Relationship between global leadership initiative on malnutrition (GLIM) defined malnutrition and survival, length of stay and post-operative complications in people with cancer: A systematic review
Open accessAbstract
Background & aims The predictive validity of the GLIM criteria for survival, length of hospital stay (LOHS) and post-operative complications among people with cancer have not been systematically reviewed. This systematic review aims to determine whether GLIM malnutrition is predictive of these outcomes, and whether the predictive validity is affected by how phenotypic and etiologic criteria are assessed. Methods Cohort studies published after 2018 were systematically reviewed according to PRISMA guidelines from Embase, Medline Complete and CINAHL Complete. Risk of bias and methodologic quality were assessed using the Journal of the Academy of Nutrition and Dietetics' Quality Criteria Checklist tool for Primary research. Results In total, 21 studies were included, including 28,726 participants. All studies investigated survival, where 18 reported GLIM malnutrition is associated with decreased survival. LOHS was investigated in six studies, with all finding an association between GLIM malnutrition and longer LOHS. Post-operative complications were assessed in seven studies, of which five reported GLIM malnutrition was predictive of increased post-operative complications. Methods to assess the GLIM phenotypic and etiologic criteria varied, with consistent predictive ability for survival regardless of method of assessing reduced muscle mass. However, predictive ability was more variable across different measures of inflammation and reduced intake. Conclusion GLIM malnutrition was consistently predictive of worse clinical outcomes. Different measures of reduced muscle mass did not affect the predictive ability of GLIM for survival. However, variation in assessment of the etiologic criteria resulted in varying predictive ability of the GLIM diagnosis for survival.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Mortality and disease-free survival were consistently worse among those diagnosed with malnutrition by GLIM, and these clinical outcomes were even worse for severe compared with moderate malnutrition.
“Mortality and disease‐free survival were consistently worse among those diagnosed with malnutrition by the GLIM approach, and these clinical outcomes were even worse for those patients with severe compared with moderate malnutrition.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [16]
Eight systematic reviews, some with meta-analyses, of predictive validity (mainly mortality as the outcome) were published.
“Concurrently, eight SRs, some with meta‐analyses, of predictive validity (mainly mortality as the outcome) were published (Table 1). 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [16]
The largest systematic review/meta-analysis focused on patients with cancer included 21 cohort studies with 28,726 patients (14 from China, two from Spain, two from Australia, one from Greece, one from Turkey, and one from Japan).
“The largest SR/meta‐analysis, focused on patients with cancer, included 21 cohort studies with 28,726 patients (14 from China, two from Spain, two from Australia, one from Greece, one from Turkey, and one from Japan). 16”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [16]
Cites
Page, M. J., Moher, D., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., et al. (2021) · BMJ · doi:10.1136/bmj.n160 · Cited by 11,883 · see citing works
The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., et al. (2021) · International Journal of Surgery · doi:10.1016/j.ijsu.2021.105906 · Cited by 11,748 · see citing works
Poulter, S., Steer, B., Baguley, B., Edbrooke, L., & Kiss, N. (2021) · Nutrients · doi:10.3390/nu13082602 · Cited by 35 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
GLIM consensus approach to diagnosis of malnutrition: A 5‐year update
Jensen, G. L., Cederholm, T., Correia, M. I. T. D., Gonzalez, M. C., Fukushima, R., Pisprasert, V., Blaauw, R., Braz, D. C., Carrasco, F., Cruz Jentoft, A. J., et al. (2025) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.2756 · Cited by 75 · 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
Effects of high-protein supplementation during cancer therapy: a systematic review and meta-analysis
Orsso, C. E., Caretero, A., Poltronieri, T. S., Arends, J., de van der Schueren, M. A. E., Kiss, N. K., Laviano, A., & Prado, C. M. M. (2024) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2024.08.016 · Cited by 36 · see citing works
Self-citationSeid, A., Debebe, Z. Y., Ayelign, A., Abeje, M., Endris, B. S., Assefa, M., & Jemal, A. (2025) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.70012 · Cited by 32 · see citing works
Exploring the intersections of frailty, sarcopenia, and cachexia with malnutrition
Jensen, G. L., & Cederholm, T. (2024) · Nutrition in Clinical Practice · doi:10.1002/ncp.11180 · Cited by 19 · see citing works
Diagnosis of malnutrition in cancer patients
Song, C.-H., & Shi, H.-P. (2023) · Cancer Biology and Medicine · doi:10.20892/j.issn.2095-3941.2023.0473 · Cited by 19 · see citing works
“…among cancer patients, including older adults with cancer, cancer patients undergoing chemotherapy or major abdominal surgery, and patients with esophageal cancer, head and neck cancer, gastric cancer, colorectal cancer, lung cancer, hematologic malignancies, and pancreatic cancer 17 .”
