Yupeng Zhang1, Li Zhang1, Xuejin Gao1, Cong Dai2, Yuhong Huang2, Yan Wu3, Wei Zhou4, Qian Cao5, Xue Jing6, Haitao Jiang7, Weiming Zhu8, Xinying Wang9. 1. Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China. 2. Department of Gastroenterology, First Affiliated Hospital, China Medical University, Shenyang, 110001, China. 3. Department of Pharmacy, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, 310016, China. 4. Department of General Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, 310016, China. 5. Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, 310016, China. 6. Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China. 7. Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China. 8. Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China. Electronic address: juwiming@126.com. 9. Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China. Electronic address: wangxinying@nju.edu.cn.
Abstract
BACKGROUND & AIMS: The Global Leadership Initiative on Malnutrition (GLIM) has recently been proposed as a consensus criterion for identifying malnutrition. However, data on the application of GLIM criteria in patients with inflammatory bowel disease (IBD) are limited. Therefore, this study aimed to explore the validity of this neoteric criterion for identifying malnutrition and investigate the association between malnutrition and quality of life (QoL) in patients with IBD. METHODS: This multicenter, prospective, observational study assessed hospitalized patients with IBD at four general hospitals. Nutritional status was evaluated using criteria from the World Health Organization (WHO) related body mass index (BMI) cut-off value, Subjective Global Assessment (SGA), European Society for Clinical Nutrition and Metabolism (ESPEN) criteria of malnutrition in 2015, and GLIM criteria. Kappa (K) values were calculated to determine interrater validity and consistency among different prevalence of malnutrition. Patients' QoL was assessed by the Inflammatory Bowel Disease Questionnaire (IBDQ). RESULTS: A total of 238 hospitalized patients with IBD were enrolled, with a mean age of 38.5 ± 14.0 years, 68.5% of them were male, and 177 with Crohn's disease (CD). Among all patients, 39.5% were underweight (BMI < 18.5 kg/m2), and the prevalence of malnutrition was 66.0%, 47.5%, and 60.1% according to SGA, ESPEN, and GLIM criteria, respectively. Moreover, the prevalence of malnutrition was significantly higher among patients with CD than those with ulcerative colitis (UC), according to GLIM criteria (69.5% vs. 32.8%, p < 0.001). The GLIM criteria showed a substantial concordance with ESPEN criteria (K = 0.67, 95% confidence interval [CI] 0.58-0.76, p < 0.001), and a fair concordance with the SGA (K = 0.57, 95% CI 0.46-0.68, p < 0.001) and WHO criteria (K = 0.52, 95% CI 0.43-0.62, p < 0.001). An impairment in the nutritional status was accompanied by a progressive reduction in the patients' QoL. CONCLUSIONS: The prevalence of malnutrition is high in patients with IBD. The GLIM criteria may be an appropriate and effective tool to identify malnutrition in the IBD populations due to its substantial concordance with ESPEN and a fair concordance with SGA and WHO-related BMI. GLIM-defined malnutrition showed an enormous adverse impact on patients' QoL.
BACKGROUND & AIMS: The Global Leadership Initiative on Malnutrition (GLIM) has recently been proposed as a consensus criterion for identifying malnutrition. However, data on the application of GLIM criteria in patients with inflammatory bowel disease (IBD) are limited. Therefore, this study aimed to explore the validity of this neoteric criterion for identifying malnutrition and investigate the association between malnutrition and quality of life (QoL) in patients with IBD. METHODS: This multicenter, prospective, observational study assessed hospitalized patients with IBD at four general hospitals. Nutritional status was evaluated using criteria from the World Health Organization (WHO) related body mass index (BMI) cut-off value, Subjective Global Assessment (SGA), European Society for Clinical Nutrition and Metabolism (ESPEN) criteria of malnutrition in 2015, and GLIM criteria. Kappa (K) values were calculated to determine interrater validity and consistency among different prevalence of malnutrition. Patients' QoL was assessed by the Inflammatory Bowel Disease Questionnaire (IBDQ). RESULTS: A total of 238 hospitalized patients with IBD were enrolled, with a mean age of 38.5 ± 14.0 years, 68.5% of them were male, and 177 with Crohn's disease (CD). Among all patients, 39.5% were underweight (BMI < 18.5 kg/m2), and the prevalence of malnutrition was 66.0%, 47.5%, and 60.1% according to SGA, ESPEN, and GLIM criteria, respectively. Moreover, the prevalence of malnutrition was significantly higher among patients with CD than those with ulcerative colitis (UC), according to GLIM criteria (69.5% vs. 32.8%, p < 0.001). The GLIM criteria showed a substantial concordance with ESPEN criteria (K = 0.67, 95% confidence interval [CI] 0.58-0.76, p < 0.001), and a fair concordance with the SGA (K = 0.57, 95% CI 0.46-0.68, p < 0.001) and WHO criteria (K = 0.52, 95% CI 0.43-0.62, p < 0.001). An impairment in the nutritional status was accompanied by a progressive reduction in the patients' QoL. CONCLUSIONS: The prevalence of malnutrition is high in patients with IBD. The GLIM criteria may be an appropriate and effective tool to identify malnutrition in the IBD populations due to its substantial concordance with ESPEN and a fair concordance with SGA and WHO-related BMI. GLIM-defined malnutrition showed an enormous adverse impact on patients' QoL.
Authors: Olga Maria Nardone; Andrea Ponsiglione; Roberto de Sire; Giulio Calabrese; Raffaele Liuzzi; Anna Testa; Alessia Dalila Guarino; Oriana Olmo; Antonio Rispo; Luigi Camera; Fabiana Castiglione Journal: Nutrients Date: 2022-08-23 Impact factor: 6.706