与 PG-SGA 相比，人体成分测量可提高 GLIM 标准在诊断门诊癌症患者营养不良方面的性能：一项前瞻性横断面研究。
Body Composition Measurement Improved Performance of GLIM Criteria in Diagnosing Malnutrition Compared to PG-SGA in Ambulatory Cancer Patients: A Prospective Cross-Sectional Study.
机构信息
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Day Oncology Unit, Peking University Cancer Hospital & Institute, Beijing 100142, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Supportive Care Department, Peking University Cancer Hospital & Institute, Beijing 100142, China.
出版信息
Nutrients. 2021 Aug 10;13(8):2744. doi: 10.3390/nu13082744.
BACKGROUND AND AIMS
Muscle mass reduction (MMR) is one of the three etiologic criteria in the Global Leadership Initiative on Malnutrition (GLIM) framework. This study aimed to evaluate the value of MMR in GLIM criteria among ambulatory cancer patients.
METHODS
A single-center prospective cross-sectional study was conducted. All participants underwent calf circumference (CC) measurement and body composition measurement by bioelectrical impedance analysis (BIA). MMR was identified by CC, fat-free mass index (FFMI), appendicular skeletal muscle index (ASMI), or combinations of the above three indicators. Patients-generated Subjective Global Assessment (PG-SGA) was used as the comparator.
RESULTS
A total of 562 cancer patients receiving intravenous treatment were evaluated. Of the participants, 62.8% (355/562) were male. The median age of the patients was 59.0 years (range, 21-82 y). The median BMI was 22.8 kg/m (range, 14.6-34.5 kg/m). A total of 41.8% of patients were evaluated as malnutrition (PG-SGA ≥ 4), and 11.9% were diagnosed with severe malnutrition (PG-SGA ≥ 9). For the GLIM criteria, the prevalence of malnutrition was 26.9%, and severe malnutrition was 12.3%. For all criteria combinations of GLIM together versus PG-SGA, sensitivity was 60.4% (53.8-66.7), specificity was 97.9% (95.4-99.1), while the accordance between GLIM and PG-SGA was moderate (κ = 0.614). The performance of the GLIM worsened when MMR was excluded (κ = 0.515), with reduced sensitivity (50.2% (43.7-56.8)) and the same specificity (97.9% (95.4-99.1)). Including FFMI and ASMI by BIA can further improve the performance of GLIM than using CC alone (κ = 0.614 vs. κ = 0.565).
CONCLUSIONS
It is important to include MMR in the GLIM framework. Using body composition measurement further improves the performance of the GLIM criteria than using anthropometric measurement alone.
背景与目的
肌肉质量减少（MMR）是全球营养不良倡议（GLIM）框架中的三个病因标准之一。本研究旨在评估门诊癌症患者 GLIM 标准中 MMR 的价值。
方法
进行了一项单中心前瞻性横断面研究。所有参与者均接受小腿围（CC）测量和生物电阻抗分析（BIA）的身体成分测量。通过 CC、去脂体重指数（FFMI）、四肢骨骼肌指数（ASMI）或上述三个指标的组合来确定 MMR。患者生成的主观整体评估（PG-SGA）被用作比较器。
结果
共评估了 562 名接受静脉治疗的癌症患者。参与者中，62.8%（355/562）为男性。患者的中位年龄为 59.0 岁（范围，21-82 岁）。中位 BMI 为 22.8kg/m（范围，14.6-34.5kg/m）。共有 41.8%的患者被评估为营养不良（PG-SGA≥4），11.9%被诊断为严重营养不良（PG-SGA≥9）。对于 GLIM 标准，营养不良的患病率为 26.9%，严重营养不良的患病率为 12.3%。对于 GLIM 与 PG-SGA 所有标准组合的比较，灵敏度为 60.4%（53.8-66.7），特异性为 97.9%（95.4-99.1），而 GLIM 与 PG-SGA 的一致性为中等（κ=0.614）。当排除 MMR 时，GLIM 的性能会恶化（κ=0.515），灵敏度降低（50.2%（43.7-56.8）），特异性相同（97.9%（95.4-99.1））。通过 BIA 纳入 FFMI 和 ASMI 可以比单独使用 CC 进一步提高 GLIM 的性能（κ=0.614 比 κ=0.565）。
结论
在 GLIM 框架中纳入 MMR 很重要。使用身体成分测量比单独使用人体测量学进一步提高 GLIM 标准的性能。
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