BackgroundChiloiro, G., Cintoni, M., Palombaro, M., Romano, A., Reina, S., Pulcini, G., Corvari, B., Franco, S. D., Meldolesi, E., Egidi, G., et al. (2024) · Clinical and Translational Radiation Oncology · doi:10.1016/j.ctro.2024.100789 · Cited by 17 · see citing works
“[4 ].”
Gómez, J. J. L., Asensio, L. E., Cebriá, Á., Izaola-Jáuregui, O., Pérez-López, P., González-Gutiérrez, J., Primo, D., Jiménez-Sahagún, R., Hoyos, E. G., Rico, D., et al. (2025) · Nutrients · doi:10.3390/nu17101620 · Cited by 13 · see citing works
“The predictive capability of a GLIM diagnosis for survival appears to be influenced by the specific etiologic criteria applied [4].”
Sandini, M., Gianotti, L., Paiella, S., Bernasconi, D., Roccamatisi, L., Famularo, S., Donadon, M., Lucca, G. D. D., Cereda, M., Baccalini, E., et al. (2024) · Annals of Surgical Oncology · doi:10.1245/s10434-024-15143-w · Cited by 12
“12 17 BIVA works by measuring tissue resistance (R) and reactance (Xc) after alternating current has passed through the body.”
BackgroundNutritional Assessment Tools for Patients with Cancer: A Narrative Review
Wang, P., Soh, K. L., Khazaai, H. B., Ning, C., Huang, X., Yu, J., & Liao, J. (2024) · Current Medical Science · doi:10.1007/s11596-023-2808-4 · Cited by 11 · see citing works
“…head and neck cancer [91] , esophageal cancer [92] , colorectal cancer [54] , and osteosarcoma [93] Mortality and survival [94–96] , complications [94, 97, 98] , hospitalization periods [94, 99] , quality of life [100–102] , anxious and depressive symptoms [101, 103] Lower diagnostic accuracy…”
InfluentialSulosaari, V., Beurskens, J., Laviano, A., & Erickson, N. (2024) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2024.151798 · Cited by 10 · see citing works
Zheng, K., Liu, X.-L., Li, Y.-G., Cui, J., & Li, W. (2024) · Scientific Reports · doi:10.1038/s41598-024-63806-1 · Cited by 9 · see citing works
“From an objective perspective, malnutrition not only affects the choice of anti-tumor treatment, reduces response rates to treatment, increases subjective symptoms, and lowers the quality of life, but also increases the incidence of complications and mortality 44,45 .”
BackgroundWang, F., Wang, C., Zhang, L.-W., & Li, X. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1642171 · Cited by 6 · see citing works
The Global Leadership Initiative on Malnutrition (GLIM)
Jensen, G. L., & Compher, C. W. (2025) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2025.06.028 · Cited by 4 · see citing works
López-Plaza, B., Álvarez-Mercado, A., Arcos-Castellanos, L., Plaza-Díaz, J., Ruiz-Ojeda, F. J., Brandimonte-Hernández, M., Feliú-Batlle, J., Hummel, T., Gil, Á., & Milla, S. P. (2024) · Nutrients · doi:10.3390/nu16121905 · Cited by 5 · see citing works
“This condition determines the outcome of cancer patients [22] since its presence is associated with treatment-induced toxicity, an increase in the postoperative risk of complications [23], poor prognosis, overall survival reduction [24], and increased mortality.”
BackgroundNguyen, B., Ruediger, D., Wischmeyer, P. E., Agarwal, S. M., & Haines, K. (2025) · Journal of Surgical Research · doi:10.1016/j.jss.2025.04.011 · Cited by 4 · see citing works
Choron, R., Rallo, M., Piplani, C., Youssef, S., Teichman, A., Bargoud, C., Sciarretta, J., Smith, R. N., Hanos, D. S., Afif, I. N., et al. (2024) · Journal of Trauma and Acute Care Surgery · doi:10.1097/ta.0000000000004303 · Cited by 4 · see citing works
“Overall, hospital length of stay was shorter among EN patients versus both PN groups (27 [24] days vs. 44 [62] days vs. 45 [31] days, p = 0.001).”
InfluentialCombining GLIM phenotypic criteria improves survival prediction in cancer-associated malnutrition.
Gallardo, M. G., Jiménez, B. R., Pena, N. G., Gómez, P. R. D. V., Padillo, J. P., Arenas, Á. V., López, M. L., Aguilera, B. G., Martínez-Brocca, M. A., & Restrepo, J. R. R. (2025) · Nutrition (Burbank, Los Angeles County, Calif.) · doi:10.1016/j.nut.2025.112958 · Cited by 3 · see citing works
Okazoe, Y., Yanagimoto, H., Tsugawa, D., Akita, M., Mizumoto, T., Yoshida, T., So, S., Ishida, J., Urade, T., Nanno, Y., et al. (2025) · Surgery today (Print) · doi:10.1007/s00595-025-03051-9 · Cited by 3 · see citing works
“Brown et al. [11] performed a systematic review and elicited that GLIM-defined malnutrition in patients with cancer was consistently associated with more postoperative complications and a prolonged postoperative hospital stay.”
