Incorporating CT-Derived Body Composition analysis into the Global Leadership Initiative on Malnutrition criteria is associated with overall survival: findings from an international cancer cohort.

Abstract

Background: Cancer-associated malnutrition is highly prevalent and linked to adverse outcomes. However, studies evaluating malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria with inclusion of computed tomography (CT)-derived muscle mass is limited, particularly in Caucasian oncology populations. Moreover, the prevalence of GLIM-defined malnutrition and its association with overall survival across different treatment intents remain insufficiently characterized.

Objective: This study investigates whether incorporating CT-derived body composition assessment into the GLIM criteria improves the detection of malnutrition in oncology patients, and to evaluate its association with overall survival across different treatment intent groups.

Design: Secondary analysis of data from two observational, prospective studies in Ireland and the United Kingdom that both examined nutritional and inflammatory status and survival in patients. GLIM phenotypic and etiologic criteria were retrospectively applied using data available from these studies. Reduced muscle mass was derived from CT.

Participants: /Setting: Data were available for 1,405 patients enrolled between 2011-2016; 1,118 had evaluable CT scans. Treatment intent included curative (n=428), palliative active treatment (n=873), and supportive care (n=104).

Main outcome: Prevalence of GLIM-diagnosed malnutrition incorporating CT muscle assessment and its association with overall survival (months) by treatment intent. Survival analysis was carried out using Kaplan-Meier curves and Cox-Regression.

Statistical analysis: Descriptive statistics characterized clinical characteristics and nutritional status. Analyses were conducted in SPSS and statistical significance was considered at p<0.05.

Results: GLIM-malnutrition was identified in 40.4% (22.6% moderate; 17.8% severe). Among those with CT scans, 42.2% had low muscle mass, while only 24.8% had experienced >5% weight loss. CT analysis identified GLIM malnutrition in 22.8% of patients missed by weight/BMI criteria. Median follow-up was 102.4 months. Median survival was 30.4 months for well-nourished patients versus 13.5 months (moderate) and 6.4 months (severe) for malnourished patients (p<0.001). Adjusted hazard ratios for death were 1.379 (moderate malnutrition) and 1.799 (severe malnutrition) (p<0.001).

Conclusion: GLIM-diagnosed malnutrition, particularly when incorporating CT-derived muscle mass, is common and strongly predicts poor survival across treatment intents. CT-based assessment identifies patients with muscle wasting who may be missed by conventional criteria, supporting its integration into GLIM phenotyping.