Wu Tiantian, Zhou Mingming, Xu Kedi, Zou Yuanlin, Zhang Shaobo, Cheng Haoqing, Guo Pengxia, Song Chunhua
Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China.
Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China.
Nutr Rev. 2025 Mar 1;83(3):e877-e891. doi: 10.1093/nutrit/nuae096.
Global Leadership Initiative on Malnutrition (GLIM) and Patient-Generated Subjective Global Assessment (PG-SGA) are commonly used nutrition assessment tools, whose performance does not reach a consensus due to different and imperfect reference standards.
This study aimed to evaluate and compare the diagnostic accuracy of GLIM and PG-SGA, using a hierarchical Bayesian latent class model, in the absence of a gold standard.
A systematic search was undertaken in PubMed, Embase, and Web of Science from inception to October 2022. Diagnostic test studies comparing (1) the GLIM and/or (2) PG-SGA with "semi-gold" standard assessment tools for malnutrition were included.
Two authors independently extracted data on sensitivity, specificity, and other key characteristics. The methodological quality of each included study was appraised according to the criteria in the Quality Assessment of Diagnostic Accuracy Studies-2.
A total of 45 studies, comprising 20 876 individuals evaluated for GLIM and 11 575 for PG-SGA, were included. The pooled sensitivity was 0.833 (95% CI 0.744 to 0.896) for GLIM and 0.874 (0.797 to 0.925) for PG-SGA, while the pooled specificity was 0.837 (0.780 to 0.882) for GLIM and 0.778 (0.707 to 0.836) for PG-SGA. GLIM showed slightly better performance than PG-SGA, with a higher diagnostic odds ratio (25.791 vs 24.396). The diagnostic performance of GLIM was most effective in non-cancer patients with an average body mass index (BMI) of <24 kg/m2, followed by non-cancer patients with an average age of ≥60 years. PG-SGA was most powerful in cancer patients with an average age of <60 years, followed by cancer patients with an average BMI of <24 kg/m2.
Both GLIM and PG-SGA had moderately high diagnostic capabilities. GLIM was most effective in non-cancer patients with a low BMI, while PG-SGA was more applicable in cancer patients.
PROSPERO registration No. CRD42022380409.
全球营养不良领导倡议（GLIM）和患者主观整体评定法（PG-SGA）是常用的营养评估工具，由于参考标准不同且不完善，其性能尚未达成共识。
本研究旨在使用分层贝叶斯潜在类别模型，在没有金标准的情况下评估和比较GLIM和PG-SGA的诊断准确性。
从数据库建立至2022年10月，在PubMed、Embase和Web of Science中进行了系统检索。纳入了比较（1）GLIM和/或（2）PG-SGA与营养不良“半金标准”评估工具的诊断试验研究。
两位作者独立提取了关于敏感性、特异性和其他关键特征的数据。根据《诊断准确性研究质量评估-2》中的标准对每项纳入研究的方法学质量进行评估。
共纳入45项研究，其中20876人接受了GLIM评估，11575人接受了PG-SGA评估。GLIM的合并敏感性为0.833（95%CI 0.744至0.896），PG-SGA为0.874（0.797至0.925）；GLIM的合并特异性为0.837（0.780至0.882），PG-SGA为0.778（0.707至0.836）。GLIM的表现略优于PG-SGA，诊断比值比更高（25.791对24.396）。GLIM在平均体重指数（BMI）<24kg/m²的非癌症患者中诊断性能最有效，其次是平均年龄≥60岁的非癌症患者。PG-SGA在平均年龄<60岁的癌症患者中最有效，其次是平均BMI<24kg/m²的癌症患者。
GLIM和PG-SGA均具有中等较高的诊断能力。GLIM在低BMI的非癌症患者中最有效，而PG-SGA在癌症患者中更适用。
PROSPERO注册号CRD42022380409。
