The Prevalence of Malnutrition at the Nutrition Outpatient Clinic - A Comparison of the GLIM Criteria to Clinical Practice

Abstract

Introduction: In 2018, the GLIM (Global Leadership Initiative on Malnutrition) criteria were presented in an attempt to make international consensus regarding diagnosis of malnutrition. However, the agreement between GLIM and established assessment methods is still uncertain. Therefore, in this study, the GLIM criteria were compared to the Patient-Generated Subjective Global Assessment (PG-SGA) and the International Classification of Diseases, 10th revision (ICD-10). Method: This cross-sectional study was conducted at the Nutrition Outpatient Clinic at Oslo University Hospital, which treats patients suffering from various nutrition-related issues. Patients were included from September-December 2019. The GLIM criteria is a three-step process including a screening for the risk of malnutrition in step 1, and Nutritional Risk Screening 2002 (NRS-2002) was used as the screening tool. In addition, GLIM was also performed without the screening in step 1, only performing step 2-3 which includes malnutrition diagnosis and severity grading. The GLIM results were then compared to PGSGA categories and the ICD-10 malnutrition codes. Results: The GLIM criteria, including NRS-2002 in step 1, resulted in a malnutrition prevalence of 36%, while GLIM without screening found 59% of the participants to be malnourished. NRS-2002 had a sensitivity of 61% and a specificity of 83% towards GLIM step 2. PG-SGA categorized 69% of the participants as malnourished, while the ICD-10 codes found a malnutrition prevalence of 41%. Comparing GLIM and PG-SGA regarding malnutrition diagnosis resulted in 51-77% agreement and kappa values in the range 0.28-0.51. Comparing GLIM and ICD-10 regarding malnutrition diagnosis resulted in 53-76% agreement and kappa values in the range 0.26-0.49. Conclusion: The frequency of malnutrition varied from 36-59% depending on how the GLIM process was performed. In general, GLIM showed only fair to moderate agreement with the methods used in clinical practice. A joint consensus on how to perform the GLIM process is also needed for comparisons of future studies, before making any conclusion about GLIM’s validity.