Nishioka Shinta, Kawano Marina, Nishioka Emi, Okazaki Amika, Takagi Manato, Matsushita Tatsuya, Tanaka Yuka, Taketani Yutaka, Onizuka Shinya
Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, 4-11, Ginyamachi, Nagasaki City, Nagasaki, 850-0854, Japan; Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
Department of Clinical Services, Nagasaki Rehabilitation Hospital, 4-11, Ginyamachi, Nagasaki City, Nagasaki, 850-0854, Japan.
Clin Nutr ESPEN. 2024 Dec;64:57-65. doi: 10.1016/j.clnesp.2024.09.005. Epub 2024 Sep 11.
BACKGROUND & AIMS: The Global Leadership Initiative on Malnutrition (GLIM) criteria has been recognised as major diagnostic criteria for malnutrition in adults worldwide; however, its validity in rehabilitation settings remains unclear. This study investigated the concurrent and predictive validity of the GLIM criteria for adult patients in convalescent rehabilitation wards.
This retrospective cohort study was conducted using pre-established datasets from convalescent rehabilitation wards in a hospital. The inclusion criteria were adults aged ≥18 years admitted to the wards between November 2018 and October 2020 who were available for body composition assessment. Malnutrition diagnoses were determined by registered dietitians (RDs) using the GLIM criteria. The Subjective Global Assessment (SGA) was performed by another RD and used for the malnutrition reference standard. The GLIM criteria sensitivity and specificity were examined for SGA. The odds ratios and hazard ratios of GLIM-defined malnutrition for the total score of the Functional Independence Measure (tFIM) effectiveness and non-home discharge were calculated using univariable and multivariable logistic regression analyses and Cox proportional hazard models.
Data from 723 patients were extracted from the dataset. GLIM-defined malnutrition was confirmed in 207 (28.6%) patients, 87 (12.0%) with moderate malnutrition and 120 (16.6%) with severe malnutrition. The SGA graded 146 (20.2%) patients with moderate malnutrition (grade B) and 86 (11.9%) with severe malnutrition (grade C). The GLIM criteria (malnutrition/no malnutrition) had fair sensitivity (76.7%, 95% confidence interval [CI]: 70.7-82.0%) and good specificity (94.1%, 95% CI: 91.6-96.0%), indicating acceptable concurrent validity. GLIM-defined moderate malnutrition had poorer sensitivity than severe malnutrition (42.5% vs 81.4%). Logistic regression analyses revealed no evidence for the association between GLIM-defined malnutrition and poor tFIM effectiveness (adjusted odds ratio [AOR]: 1.09, 95% CI: 0.71-1.69) and non-home discharge (AOR: 1.19, 95% CI: 0.76-1.84). The Cox proportional hazard analyses also showed no effect of malnutrition on outcomes.
The GLIM criteria had fair sensitivity and good specificity, indicating acceptable criteria for diagnosing malnutrition in rehabilitation settings. However, its predictive validity for functional recovery and discharge outcomes was insufficient.
全球营养不良领导倡议（GLIM）标准已被公认为全球成人营养不良的主要诊断标准；然而，其在康复环境中的有效性仍不明确。本研究调查了GLIM标准在康复疗养病房成年患者中的同时效度和预测效度。
本回顾性队列研究使用了一家医院康复疗养病房预先建立的数据集。纳入标准为2018年11月至2020年10月期间入住病房且可进行身体成分评估的≥18岁成年人。营养不良诊断由注册营养师（RD）根据GLIM标准确定。主观全面评定（SGA）由另一位RD进行，并用作营养不良参考标准。检验GLIM标准对SGA的敏感性和特异性。使用单变量和多变量逻辑回归分析以及Cox比例风险模型计算GLIM定义的营养不良与功能独立性测量（tFIM）总分有效性和非家庭出院之间的比值比和风险比。
从数据集中提取了723例患者的数据。207例（28.6%）患者被确诊为GLIM定义的营养不良，其中87例（12.0%）为中度营养不良，120例（16.6%）为重度营养不良。SGA将146例（20.2%）患者评定为中度营养不良（B级），86例（11.9%）为重度营养不良（C级）。GLIM标准（营养不良/无营养不良）具有较好的敏感性（76.7%，95%置信区间[CI]：70.7 - 82.0%）和良好的特异性（94.1%，95% CI：91.6 - 96.0%），表明同时效度可接受。GLIM定义的中度营养不良的敏感性低于重度营养不良（42.5%对81.4%）。逻辑回归分析未发现GLIM定义的营养不良与tFIM有效性差（调整后的比值比[AOR]：1.09，95% CI：0.71 - 1.69）和非家庭出院（AOR：1.19，95% CI：0.76 - 1.84）之间存在关联的证据。Cox比例风险分析也显示营养不良对结局无影响。
GLIM标准具有较好的敏感性和良好的特异性，表明其在康复环境中诊断营养不良的标准可接受。然而，其对功能恢复和出院结局的预测效度不足。
