Cited by 96Nutrition and Health in AgingClinical Nutrition and GastroenterologyBody Composition Measurement Techniques

Agreement between GLIM and PG-SGA for diagnosis of malnutrition depends on the screening tool used in GLIM

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Henriksen, Christine, Paur, Ingvild, Pedersen, Astrid, Kværner, Ane Sørlie, Ræder, Hanna, Henriksen, Hege Berg, Bøhn, Siv Kjølsrud, Wiedswang, Gro +1 more·2022·Clinical Nutrition

Abstract

BACKGROUND & AIM: The Global Leadership Initiative on Malnutrition (GLIM) has suggested a process for the diagnosis of malnutrition. The process consists of applying an existing screening tool for malnutrition screening, followed by malnutrition diagnostics, and finally categorization of malnutrition severity (moderate or severe) according to specific GLIM criteria. However, it is not known how well the GLIM process agrees with other diagnostic tools used in the current clinical practice. The aim of this study was to validate the GLIM process against the Patient Generated-Subjective Global Assessment (PG-SGA) when different screening tools were applied in the screening step of the GLIM process. METHODS: Colorectal cancer (CRC) patients from the ongoing CRC-NORDIET study were included. For the GLIM process, the patients were first screened for malnutrition using either 1) Nutritional risk screening, first 4 questions (NRS-2002-4Q), 2) Malnutrition Screening Tool (MST), 3) Malnutrition Universal Screening Tool (MUST) or 4) the PG-SGA short form (PG-SGA-SF). The GLIM malnutrition diagnosis was then based on combining the result from each of the screening methods with the etiological and phenotypic GLIM-criteria including weight loss, BMI and fat free mass. In parallel, the patients were diagnosed using the PG-SGA methodology categorizing the patients into either A: well nourished, B: moderately malnourished or C: severely malnourished. The four different GLIM based diagnoses were then validated against the diagnosis obtained by the PG-SGA tool. Sensitivity, specificity and positive predictive value (PPV) were calculated to evaluate validity. RESULTS: In total, 426 patients were included (mean age: 66, ±8 years) at a mean time of 166 (±56) days after surgery. The GLIM diagnosis based on the four different screening tools identified 10-24% of the patients to be malnourished, of which 3-8% were severely malnourished. The PG-SGA method categorized 15% as moderately malnourished (PG-SGA: category B) and no patients as severely malnourished (PG-SGA: category C). The agreement between the PG-SGA and GLIM process was in general low, but differed according to the tools: PG-SGA SF (sensitivity 47%, PPV 71%), MST (sensitivity 56%, PPV 47%), NRS-2002-4Q (sensitivity 63%, PPV 53%) and MUST (sensitivity 53%, PPV 34%). CONCLUSION: In this cross-sectional study of patients with CRC, the concordance between the GLIM-criteria and PG-SGA depended on the screening tool used in the GLIM process. Malnutrition frequency based on the GLIM process schould be reported with and without the use of a screening tool.

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  • The screening tool selected-tools that identify risk of malnutrition versus tools that identify malnutrition-affects the prevalence of malnutrition diagnosed by GLIM.

    “The experience collected after the introduction of the GLIM procedure indicates that the screening tool selected—ie, tools that identify “risk of malnutrition” vs tools that identify “malnutrition”—affects the prevalence of malnutrition diagnosed by GLIM. 37 , 38”

    From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [38]

    The Conclusion reports that GLIM-diagnosed malnutrition in patients with colorectal cancer ranged from 10% to 24% depending on the step-0 screening tool. The paper does not establish the claim’s specific distinction between tools that identify risk of malnutrition and tools that identify malnutrition as the reason prevalence differs; Section 2.3 describes all four tested tools as screening for risk. (LLM, conf=0.84)

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Authors
Henriksen, C., Paur, I., Pedersen, A., Kværner, A. S., Ræder, H., Henriksen, H. B., Bøhn, S. K., Wiedswang, G., & Blomhoff, R.
Affiliations
  • University of Oslo (NO)
  • Oslo University Hospital (NO)
Corresponding author
Henriksen, Christine
Venue
Clinical Nutrition
Publisher
Elsevier BV
Published
2022-02
Volume
41
Issue
2
Pages
329-336
ISSN
0261-5614 (ISSN-L)
OpenAlex
W4200106084
Cited by
95
References
35
Citations by year
2026: 17 · 2025: 27 · 2024: 22 · 2023: 17 · 2022: 12
FWCI
8.05
Type
journal article
Language
en
Open access
Locations
  • Clinical Nutrition (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
Funders
  • South-Eastern Norway Regional Health Authority
  • Throne Holst Foundation
  • The Norwegian Cancer Society
  • Research Council of Norway
Topics
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
Keywords
GLIM criteria, Patient-Generated Subjective Global Assessment, malnutrition diagnosis, Malnutrition Screening Tool, colorectal cancer, postoperative malnutrition, Malnutrition Universal Screening Tool, diagnostic agreement, sensitivity and specificity, malnutrition severity, fat-free mass, body mass index, weight loss
MeSH terms
Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Male, Mass Screening, Middle Aged, Predictive Value of Tests, Sensitivity and Specificity, Severity of Illness Index, Colorectal Neoplasms, Reproducibility of Results, Nutrition Assessment, Malnutrition

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