Jun-Min Wei, Department of General Surgery, Beijing Hospital, No 1, Dahua Road, Beijing 100730, China, E-mail address:
J Nutr Health Aging. 2020;24(8):832-838. doi: 10.1007/s12603-020-1386-4.
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.
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.
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].
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.
全球营养不良领导倡议（GLIM）是一种新的营养不良诊断标准，需要针对不同种族进行调整和验证。我们的目的是确定中国 70 岁以上住院患者的小腿围（CC）最佳参考值，研究不同筛查工具下基于 GLIM 定义的营养不良的患病率，并评估其与临床结局的关系。
我们通过分析前瞻性多中心数据库设计了两项连续性研究。首先，我们通过接受者操作特征分析（ROC 分析）估计和验证了 CC 截断值与住院死亡率的关系。然后，使用新的 CC 值，根据 NRS 2002、MNA-SF 和 MUST，对 NRS 2002、MNA-SF 和 MUST 评估为有风险的患者进行 GLIM 标准评估。评估了一些临床参数和结局数据。
CC 的最佳截断值为男性患者 29.6cm，女性患者 27.5cm。使用 NRS2002、MNA-SF 和 MUST，GLIM 定义的营养不良患病率分别为 27.5%、32.6%和 25.4%。与正常患者相比，GLIM 定义的营养不良患者的 BMI、总蛋白、白蛋白、中性粒细胞/淋巴细胞比值、CC、并发症发生率、住院死亡率、住院时间和总住院费用明显更差。多变量 logistic 回归显示，使用 MNA-SF，GLIM 定义的营养不良与住院死亡率的比值比（OR）显著相关[OR=1.231，95%CI（1.022，1.484），P=0.029]。
我们通过住院死亡率验证了中国 70 岁以上住院患者 CC 的参考值，可用于 GLIM 标准。该人群的营养风险和营养不良患病率较高。使用 MNA-SF 的 GLIM 标准似乎是诊断营养不良的首选方法。
