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Is hand grip strength a necessary supportive index in the phenotypic criteria of the GLIM-based diagnosis of malnutrition in patients with cancer?

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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.

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Data availability

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Abbreviations

GLIM:

Global Leadership Initiative on Malnutrition

HGS:

Hand grip strength

CC:

Calf circumference

QOL:

Quality of life

PG-SGA:

Patient-Generated Subjective Global Assessment

AMC:

Arm muscle circumference

RMM:

Reduced muscle mass

INSCOC:

Investigation on Nutrition Status and its Clinical Outcome of Common Cancers

KPS:

Karnofsky Performance Status

MAC:

Mid-arm circumference

TSF:

Triceps skinfold thickness

p5:

Fifth percentile

p15:

15th percentile

COPD:

Chronic obstructive pulmonary disease

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Acknowledgments

We thank all of the committee and board members of the Chinese Society of Nutritional Oncology (CSNO). We would also like to thank WINCOME Computer and Technology Corporation for establishing the Electronic Data Capture (EDC) System for the present study. We also thank the INSCOC project members for their substantial work on data collection and patient follow-up.

Funding

This work was supported by the National Natural Science Foundation of China (81673167, Hongxia Xu), the Chongqing Technology Innovation and Application Demonstration Project for Social Livelihood (cstc2018jscx-msybX0094, Jie Liu), and the National Key Research and Development Program (2017YFC1309200, Hanping Shi).

Author information

Authors and Affiliations

  1. Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Changjiangzhilu 10#, Yuzhong District, Chongqing, 400042, China

    Liangyu Yin, Xin Lin, Zhiping Zhao, Na Li, Xiumei He, Mengyuan Zhang, Jie Liu & Hongxia Xu

  2. Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China

    Liangyu Yin

  3. Department of Clinical Nutrition, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Jian Yang

  4. Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian, China

    Zengqing Guo

  5. Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China

    Zengning Li

  6. Department of Gastrointestinal Surgery, Institute of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China

    Kunhua Wang

  7. Department of Clinical Nutrition, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China

    Min Weng

  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

    Minghua Cong

  9. Department of Nutrition and Metabolism of Oncology, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui, China

    Suyi Li

  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

    Tao Li

  11. Department of Oncology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China

    Hu Ma

  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

    Yi Ba

  13. Cancer Center, The First Hospital of Jilin University, Changchun, Jilin, China

    Wei Li & Jiuwei Cui

  14. Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China

    Chunhua Song

  15. Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China

    Hanping Shi

Authors
  1. Liangyu Yin
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  2. Xin Lin
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  3. Zhiping Zhao
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  4. Na Li
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  5. Xiumei He
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  6. Mengyuan Zhang
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  7. Jian Yang
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  9. Zengning Li
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  10. Kunhua Wang
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  11. Min Weng
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  13. Suyi Li
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  14. Tao Li
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  15. Hu Ma
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  17. Wei Li
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  19. Jie Liu
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  20. Chunhua Song
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  21. Hanping Shi
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  22. Hongxia Xu
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Contributions

LYY, JL, CHS, HPS, and HXX designed the research; LYY and HXX conducted the research; LYY performed the statistical analysis and wrote the manuscript; XL, ZPZ, NL, XMH, MYZ, JY, ZQG, ZNL, KHW, MW, MHC, SYL, TL, HM, YB, WL, and JWC critically reviewed the manuscript; and all authors interpreted the data, provided critical input, and read and approved the final manuscript.

Corresponding authors

Correspondence to Jie Liu, Chunhua Song, Hanping Shi or Hongxia Xu.

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The authors declare that they have no conflict of interest.

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The study protocol was approved by the institutional review board at Daping Hospital (no. 2018-22).

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All patients provided written consent for the scientific use of their data.

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Yin, L., Lin, X., Zhao, Z. et al. Is hand grip strength a necessary supportive index in the phenotypic criteria of the GLIM-based diagnosis of malnutrition in patients with cancer?. Support Care Cancer 29, 4001–4013 (2021). https://doi.org/10.1007/s00520-020-05975-z

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