Applicability Of GLIM Criteria In Nutritional Evaluation Of Inpatients With Gastrointestinal Cancer

Objective:Gastrointestinal Cancer（GIC）ranks among the forefront in terms of incidence and mortality,which seriously threatens human life and health and greatly increases the burden of cancer diseases worldwide and in our country.The prevention and treatment of GIC has become an important public health problem.Malnutrition is an important factor in the occurrence and development of cancer,and a major negative factor for the most common complications and adverse clinical outcomes in cancer patients.Studies show that the incidence of malnutrition in GIC inpatients is as high as 70%,but the rate of nutritional treatment is not high.Therefore,it is extremely necessary to evaluate the nutritional status of GIC patients in time and take active nutritional intervention measures.Patient-generated subjective global assessment（PG-SGA）can be used as a nutritional assessment method for cancer patients,and it has been well verified clinically.Our country has also used PG-SGA as a national standard for nutritional evaluation of cancer patients,but due to the late proposal of GLIM criteria,it has not been popularized and used in clinical practice.Therefore,in this study,patients with GIC were selected as research objects.GLIM and PG-SGA were respectively used for nutritional assessment,body composition of patients with GIC was measured,and biochemical indicators detected within 48 hours after admission were collected.Taking PG-SGA as the reference standard,the application effect of GLIM and PG-SGA in the assessment of GIC patients with malnutrition was compared to analyze the influencing factors of different methods in the diagnosis of malnutrition,so as to provide an appropriate assessment tool for the diagnosis of GIC patients with malnutrition and provide a basis for the clinical application of GLIM criteria.Methods:（1）Nutrition Risk Screening 2002（NRS2002）was used to perform nutritional risk screening for GIC patients admitted to the Department of Oncology,The First Affiliated Hospital of China Medical University from September 2021 to July 2022.GLIM criteria and PG-SGA were used for nutritional assessment,and Kappa consistency test was used to analyze the consistency of GLIM criteria and PG-SGA scale.（2）GLIM criteria was used to divide patients into non-dystrophic group and dystrophic group.Nutrient-related biochemical indexes,body composition and clinical characteristics of patients in the two groups were compared to verify the application effect of GLIM criteria in the nutritional assessment of GIC patients.（3）To explore the application effect of GLIM criteria combination of different phenotypes and etiological types in the assessment of GIC patients with malnutrition.（4）Univariate and multivariate analysis was used to explore the influencing factors of malnutrition in GIC patients.Results:（1）PG-SGA using to diagnose malnutrition patients was 60.6%.The morbidity of malnutrition diagnosed by GLIM method was 75.3%,of which 62.6%were moderate and 30.3%were severe.Hemoglobin（130.07±23.07 g/L vs.121.93±25.12 g/L,P=0.044）,serum albumin（39.01±3.74 g/L vs.37.35±4.17 g/L,P=0.023）,serum prealbumin（20.58±3.96 g/L vs.18.30±5.44 g/L,P=0.010）,body mass index（24.06±2.61 kg/m2 vs.22.48±3.36 kg/m2,P=0.003）,body fat（19.97±5.95 kg vs.17.28±6.85 kg,P=0.016）,fat-free body mass index（17.15±1.87 kg/m2 vs.16.22±1.99 kg/m2,P=0.004）,skeletal muscle mass（26.19±5.65 kg vs.24.03±5.40 kg,P=0.017）,skeletal muscle mass index（9.25±1.23 kg/m2 vs.8.48±1.54 kg/m2,P=0.002）and visceral fat area（88.11±35.63cm2vs.78.15±38.27 cm2,P=0.002）were low.Elder and low TPAI were independent risk factors for malnutrition.（2）GLIM criteria were used to diagnose malnutrition.AUC^ROCof each diagnostic variable was calculated,and TPAI was found to have the best diagnostic value for malnutrition.Among all the single diagnostic indicators,the correlation coefficient between TPAI and GLIM was the largest（Pearson correlation coefficient was-0.224,P=0.002）.（3）Malnutrition diagnosed with involuntary weight loss,BMI,body composition and TPAI included in GLIM criteria had the highest similarity to PG-SGA,and GLIM sensitivity increased after TPAI was included（81.7%）.（4）Both PG-SGA and GLIM criteria could diagnose dystrophy in GIC patients,and the difference between them was not statistically significant.Conclusions:（1）TPAI was more sensitive than SMI and FFMI in the diagnosis of malnutrition as a diagnostic criterion for muscle mass loss.（2）Elder and low TPAI were independent risk factors for malnutrition.（3）The consistency of GLIM criteria and PG-SGA in the diagnosis of dystrophy in GIC patients was moderate.