| There is no uniform standard for the diagnosis of malnutrition,the Global Leadership Initiative on Malnutrition(GLIM)criteria aims to establish a universal method for nutritional assessment worldwide,but it lacks clinical efficacy,it is of great significance to explore the clinical application of GLIM criteria.This study is divided into two parts,through the application and verification of GLIM criteria,this study provides a basis and a new method for the diagnosis(evaluation)of clinical malnutrition.Part1 Application of the preoperative fat free mass index within the GLIM criteria in patients undergoing gastroesophageal cancer surgeryObjectiveTo investigate the effect of fat free mass index(FFMI)on the clinical prognosis of patients undergoing gastroesophageal cancer surgery,and validate the role of FFMI in the Global Leadership Initiative on Malnutrition(GLIM).MethodsPatients who underwent surgery for gastroesophageal cancer in four tertiary referral hospitals from September 2015 to June 2018 were collected,the body fat free mass was determined by the body composition analyzer and FFMI was calculated,according to the FFMI bound of GLIM criteria,the patients were divided into FFMI reduction group and FFMI normal group,the clinical outcomes of the two groups were compared.The correlation and consistency of body mass index(BMI)and FFMI in the diagnosis of malnutrition were also observed.ResultsCompared to the FFMI normal group,the postoperative hospital stay,postoperative incision healing time and postoperative antibiotic use time of the FFMI reduction group were prolonged(P<0.05),while there was no significant difference in length of stay,duration of postoperative parenteral nutrition and other clinical outcomes such as postoperative complications(P>0.05).There was a strong linear correlation between BMI and FFMI(r=0.661),there was no statistically significant difference in the positive rate of diagnosis of malnutrition by BMI and FFMI combined with disease burden(McNemar test P=0.791)and had a moderate consistency(Kappa=0.457,P=0.001).ConclusionPreoperative reduction of FFMI in patients with gastroesophageal cancer is closely related to postoperative clinical outcomes,and FFMI can be used as one of the phenotypic criterion of GLIM criteria.Part2 Application of GLIM criteria in nutritional assessment of patients with gastrointestinal dysfunctionObjectiveTo explore the application effect of GLIM standard in nutritional assessment of patients with gastrointestinal dysfunction.MethodsThe patients with gastrointestinal dysfunction admitted to the Clinical Nutrition Treatment Center of General Surgery in the General Hospital of Eastern Theater Command from January 2015 to January 2020 were collected.GLIM and ESPEN criteria were used to diagnose malnutrition.The consistency between these criteria and the consistency and efficacy of GLIM phenotypic criteria were recorded.ResultsThe malnutrition rate of GLIM diagnosis(93.4%)was higher than that of ESPEN diagnosis(80.9%),and the kappa value of the consistency test was 0.459.Combined with etiologic criteria,fat free mass index(FFMI)(79.7%)had a higher malnutrition rate than body mass index(BMI)(70.6%),appendicular skeletal muscle index(ASMI)(55.6%),and skeletal muscle index(SMI)(53.1%),the correlation between FFMI and them was strong and the consistency was moderate.At the same time,there was no significant difference in area under the curve of malnutrition diagnosis[except ASMI(P<0.001)].Based on the 2015 ESPEN consensus,combined with etiological criterion,reduced muscle mass had the highest sensitivity(91.9%)in GLIM phenotypic criteria,FFMI had the highest sensitivity(90.7%)in reduced muscle mass criterion.There was a certain correlation between muscle mass and other nutritional indicators.The proportion of non-voluntary weight loss,low SMI and high C-reactive protein was higher in the extended length of stay group(P<0.05).ConclusionGLIM criteria can be used as a new method for the diagnosis of malnutrition,and more confirmative studies are needed. |
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