Analysis of ESPEN and GLIM algorithms reveals specific drivers for the diagnosis of malnutrition in patients with chronic gastrointestinal diseases

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2023-02, Vol.106, p.111887-111887, Article 111887
• Main Authors: Bannert, Karen, Sautter, Lea Franziska, Wiese, Mats Lukas, Meyer, Fatuma, Ehlers, Luise, Fromhold-Treu, Sophie, Karbe, Cathleen, Gärtner, Simone, Lerch, Markus M., Aghdassi, Ali A., Jaster, Robert, Valentini, Luzia, Lamprecht, Georg
• Format: Article
• Language: English
• Subjects: Algorithms; Body mass index; Body size; Body weight loss; C-reactive protein; Chronic Disease; Chronic illnesses; Chronic pancreatitis; Cirrhosis; Clinical nutrition; Clinical trials; Criteria; Cross-Sectional Studies; ESPEN; Fat-free body mass; Food; Food intake; Gastroenterology; Gastrointestinal diseases; Gastrointestinal Diseases - complications; Gastrointestinal Diseases - diagnosis; GLIM; Humans; Inflammation; Laboratories; Leadership; Liver Cirrhosis; Malabsorption; Malnutrition; Malnutrition - diagnosis; Malnutrition - etiology; Medical diagnosis; Normal distribution; Nutrition; Nutrition Assessment; Nutrition therapy; Nutritional Status; Pancreatitis; Parenteral nutrition; Patients; Risk; Short bowel syndrome; Weight Loss; Weight reduction
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2022.111887

•Analysis of different risk screening tools in combination with the European Society for Clinical Nutrition and Metabolism and Global Leadership Initiative on Malnutrition (GLIM) diagnostic algorithms in liver cirrhosis, short bowel syndrome, and chronic pancreatitis•Two- to three-fold higher prevalence of malnutrition in chronic gastrointestinal diseases with current GLIM compared with the European Society for Clinical Nutrition and Metabolism algorithm•Better performance of malnutrition risk screening tools (Malnutrition Universal Screening Tool and Royal Free Hospital Nutritional Prioritizing Tool) in conjunction with the GLIM algorithm than the Nutritional Risk Screening 2002•Identification of disease-specific drivers for malnutrition diagnosis among individual diagnostic criteria suggests different underlying mechanisms Disease-related malnutrition (MN) is common in patients with liver cirrhosis (LC), short bowel syndrome (SBS), and chronic pancreatitis (CP). Different MN risk screening tools and diagnostic criteria of the European Society for Clinical Nutrition and Metabolism (ESPEN) and Global Leadership Initiative on Malnutrition (GLIM) algorithms were analyzed for their diagnostic accuracy and role as specific drivers to diagnose MN in patients with LC, SBS, and CP. A total of 187 patients with LC, SBS, and CP, as well as control patients were prospectively recruited in a multicenter cross-sectional study. MN risk was screened using Nutritional Risk Screening 2002 (NRS-2002), the Malnutrition Universal Screening Tool (MUST), and the Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), and diagnosed using the ESPEN, GLIM, and GLIMCRP+ (GLIM incorporating C-reactive protein [CRP] >5 mg/L) algorithms. For each of the individual diagnostic criteria, relative frequency, sensitivity, specificity, as well as positive and negative predictive values were calculated. NRS-2002 was only sensitive in conjunction with ESPEN, while MUST was sensitive additionally with the GLIM algorithm. RFH-NPT worked the best for LC. GLIM and GLIMCRP+ diagnosed MN more frequently than the ESPEN algorithm. Diagnostic criteria were detected at remarkably different relative frequencies starting with reduced food intake/malabsorption and chronic disease/inflammation, followed by weight loss, reduced fat-free mass index, low body mass index, and body mass index