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A Cross-Sectional Study of Glim-Defined Malnutrition Based on New Validated Calf Circumference Cut-Off Values and Different Screening Tools in Hospitalised Patients over 70 Years Old

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The journal of nutrition, health & aging

Abstract

Background & aims

The Global Leadership Initiative on Malnutrition (GLIM) is new criteria for diagnosing malnutrition that need validation adjusted to race. Our aim is to determine the optimal reference values of calf circumference (CC), investigate the prevalence of GLIM-defined malnutrition based on different screening tools in inpatients over 70 years old in China and assess its relationship with clinical outcomes.

Methods

We designed two continuity studies by analyzing a prospective multicenter database. First, we estimated and validated the CC cut-off values by receiver operating characteristic analyses against in-hospital mortality. Then the patients who were at risk by NRS 2002, MNA-SF and MUST were assessed by the GLIM criteria using the new CC values. Some clinical parameters and outcome data were evaluated.

Results

The optimal cut-off values of CC were 29.6 cm for male patients and 27.5 cm for female patients. The prevalence of GLIM-defined malnutrition was 27.5% by using NRS2002, 32.6% by using MNA-SF and 25.4% by using MUST. Patients with GLIM-defined malnutrition showed significantly worse values in BMI, total protein, albumin, neutrophil/lymphocyte ratio, CC, rate of complication, in-hospital mortality, length of stay, and total hospital cost than normal patients. Multivariate logistic regression showed the odds ratio of in-hospital mortality was significantly associated with GLIM defined malnutrition by using MNA-SF [OR = 1.231, 95%CI (1.022, 1.484), P = 0.029].

Conclusions

The Chinese reference values of CC for inpatients over 70 years old were validated by in-hospital mortality, which could be implemented in GLIM criteria. And this population possessed a high prevalence of nutrition risk and malnutrition. GLIM criteria with MNA-SF seems to be the first choice to diagnose malnutrition.

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Acknowledgements

The authors thank the support of members of Geriatric Study Group and [Nutritional screening — Undernutrition — Support — Outcome — Cost/effectiveness ratio (NUSOC) multicenter data sharing cooperative group] from Chinese Society for Parenteral and Enteral Nutrition (CSPEN).

Funding

Funding sources Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No 1, Dahua Road, 100730, Beijing, China

    J.-Y. Xu, M.-W. Zhu, L. Li & Jun-Min Wei

  2. Department of Donghuamen Community Health Service, Community Health Service Administration Center of Dongcheng District, 100051, Beijing, China

    H. Zhang

  3. Intensive Care Unit, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, China

    P.-X. Tang

  4. Department of Clinical Nutrition, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China

    W. Chen

Authors
  1. J.-Y. Xu
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  2. M.-W. Zhu
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  3. H. Zhang
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  4. L. Li
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  5. P.-X. Tang
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  6. W. Chen
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  7. Jun-Min Wei
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Corresponding author

Correspondence to Jun-Min Wei.

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Conflict of Interest: The authors have no conflict of interest issue with this study.

Additional information

Statement of authorship: (I) Conception and design: JM Wei, JY Xu; (II) Administrative support: JM Wei; (III) Provision of study materials or patients: JM Wei. MW Zhu; (IV) Collection and assembly of data: JY Xu, H Zhang, L LI, PX Tang; (V) Data analysis and interpretation: JY Xu, W Chen, H Zhang, L Li; (VI) Manuscript writing: All authors; (VI) Final approval of manuscript: All authors.

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Xu, JY., Zhu, MW., Zhang, H. et al. A Cross-Sectional Study of Glim-Defined Malnutrition Based on New Validated Calf Circumference Cut-Off Values and Different Screening Tools in Hospitalised Patients over 70 Years Old. J Nutr Health Aging 24, 832–838 (2020). https://doi.org/10.1007/s12603-020-1386-4

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  • DOI: https://doi.org/10.1007/s12603-020-1386-4

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