Xie, T., Li, J., Wu, X., Yang, X.-X., Wang, M.-M., Dong, Q., Chen, X., Chen, W., & Zheng, X.-Y. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1559111 · Cited by 3 · see citing works
Surma, S., Czapla, M., Uchmanowicz, I., Juárez‐Vela, R., Pietrzykowski, Ł., Uchmanowicz, B., Leśkiewicz, M., Griesmann, K., Burzyński, M., Smereka, J., et al. (2025) · Nursing Reports · doi:10.3390/nursrep15030110 · Cited by 3 · see citing works
Zhang, G., Lyu, Y., Liu, X., Chen, Y., Ming, F., & Huang, J. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1802280 · Cited by 2 · see citing works
“Since its official release in 2019, the GLIM criteria have swiftly emerged as a pivotal focus in oncological nutrition research (13–15 , 20 ).”
Wang, H., Liu, C., Zheng, X., Huang, Y., Wei, K., Liu, J., Zhou, H.-C., Zhang, Y.-M., Wang, C., & Feng, Z.-E. (2026) · JPEN - Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.70061 · Cited by 2
Lan, L., Guo, S.-Y., Han, Y., Zhai, S., Liu, Y., Li, P., Zhang, X.-D., & Dong, S.-P. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1633212 · Cited by 2
Management of Traumatic Duodenal Injury: Is There a Role for Early Parenteral Nutrition?
Vira, A., Roberts, P., Preus, R., Posey, C., Miller, S. G., Simmons, J. D., Polite, N. M., Bright, A. C., Kinnard, C. M., Williams, A. Y., et al. (2024) · Journal of Surgical Research · doi:10.1016/j.jss.2024.07.119 · Cited by 2
Zheng, X., Zhang, X., Zhang, Y.-J., Huang, F.-Y., Wang, Y., Gao, R., Li, Q.-M., Liu, W.-Q., Luo, C.-N., & Liu, F. (2024) · journal of nutritional oncology · doi:10.1097/jn9.0000000000000033 · Cited by 2 · see citing works
Wei, L.-S., Yang, J.-J., Wang, S.-Y., Xu, N., Chen, Y.-B., Zhong, P., Lin, S.-Y., Shi, H.-P., Chen, J.-Q., & Xie, H.-L. (2026) · Supportive Care in Cancer · doi:10.1007/s00520-026-10965-8 · Cited by 1 · see citing works
Salman, L., Kulkarni, A., & McGee, J. (2026) · Current Oncology · doi:10.3390/curroncol33060358 · Cited by 1 · see citing works
Zhang, L., Guo, R., Ou, Y.-Y., Zhuang, Y., Li, M., Li, Z.-J., & Chen, P.-J. (2026) · Discover Oncology · doi:10.1007/s12672-026-05247-y · Cited by 1
“Cancer-related malnutrition increases treatment-related adverse effects, prolongs hospitalization [2, 3], and significantly impairs quality of life and prognosis [4, 5–6].”
Gao, C., & Zhang, X. (2026) · Frontiers in Oncology · doi:10.3389/fonc.2026.1789366 · Cited by 1 · see citing works
Jiménez, B. R., Gallardo, M. A. I., Pena, N. G., López, M. L., Aguilera, B. G., Martín, M. C. C., Naranjo, M. M. C., & Gómez, P. R. D. V. (2026) · Nutrition · doi:10.1016/j.nut.2026.113296 · Cited by 1 · see citing works
Li, W., Zhang, J., Liu, J., Xu, F.-Y., Hua, C., Qiu, Q., & Xie, H. (2026) · Hematology · doi:10.1080/16078454.2026.2631924 · Cited by 1 · see citing works
The relationship between malnutrition, frailty, and sarcopenia according to the GLIM and MNA-SF
Aydin, A. E., Seydi, K. A., Gozen, F., & Bulut, E. A. (2025) · Irish Journal of Medical Science · doi:10.1007/s11845-025-04190-1 · Cited by 1 · see citing works
Impact of GLIM-criteria-defined malnutrition on outcomes in gastrointestinal cancer patients
Quintana, J. M., Larrea, N., Martín, J., Bolinaga, I., Sarasqueta, C., Perales, A., Iglesias, N. C., Yoldi, A., & Garcia, Y. (2025) · Nutrition · doi:10.1016/j.nut.2025.112980 · Cited by 1 · see citing works
Dai, Z.-S., Wu, Y., Huang, H.-Q., Chen, J., Jiang, H., Wang, Y., & Zheng, H.-Z. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-06399-2 · Cited by 1
Liu, C.-C., Yang, J., Yin, G., Tian, Z., & Qin, C. (2025) · World Journal of Gastrointestinal Surgery · doi:10.4240/wjgs.v17.i8.107706 · Cited by 1 · see citing works
“Additionally, the Global Leadership Initiative on Malnutrition (GLIM) criteria, which combines phenotypic and etiological factors for a more comprehensive evaluation of malnutrition, could offer a more standardized approach for assessing nutritional outcomes [58,59].”
