Applicability of the GLIM criteria for the diagnosis of malnutrition in older adults in the emergency ward: A pilot validation study

Autor(es)

Munoz Fernandez, Shirley Steffany ^[1] ; Garcez, Flavia Barreto ^[2] ; Garcia de Alencar, Julio Cesar ^[3] ; Cederholm, Tommy ^{[4, 5]} ; Aprahamian, Ivan ^[2] ; Morley, John Edward ^[6] ; de Souza, Heraldo Possolo ^[3] ; Avelino da Silva, Thiago Junqueira ^[2] ; Lima Ribeiro, Sandra Maria ^{[1, 7]}

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Sch Publ Hlth, Nutr Dept, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Geriatr Div, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Fac Med, Dept Clin Med, Disciplina Emergencias Clin, Sao Paulo - Brazil

^[4] Uppsala Univ, Dept Publ Hlth & Caring Sci, Clin Nutr & Metab, Uppsala - Sweden

^[5] Karolinska Univ Hosp, Stockholm - Sweden

^[6] St Louis Univ, Sch Med, Div Geriatr Med, St Louis, MO 63104 - USA

^[7] Univ Sao Paulo, Sch Arts Sci & Humanity, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: Clinical Nutrition; v. 40, n. 11, p. 5447-5456, NOV 2021.
• Citações Web of Science: 0

Resumo

Background \& aims: Acutely ill older adults are at higher risk of malnutrition. This study aimed to explore the applicability and accuracy of the GLIM criteria to diagnose malnutrition in acutely ill older adults in the emergency ward (EW). Methods: We performed a retrospective secondary analysis, of an ongoing cohort study, in 165 participants over 65 years of age admitted to the EW of a Brazilian university hospital. Nutrition assessment included anthropometry, the Simplified Nutritional Assessment Questionnaire (SNAQ), the Malnutrition Screening Tool (MST), and the Mini-Nutritional Assessment (MNA). We diagnosed malnutrition using GLIM criteria, defined by the parallel presence of at least one phenotypic {[}nonvolitional weight loss (WL), low BMI, low muscle mass (MM)] and one etiologic criterion {[}reduced food intake or assimilation (RFI), disease burden/inflammation]. We used the receiver operating characteristic (ROC) curves and Cox and logistic regression for data analyses. Results: GLIM criteria, following the MNA-SF screening, classified 50.3% of participants as malnourished, 29.1% of them in a severe stage. Validation of the diagnosis using MNA-FF as a reference showed good accuracy (AUC = 0.84), and moderate sensitivity (76%) and specificity (75.1%). All phenotypic criteria combined with RFI showed the best metrics. Malnutrition showed a trend for an increased risk of transference to intensive care unit (OR = 2.08, 95% CI 0.99, 4.35), and severe malnutrition for in-hospital mortality (HR = 4.23, 95% CI 1.2, 14.9). Conclusion: GLIM criteria, following MNA-SF screening, appear to be a feasible approach to diagnose malnutrition in acutely ill older adults in the EW. Nonvolitional WL combined with RFI or acute inflammation were the best components identified and are easily accessible, allowing their potential use in clinical practice. (c) 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. (AU)

• Processo FAPESP: 16/14566-4 - Marcadores de diagnóstico e prognóstico em pacientes graves atendidos em serviço de emergência
• Beneficiário: Heraldo Possolo de Souza
• Modalidade de apoio: Auxílio à Pesquisa - Temático