Dissecting the global leadership initiative on malnutrition criteria in advanced cancer: Reduced intake vs. inflammation

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-03-12 DOI:10.1016/j.clnesp.2025.03.007

Michael S. Yule , Andressa M. Machado , Leo R. Brown , Bruna M.M. Rocha , Rebekah Patton , Judith Sayers , Iona Munro , Jennifer Baxter , Amy McLuskie , Paula P. Lajolo , Jann Arends , Carlos E. Paiva , Mark Stares , Duncan Brown , Iain Phillips , Donald C. McMillan , Yara C.P. Maia , Richard J.E. Skipworth , Barry J.A. Laird

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引用次数: 0

Abstract

Background & aims

The Global Leadership Initiative on Malnutrition (GLIM) criteria have been recommended for the diagnosis of malnutrition. It requires that the patient meets at least one phenotypic criterion and at least one aetiological criterion. For the latter, the patient must either demonstrate reduced food intake or have evidence of systemic inflammation. As both are common in advanced cancer, the aim of the present study was to determine, in patients who met the GLIM phenotypical criteria, which GLIM aetiological criteria (reduced food intake or systemic inflammation) is most useful in predicting overall survival (OS).

Methods

Data from two cancer biobanks were combined. Inclusion criteria were: ≥18 years, advanced cancer (stage III or IV) and ability to provide written consent. Weight loss (WL) was selected as the phenotypic criterion of choice, as preliminary analysis demonstrated it to be a superior predictor of OS compared to body mass index. Malnutrition type 1 was defined as >5 % WL over 6 months and a C reactive protein (CRP) ≥3 mg/l. Further analysis was performed with a CRP >10 mg/l cut-off. Malnutrition type 2 was defined as >5 % WL over 6 months and reduced food intake, as reported in the Patient Generated Subjective Global Assessment. Survival was assessed using Kaplan-Meier methodology, log-rank tests and Cox proportional hazards models, with hazard ratios (HR) and confidence intervals (CI) reported.

Results

In total, 176 patients were studied, with 147 events observed. The 3-month mortality rate was 32.4 % (CI: 25.1 to 39.0) and the 1-year mortality rate was 71.8 % (CI: 63.8 to 78.0). Malnutrition type 1 and malnutrition type 2 were observed in 37.8 % (HR: 2.27 [CI: 1.54 to 3.33], p < 0.001) and 26.3 % (HR: 1.74 [CI: 1.19 to 2.54], p = 0.005) of patients respectively, with both significantly increasing the risk of death. Following adjustment for relevant confounders both malnutrition type 1 (HR: 1.92 [CI: 1.25 to 2.94], p = 0.003) and malnutrition type 2 (HR: 1.61 [CI: 1.09 to 2.38], p = 0.019) remained significant predictors of OS. Median survival for patients with malnutrition type 1 was 2.14 (CI: 1.74 to 4.90) months compared to 9.5 (6.94–13.64) months for those without (p < 0.001). For malnutrition type 2, this was 2.37 (CI: 1.64 to 5.46) vs. 7.40 months (CI: 6.08 to 10.16), p = 0.004. When the CRP threshold was increased to >10 mg/l, malnutrition type 1 was observed in fewer patients (30.4%), median survival was shorter (1.91 [CI: 1.25 to 2.99] vs. 9.86 months [CI: 7.27 to 14.7], p < 0.001) and in both univariable (HR: 2.91 [CI: 1.94 to 4.63], p < 0.001) and multivariable (HR: 2.32 [CI: 1.50 to 3.60], p < 0.001) analyses, the risk of death increased.

Conclusion

The results suggest that the inflammatory component of GLIM appears superior compared to reduced intake in predicting OS and notably, a higher CRP threshold correlates with shorter OS. Therefore, whilst GLIM has multiple potential combinations, all treated with equal regard, these data suggest that the inflammatory aetiological component should be hierarchical to others.

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剖析晚期癌症患者营养不良全球领导倡议标准：摄入量减少与炎症。

背景与目的：全球营养不良领导倡议（GLIM）标准已被推荐用于营养不良的诊断。该标准要求患者至少符合一项表型标准和至少一项病因标准。对于后者，患者必须表现出食物摄入量减少或有全身炎症的证据。由于这两种情况在晚期癌症中都很常见，本研究旨在确定在符合 GLIM 表型标准的患者中，哪种 GLIM 病因标准（食物摄入减少或全身炎症）对预测总生存期（OS）最有用：方法：合并两个癌症生物库的数据。纳入标准为：年龄≥18岁，晚期癌症（III期或IV期），能够提供书面同意书。体重减轻（WL）被选为表型标准，因为初步分析表明，与体重指数相比，体重减轻能更好地预测OS。1型营养不良的定义是：6个月内体重减轻>5%，C反应蛋白（CRP）≥3毫克/升。进一步分析以 CRP >10mg/l 为截止值。2型营养不良的定义是6个月内WL>5%且食物摄入量减少，如患者主观全面评估报告所示。采用 Kaplan-Meir 方法、对数秩检验和 cox 比例危险模型评估生存率，并报告危险比（HR）和置信区间（CI）：共研究了 176 名患者，观察到 147 起事件。3个月死亡率为32.4%（CI：25.1-39.0），1年死亡率为71.8%（CI：63.8-78.0）。37.8%的患者观察到营养不良类型1和营养不良类型2（HR：2.27 [CI：1.54至3.33]，p10mg/l，观察到营养不良类型1的患者较少（30.4%），中位生存期较短（1.91 [CI：1.25至2.99] 对9.86个月 [CI：7.27至14.7]，p结论：结果表明，与减少摄入量相比，GLIM 中的炎症成分在预测 OS 方面更具优势，值得注意的是，较高的 CRP 阈值与较短的 OS 相关。因此，虽然 GLIM 有多种可能的组合，但所有组合都应受到同等对待，这些数据表明，炎症病因成分应优先于其他成分。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.