Prevalence and prognostic implications of malnutrition as defined by GLIM criteria in elderly patients with heart failure
Open accessAbstract
BACKGROUND & AIMS: Although the Global Leadership Initiative on Malnutrition (GLIM) proposed a consensus scheme for diagnosing malnutrition in adults in clinical settings globally, the prevalence and prognostic value of malnutrition defined by GLIM criteria have yet to be evaluated in elderly patients with heart failure. This study aimed to determine the prevalence and prognostic implication of malnutrition as defined by GLIM criteria in comparison to those for a pre-existing definition of malnutrition, the geriatric nutritional risk index (GNRI), in elderly patients with heart failure METHODS: We evaluated malnutrition by two metrics, the GLIM criteria and geriatric nutritional risk index (GNRI), in 890 hospitalized patients with decompensation of heart failure aged ≥65 years, able to ambulate at discharge. The primary outcome was all-cause death within 1 year of discharge. RESULTS: According to GLIM criteria and GNRI <92, 42.4% and 46.5% of participants, respectively, had malnutrition, with moderate agreement (Cohen's kappa coefficient: 0.46 [95% confidence interval: 0.40-0.51]). During 1 year of follow-up, 101 (11.4%) deaths were observed, and malnutrition defined by either the GLIM criteria or GNRI was associated with a higher mortality rate, independent of other prognostic factors (GNRI: hazard ratio, 1.45, P = 0.031; GLIM: hazard ratio, 1.57, P = 0.016). Although malnutrition defined by either criterion showed additive prognostic value when added to a model incorporating pre-existing prognostic factors, defining malnutrition by GLIM criteria instead of the GNRI yielded a statistically significant improvement in model prognostic predictive ability (net-reclassification improvement, 0.44, P < 0.001; integrated discrimination index, 0.013, P < 0.001). CONCLUSIONS: In elderly patients with heart failure, 42.4% are malnourished according to the GLIM criteria, which is associated with a poor prognosis, independent of known prognostic factors. CLINICAL TRIAL REGISTRATION: University Hospital Medical Information Network (UMIN-CTR, https://www.umin.ac.jp/ctr/index.htm, study unique identifier: UMIN000023929).
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Among older adults with heart failure, GLIM-defined malnutrition is linked to higher mortality independently of other prognostic factors and has better prognostic ability than the Geriatric Nutritional Risk Index.
“Among older adults with HF, GLIM-defined malnutrition was linked to higher mortality independently of other prognostic factors and demonstrated better prognostic ability than the Geriatric Nutritional Risk Index (Table 2).7”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [7]
Malnutrition prevalence among hospitalized patients is estimated to range from 20% to 60%.
“Malnutrition prevalence estimates range from 20% to 60% for hospitalized patients.”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [7]
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Diagnosis and management of malnutrition in patients with heart failure
Esteban-Fernández, A., Villar-Taibo, R., Alejo, M., Arroyo, D., Bonilla Palomas, J. L., Cachero, M., Joaquin, C., Méndez Bailón, M., Pérez-Rivera, J. Á., Romero-Vigara, J. C., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12093320 · Cited by 61 · see citing works
Bian, W., Li, Y., Wang, Y., Chang, L., Deng, L., Li, Y., Jiang, H., & Zhou, P. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1174945 · Cited by 47 · see citing works
“It has been reported that malnutrition diagnosed by the GLIM criteria is significantly associated with a poor prognosis (6, 15, 78); it will not only increase the complications of patients (79) and prolong the length of hospital stay (80) but also increase the mortality rate (73).”
BackgroundSánchez-Rodríguez, D., De Meester, D., Minon, L., Claessens, M., Gümüs, N., Lieten, S., Benoit, F., Surquin, M., & Marco, E. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20075320 · Cited by 32 · see citing works
Vest, A. R., DiDomenico, R. J., Lichtenstein, L., Slater, T., Ekpo, E., Damluji, A. A., Bohula, E., Alviar, C. L., on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology, & Council on Cardiovascular and Stroke Nursing (2026) · Circulation · doi:10.1161/cir.0000000000001405 · Cited by 15 · see citing works
- Authors
- Hirose, S., Matsue, Y., Kamiya, K., Kagiyama, N., Hiki, M., Dotare, T., Sunayama, T., Konishi, M., Saito, H., Saito, K., Ogasahara, Y., Maekawa, E., Kitai, T., Iwata, K., Jujo, K., Wada, H., Kasai, T., Momomura, S.-I., & Minamino, T.
- Affiliations
- Juntendo University (JP)
- Kitasato University (JP)
- Yokohama City University Medical Center (JP)
- Sakakibara Hospital (JP)
- Kobe City Medical Center General Hospital (JP)
- Jichi Medical University (JP)
- Saitama Citizens Medical Center (JP)
- Japan Agency for Medical Research and Development (JP)
- Corresponding author
- Matsue, Yuya
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2021-06
- Volume
- 40
- Issue
- 6
- Pages
- 4334-4340
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W3123206395
- Cited by
- 101
- References
- 0
- Citations by year
- 2026: 12 · 2025: 24 · 2024: 24 · 2023: 17 · 2022: 18 · 2021: 5
- FWCI
- 10.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Novartis Pharma
- Japan Society for the Promotion of Science (18K15862)
- Japan Heart Foundation
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Keywords
- malnutrition, GLIM criteria, Geriatric Nutritional Risk Index, heart failure, elderly patients, acute decompensated heart failure, all-cause mortality, prognostic factors, nutritional assessment, malnutrition prevalence
- MeSH terms
- Aged, Aged, 80 and over, Female, Heart Failure, Humans, Male, Nutritional Status, Prognosis, Nutrition Assessment, Prevalence, Malnutrition
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