
- Department of Clinical Nutrition, Daping Hospital Army Medical University (Third Military Medical University) Chongqing China
- Institute of Hepatopancreatobiliary Surgery, Southwest Hospital Army Medical University (Third Military Medical University) Chongqing China
| | - Xin Lin
- Department of Clinical Nutrition, Daping Hospital Army Medical University (Third Military Medical University) Chongqing China
| | - Na Li
- Department of Clinical Nutrition, Daping Hospital Army Medical University (Third Military Medical University) Chongqing China
| | - Mengyuan Zhang
- Department of Clinical Nutrition, Daping Hospital Army Medical University (Third Military Medical University) Chongqing China
| | - Xiumei He
- Department of Clinical Nutrition, Daping Hospital Army Medical University (Third Military Medical University) Chongqing China
| | - Jie Liu
- Department of Clinical Nutrition, Daping Hospital Army Medical University (Third Military Medical University) Chongqing China
| | - Jun Kang
- Department of Respiratory and Critical Medicine, Daping Hospital Army Medical University (Third Military Medical University) Chongqing China
| | - Xiao Chen
- Cancer Center of the First Hospital of Jilin University Changchun Jilin China
| | - Chang Wang
- Cancer Center of the First Hospital of Jilin University Changchun Jilin China
| | - Xu Wang
- Cancer Center of the First Hospital of Jilin University Changchun Jilin China
| | - Tingting Liang
- Cancer Center of the First Hospital of Jilin University Changchun Jilin China
| | - Xiangliang Liu
- Cancer Center of the First Hospital of Jilin University Changchun Jilin China
| | - Li Deng
- Cancer Center of the First Hospital of Jilin University Changchun Jilin China
| | - Wei Li
- Cancer Center of the First Hospital of Jilin University Changchun Jilin China
| | - Chunhua Song
- Department of Epidemiology, College of Public Health Zhengzhou University Zhengzhou Henan China
| | - Jiuwei Cui
- Cancer Center of the First Hospital of Jilin University Changchun Jilin China
| | - Hanping Shi
- Department of Gastrointestinal Surgery Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University Beijing China
| | - Hongxia Xu
- Department of Clinical Nutrition, Daping Hospital Army Medical University (Third Military Medical University) Chongqing China
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Xu JY, Zhu MW, Zhang H, Li L, Tang PX, Chen W, Wei JM. A Cross-Sectional Study of GLIM-Defined Malnutrition Based on New Validated Calf Circumference Cut-off Values and Different Screening Tools in Hospitalised Patients over 70 Years Old. J Nutr Health Aging 2020; 24:832-838. [PMID: 33009533 DOI: 10.1007/s12603-020-1386-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS The Global Leadership Initiative on Malnutrition (GLIM) is new criteria for diagnosing malnutrition that need validation adjusted to race. Our aim is to determine the optimal reference values of calf circumference (CC), investigate the prevalence of GLIM-defined malnutrition based on different screening tools in inpatients over 70 years old in China and assess its relationship with clinical outcomes. METHODS We designed two continuity studies by analyzing a prospective multicenter database. First, we estimated and validated the CC cut-off values by receiver operating characteristic analyses against in-hospital mortality. Then the patients who were at risk by NRS 2002, MNA-SF and MUST were assessed by the GLIM criteria using the new CC values. Some clinical parameters and outcome data were evaluated. RESULTS The optimal cut-off values of CC were 29.6 cm for male patients and 27.5 cm for female patients. The prevalence of GLIM-defined malnutrition was 27.5% by using NRS2002, 32.6% by using MNA-SF and 25.4% by using MUST. Patients with GLIM-defined malnutrition showed significantly worse values in BMI, total protein, albumin, neutrophil/lymphocyte ratio, CC, rate of complication, in-hospital mortality, length of stay, and total hospital cost than normal patients. Multivariate logistic regression showed the odds ratio of in-hospital mortality was significantly associated with GLIM defined malnutrition by using MNA-SF [OR = 1.231, 95%CI (1.022, 1.484), P = 0.029]. CONCLUSIONS The Chinese reference values of CC for inpatients over 70 years old were validated by in-hospital mortality, which could be implemented in GLIM criteria. And this population possessed a high prevalence of nutrition risk and malnutrition. GLIM criteria with MNA-SF seems to be the first choice to diagnose malnutrition.
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Affiliation(s)
- J-Y Xu
- Jun-Min Wei, Department of General Surgery, Beijing Hospital, No 1, Dahua Road, Beijing 100730, China, E-mail address:
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