Center for Nutrition and Intestinal Failure, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark.
Center for Nutrition and Intestinal Failure, Danish Nutrition Science Centre, Aalborg University Hospital, Mølleparkvej 4, 9000 Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Clin Nutr ESPEN. 2021 Aug;44:449-457. doi: 10.1016/j.clnesp.2021.04.012. Epub 2021 Apr 26.
BACKGROUND & AIM: Due to lack of global consensus in diagnosing malnutrition, Global Leadership Initiative on Malnutrition (GLIM) has suggested the GLIM criteria based on etiological and phenotypical criteria. The aim of this study was to investigate the prevalence of malnutrition in patients with intestinal insufficiency (INS) or intestinal failure (IF) based on the different GLIM criteria combinations to diagnose malnutrition. Furthermore, the aim was to investigate the severity of malnutrition in the two patient groups.
A cross-sectional study with INS patients on enteral nutrition and IF patients on home parenteral nutrition. We recorded age, gender, weight, height, fat free mass index (FFMI) by bioelectrical impedance analysis, handgrip strength (HGS), arm muscle circumference (AMC) and biochemical parameters: plasma albumin (p-alb) and plasma C-reactive protein (p-CRP). Further, we calculated Glasgow prognostic score (GPS) and body mass index (BMI).
T-test, Chi-square test and simple logistic regression analysis. Significance level: p < 0.05.
In total 277 INS and IF patients were included (age 59.5 ± 15.2 years, male 43,7%, BMI 22.1 ± 4.3 kg/m2). Groups were comparable according to number, age and gender but more IF patients had decreased BMI, p-alb, HGS and FFMI and increased CRP and GPS 1 or 2. Prevalence of malnutrition using GPS 1 or 2 combined with BMI, FFMI or HGS was 22.6%, 23.4%, 26.3% for INS, respectively (p = 0.756) and 40.7%, 40.0%, 59.3% for IF, respectively (p = 0.001). Agreement between the criteria combinations were: 8.0% for INS and 25.7% for IF. Significantly more with IF was diagnosed with severe malnutrition as compared to no malnutrition (43 vs. 26, p = 0.012, OR 2.1 [CI95% 1.2-3.8]), but only a tendency in the group with moderate malnutrition as compared to no malnutrition (27 vs. 22, p = 0.180, OR 1.6 [CI95% 0.8-3.0]) CONCLUSION: We found both prevalence and severity of malnutrition to be higher in IF than INS patients. GLIM-criteria were able to identify approximately same prevalence of malnutrition in INS but not in IF, when combining GPS 1 or 2 with BMI, FFMI and HGS. However, the agreement was poor in both groups. Consequently, further validation of GLIM is needed - including association to clinical outcome in lack of a gold standard.
由于缺乏全球共识的营养不良诊断，全球营养不良领导倡议（GLIM）根据病因和表型标准提出了 GLIM 标准。本研究的目的是基于不同的 GLIM 标准组合来调查肠内营养的肠内不全（INS）或肠衰竭（IF）患者的营养不良发生率。此外，目的是调查两组患者营养不良的严重程度。
这是一项 INS 患者接受肠内营养和 IF 患者接受家庭肠外营养的横断面研究。我们记录了年龄、性别、体重、身高、无脂肪质量指数（FFMI）通过生物电阻抗分析、握力（HGS）、臂肌围（AMC）和生化参数：血浆白蛋白（p-alb）和血浆 C 反应蛋白（p-CRP）。此外，我们还计算了格拉斯哥预后评分（GPS）和体重指数（BMI）。
T 检验、卡方检验和简单逻辑回归分析。显著性水平：p < 0.05。
共纳入 277 例 INS 和 IF 患者（年龄 59.5 ± 15.2 岁，男性 43.7%，BMI 22.1 ± 4.3 kg/m2）。根据数量、年龄和性别，两组具有可比性，但 IF 患者的 BMI、p-alb、HGS 和 FFMI 降低，CRP 和 GPS 1 或 2 升高。使用 GPS 1 或 2 联合 BMI、FFMI 或 HGS 诊断 INS 营养不良的患病率分别为 22.6%、23.4%和 26.3%（p = 0.756），IF 分别为 40.7%、40.0%和 59.3%（p = 0.001）。各标准组合之间的一致性为：INS 为 8.0%，IF 为 25.7%。IF 患者中，与无营养不良相比，诊断为严重营养不良的患者明显更多（43 例与 26 例，p = 0.012，OR 2.1[95%CI95%1.2-3.8]），但与无营养不良相比，中度营养不良患者有趋势（27 例与 22 例，p = 0.180，OR 1.6[95%CI95%0.8-3.0]）。
我们发现 IF 患者的营养不良患病率和严重程度均高于 INS 患者。在 INS 中，GLIM 标准能够通过结合 GPS 1 或 2 与 BMI、FFMI 和 HGS 来识别出与营养不良相似的患病率，但在 IF 中却无法识别。然而，两组的一致性都很差。因此，需要进一步验证 GLIM，包括在缺乏金标准的情况下与临床结果的关联。
