Applicability of the GLIM criteria for the diagnosis of malnutrition in older adults in the emergency ward: A pilot validation study

Acutely ill older adults are at higher risk of malnutrition. This study aimed to explore the applicability and accuracy of the GLIM criteria to diagnose malnutrition in acutely ill older adults in the emergency ward (EW). We performed a retrospective secondary analysis, of an ongoing cohort study, i...

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Bibliographic Details
Published in:	Clinical nutrition (Edinburgh, Scotland) Vol. 40; no. 11; pp. 5447 - 5456
Main Authors:	Muñoz Fernandez, Shirley Steffany, Garcez, Flavia Barreto, Alencar, Julio César García de, Cederholm, Tommy, Aprahamian, Ivan, Morley, John Edward, de Souza, Heraldo Possolo, Avelino da Silva, Thiago Junqueira, Ribeiro, Sandra Maria Lima
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-11-2021
Subjects:	Acute disease Acute Disease - mortality Aged Aged, 80 and over Anthropometry Brazil Emergency Service, Hospital Female Geriatric Assessment - methods GLIM criteria Hospital Mortality Humans Male Malnutrition Malnutrition - diagnosis Malnutrition - mortality Mass Screening - standards Nutrition Assessment Nutrition screening Nutritional assessment Older adults Pilot Projects Predictive Value of Tests Retrospective Studies Risk Assessment - standards Sensitivity and Specificity Surveys and Questionnaires Brazil Nutritional assessment Acute disease Nutrition screening Malnutrition Older adults GLIM criteria
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Summary:	Acutely ill older adults are at higher risk of malnutrition. This study aimed to explore the applicability and accuracy of the GLIM criteria to diagnose malnutrition in acutely ill older adults in the emergency ward (EW). We performed a retrospective secondary analysis, of an ongoing cohort study, in 165 participants over 65 years of age admitted to the EW of a Brazilian university hospital. Nutrition assessment included anthropometry, the Simplified Nutritional Assessment Questionnaire (SNAQ), the Malnutrition Screening Tool (MST), and the Mini-Nutritional Assessment (MNA). We diagnosed malnutrition using GLIM criteria, defined by the parallel presence of at least one phenotypic [nonvolitional weight loss (WL), low BMI, low muscle mass (MM)] and one etiologic criterion [reduced food intake or assimilation (RFI), disease burden/inflammation]. We used the receiver operating characteristic (ROC) curves and Cox and logistic regression for data analyses. GLIM criteria, following the MNA-SF screening, classified 50.3% of participants as malnourished, 29.1% of them in a severe stage. Validation of the diagnosis using MNA-FF as a reference showed good accuracy (AUC = 0.84), and moderate sensitivity (76%) and specificity (75.1%). All phenotypic criteria combined with RFI showed the best metrics. Malnutrition showed a trend for an increased risk of transference to intensive care unit (OR = 2.08, 95% CI 0.99, 4.35), and severe malnutrition for in-hospital mortality (HR = 4.23, 95% CI 1.2, 14.9). GLIM criteria, following MNA-SF screening, appear to be a feasible approach to diagnose malnutrition in acutely ill older adults in the EW. Nonvolitional WL combined with RFI or acute inflammation were the best components identified and are easily accessible, allowing their potential use in clinical practice.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Undefined-2
ISSN:	0261-5614 1532-1983 1532-1983
DOI:	10.1016/j.clnu.2021.09.024