Liangyu Yin1,2, Xin Lin1, Zhiping Zhao1, Na Li1, Xiumei He1, Mengyuan Zhang1, Jian Yang3, Zengqing Guo4, Zengning Li5, Kunhua Wang6, Min Weng7, Minghua Cong8, Suyi Li9, Tao Li10, Hu Ma11, Yi Ba12, Wei Li13, Jiuwei Cui13, Jie Liu14, Chunhua Song15, Hanping Shi16, Hongxia Xu17. 1. Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Changjiangzhilu 10#, Yuzhong District, Chongqing, 400042, China. 2. Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China. 3. Department of Clinical Nutrition, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China. 4. Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China. 5. Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China. 6. Department of Gastrointestinal Surgery, Institute of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China. 7. Department of Clinical Nutrition, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China. 8. Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. 9. Department of Nutrition and Metabolism of Oncology, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, China. 10. Department of Radiotherapy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China. 11. Department of Oncology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China. 12. Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin, China. 13. Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China. 14. Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Changjiangzhilu 10#, Yuzhong District, Chongqing, 400042, China. dbdnajie@qq.com. 15. Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China. sch16@zzu.edu.cn. 16. Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China. shihp@ccmu.edu.cn. 17. Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Changjiangzhilu 10#, Yuzhong District, Chongqing, 400042, China. hx_xu2015@163.com.
Abstract
BACKGROUND: The Global Leadership Initiative on Malnutrition (GLIM) has the potential to gain global acceptance for diagnosing malnutrition. Of which, calf circumference (CC) was proposed as an alternative to evaluate the reduced muscle mass (RMM). The present study aimed to evaluate whether including the hand grip strength (HGS) was helpful for diagnosing malnutrition under the GLIM framework. METHODS: We performed a multicenter, observational cohort study including 3998 patients with cancer at two teaching hospitals. The RMM criterion was separately assessed using the calf circumference (CC), or the CC and HGS combined. Accordingly, two methods of GLIM diagnosis were independently developed to determine the nutritional status of the patients. The diagnostic concordance, baseline characteristics, and outcomes of patients were compared across the malnourished-CC-HGS, malnourished-CC+HGS, and well-nourished groups. The Patient-Generated Subjective Global Assessment (PG-SGA) was used as a comparator to identify the optimal method. RESULTS: Malnutrition was identified in 1120 (28%) patients by the CC method and 1060 (26.5%) patients by the CC+HGS method. Compared to the well-nourished group, the malnourished-CC+HGS group (60 patients, 1.5%) had poorer nutritional characteristics, poorer Karnofsky Performance Status scores, poorer global quality of life scores, and higher Nutritional Risk Screening 2002 scores. The severity of malnutrition diagnosed using the CC method (Kappa = 0.136) showed higher agreement with the PG-SGA than the CC+HGS method (Kappa = 0.127). CONCLUSION: Compared to CC+HGS, the CC alone appears to be adequate to evaluate RMM under the GLIM framework. A simpler method might facilitate the application of these criteria in clinical settings by increasing efficacy and minimizing missed diagnoses.
BACKGROUND: The Global Leadership Initiative on Malnutrition (GLIM) has the potential to gain global acceptance for diagnosing malnutrition. Of which, calf circumference (CC) was proposed as an alternative to evaluate the reduced muscle mass (RMM). The present study aimed to evaluate whether including the hand grip strength (HGS) was helpful for diagnosing malnutrition under the GLIM framework. METHODS: We performed a multicenter, observational cohort study including 3998 patients with cancer at two teaching hospitals. The RMM criterion was separately assessed using the calf circumference (CC), or the CC and HGS combined. Accordingly, two methods of GLIM diagnosis were independently developed to determine the nutritional status of the patients. The diagnostic concordance, baseline characteristics, and outcomes of patients were compared across the malnourished-CC-HGS, malnourished-CC+HGS, and well-nourished groups. The Patient-Generated Subjective Global Assessment (PG-SGA) was used as a comparator to identify the optimal method. RESULTS: Malnutrition was identified in 1120 (28%) patients by the CC method and 1060 (26.5%) patients by the CC+HGS method. Compared to the well-nourished group, the malnourished-CC+HGS group (60 patients, 1.5%) had poorer nutritional characteristics, poorer Karnofsky Performance Status scores, poorer global quality of life scores, and higher Nutritional Risk Screening 2002 scores. The severity of malnutrition diagnosed using the CC method (Kappa = 0.136) showed higher agreement with the PG-SGA than the CC+HGS method (Kappa = 0.127). CONCLUSION: Compared to CC+HGS, the CC alone appears to be adequate to evaluate RMM under the GLIM framework. A simpler method might facilitate the application of these criteria in clinical settings by increasing efficacy and minimizing missed diagnoses.
Entities:
Keywords:
Calf circumference; Global Leadership Initiative on Malnutrition; Hand grip strength; Patient-Generated Subjective Global Assessment; Quality of life
Authors: Xiaoling Zhang; Jialei Zhang; Yunyi Du; Xiaoyu Wu; Yali Chang; Weiling Li; Yaqin Liu; Wenqing Hu; Jun Zhao Journal: Support Care Cancer Date: 2022-06-27 Impact factor: 3.359