Ishido, K., Nakashima, M., Poudel, S., Naito, Z., Motoyoshi, A., Sano, K., & Hirano, S. (2025) · Cureus · doi:10.7759/cureus.86826 · Cited by 1 · see citing works
Malnutrition risk and overall survival at solid tumour diagnosis
McFarlane, T. L., Symanowski, J. T., Walsh, D., Aung, Y. M., Aktas, A., Szafranski, M. L., Salo, J. C., Meadors, P., & Kadakia, K. (2025) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2024-004906 · Cited by 1
Aiso, Y., Inada, J., Kikuchi, T., Sekikawa, S., Sakai, K., & Nomura, T. (2026) · International Journal of Oral & Maxillofacial Surgery · doi:10.1016/j.ijom.2026.09.025
Zhang, Y.-M., Huang, Y., Zhou, H.-C., Zhang, X., Wang, H., Liu, C., Li, J.-Z., Su, M., Wang, C., Han, Z.-X., et al. (2026) · Current Developments in Nutrition · doi:10.1016/j.cdnut.2026.109562
Zhong, W., Zhu, X., Tang, F., & Xu, L. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1939731
“In recent years, multiple studies have confirmed that the GLIM criteria can effectively identify malnutrition in cancer patients, and that a diagnosis of mal-nutrition is closely associated with adverse clinical outcomes such as infection, readmission, treatment toxicity, and mortality (17–19).”
Ballı, E., & Gürsoy, F. (2026) · Ahi evran medical journal · doi:10.46332/aemj.1908590
Zhan, Y. F., Tsang, J., & Gillis, C. (2026) · Anesthesiology · doi:10.1097/aln.0000000000006182
Zheng, L., Fu, L., Ye, X., Zhuang, B., Kim, M. J., Baydoun, M., & Casida, J. M. (2026) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2026.100965
Wang, C., Ni, N., Zhao, B., Zhang, S., & Zhang, Y.-L. (2026) · Scientific Reports · doi:10.1038/s41598-026-43025-6
“This framework has been validated across diverse populations as a reliable tool for nutritional assessment and prognosis prediction, including in oncology and transplantation settings 10–12 .”
Prealbumin predicts metachronous liver metastasis in colorectal cancer
Xie, H.-B., Zhang, B.-B., Zhao, L., Liu, L., Liu, P.-P., Zhang, X., Miao, S.-D., Wang, R., & Xu, H.-T. (2025) · BMC Cancer · doi:10.1186/s12885-025-15296-1
“Firstly, malnutrition is associated with worse postoperative outcomes and reduced survival [24].”
Mattavelli, E., Cotogni, P., Banks, H., Lorenzo, F. D., Iannelli, E., Campo, L. D. D., Perrone, L., Pinto, C., Pedrazzoli, P., & Caccialanza, R. (2025) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2025-005774
Octaviani, P., Wulandari, Y., Ibrahim, F., & Andayani, D. E. (2024) · International Journal of Public Health Science (IJPHS) · doi:10.11591/ijphs.v13i4.24175
“It also found that although the parameters for phenotypic and etiologic criteria varied across different studies in the review, the results consistently showed that GLIM criteria were associated with poor clinical outcomes [26].”
Result
- Authors
- Brown, D., Loeliger, J., Stewart, J., Graham, K. L., Goradia, S., Gerges, C., Lyons, S., Connor, M., Stewart, S., Di Giovanni, A., D'Angelo, S., & Kiss, N.
- Affiliations
- Deakin University (AU)
- Peter MacCallum Cancer Centre (AU)
- Corresponding author
- Kiss, Nicole
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2023-03
- Volume
- 42
- Issue
- 3
- Pages
- 255-268
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W4315865234
- Cited by
- 57
- References
- 0
- Citations by year
- 2026: 17 · 2025: 25 · 2024: 13 · 2023: 2
- FWCI
- 2.05
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
- Keywords
- GLIM, GLIM criteria, malnutrition, cancer, survival, length of hospital stay, postoperative complications, predictive validity, inflammation
- MeSH terms
- Humans, Leadership, Length of Stay, Neoplasms, Nutritional Status, Postoperative Complications, Nutrition Assessment, Malnutrition
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
