Nutrients, Vol. 18, Pages 462: Applying the New Inflammation Criterion Impairs GLIM Validity in Hospitalized Patients with Acute Medical Conditions
Nutrients doi: 10.3390/nu18030462
Authors:
Laia Fontané
Maria Helena Reig
Míriam Herranz
Maria Antonia Roig
Altea Pérez
Juan José Chillarón
Araceli Estepa
Silvia Toro
Humberto Navarro
Gemma Llauradó
Juan Pedro-Botet
David Benaiges
Background/Objectives: The Global Leadership Initiative on Malnutrition (GLIM) recently updated its inflammation criterion through a Delphi consensus to standardize its assessment. This study aimed to assess the impact of these new recommendations on the concurrent and predictive validity of the GLIM criteria in hospitalized medical patients. Methods: This post hoc analysis re-evaluated a previously published cohort of 119 hospitalized patients with acute medical conditions, originally assessed using the GLIM criteria and the Subjective Global Assessment (SGA) as the reference standard. Inflammation was redefined according to the 2024 GLIM Delphi consensus, and the concurrent and predictive validity of the modified GLIM criteria (GLIM-I) were examined. Receiver operating characteristic (ROC) curves were used to compare the discriminative ability of SGA, original GLIM, and GLIM-I to predict prolonged hospital stay. Results: With the updated inflammation definition, all patients met the etiologic criterion, increasing malnutrition prevalence from 41.7% to 52.2%. GLIM-I showed a sensitivity of 78.0% and specificity of 67.7% versus SGA, not reaching the predefined ≥80% threshold for concurrent validity. Predictive validity was maintained (adjusted odds ratio (OR) = 3.40; 95% CI: 1.31–8.83). SGA achieved the highest discriminative ability (area under the curve (AUC) = 0.783; 95% CI: 0.693–0.874), significantly outperforming the original GLIM (AUC = 0.723; 95% CI: 0.616–0.830; p = 0.049). GLIM-I showed similar performance (AUC = 0.731; 95% CI: 0.620–0.843; p = 0.727). Conclusions: SGA should continue to be considered the method of choice for nutritional diagnosis in hospitalized medical patients. Further research is needed to determine how the new inflammation criteria influence the validity of the GLIM framework in other clinical contexts before their widespread implementation.
Background/Objectives: The Global Leadership Initiative on Malnutrition (GLIM) recently updated its inflammation criterion through a Delphi consensus to standardize its assessment. This study aimed to assess the impact of these new recommendations on the concurrent and predictive validity of the GLIM criteria in hospitalized medical patients. Methods: This post hoc analysis re-evaluated a previously published cohort of 119 hospitalized patients with acute medical conditions, originally assessed using the GLIM criteria and the Subjective Global Assessment (SGA) as the reference standard. Inflammation was redefined according to the 2024 GLIM Delphi consensus, and the concurrent and predictive validity of the modified GLIM criteria (GLIM-I) were examined. Receiver operating characteristic (ROC) curves were used to compare the discriminative ability of SGA, original GLIM, and GLIM-I to predict prolonged hospital stay. Results: With the updated inflammation definition, all patients met the etiologic criterion, increasing malnutrition prevalence from 41.7% to 52.2%. GLIM-I showed a sensitivity of 78.0% and specificity of 67.7% versus SGA, not reaching the predefined ≥80% threshold for concurrent validity. Predictive validity was maintained (adjusted odds ratio (OR) = 3.40; 95% CI: 1.31–8.83). SGA achieved the highest discriminative ability (area under the curve (AUC) = 0.783; 95% CI: 0.693–0.874), significantly outperforming the original GLIM (AUC = 0.723; 95% CI: 0.616–0.830; p = 0.049). GLIM-I showed similar performance (AUC = 0.731; 95% CI: 0.620–0.843; p = 0.727). Conclusions: SGA should continue to be considered the method of choice for nutritional diagnosis in hospitalized medical patients. Further research is needed to determine how the new inflammation criteria influence the validity of the GLIM framework in other clinical contexts before their widespread implementation. Read More