全球营养不良领导倡议标准作为癌症患者的营养评估工具。
Global Leadership Initiative on Malnutrition criteria as a nutrition assessment tool for patients with cancer.
机构信息
Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing China; Department of Oncology, Capital Medical University, Beijing, China; Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, China.
Cancer Center, Renmin Hospital, Wuhan University, Wuhan, China.
出版信息
Nutrition. 2021 Nov-Dec;91-92:111379. doi: 10.1016/j.nut.2021.111379. Epub 2021 Jun 29.
OBJECTIVES
Since the launch of Global Leadership Initiative on Malnutrition (GLIM), there has been an urgent need to validate the new criteria, especially in patients with cancer. The aim of this study was to evaluate and validate the use of the GLIM criteria in patients with cancer.
METHOD
This multicenter cohort study compared the GLIM with the scored Patient-Generated Subjective Global Assessment (sPG-SGA). The 1-y survival rate, multivariate Cox regression analysis, κ-value, sensitivity, specificity, receiver operating characteristic (ROC) curve, and time-dependent ROC analysis were applied to identify the performance of the GLIM.
RESULTS
Among the 3777 patients in the study, 50.9% versus 49.1% or 36.3% versus 63.7% of the patients were defined as well-nourished and malnourished by GLIM or sPG-SGA, respectively. GLIM presented moderate consistency (κ = 0.54, P < 0.001), fair sensitivity and specificity (70.5 and 88.3%) compared with sPG-SGA. There was no difference in the 1-y survival rate in malnourished patients (76.9 versus 76.4%, P = 0.711), but it was significantly different in well-nourished patients (85.8 versus 90.3%, P < 0.001) between GLIM and sPG-SGA. The above difference was eliminated after omitted nutritional risk screening (NRS)-2002 screening before GLIM (88.1 versus 90.3%, P = 0.078). Omitting NRS-2002 screening before GLIM did not change the 1-y survival rate in well-nourished or malnourished patients by GLIM with NRS-2002 screening (76.9 versus 78.9%, P = 0.099; 85.8% versus 88.1%, P = 0.092) although it significantly raised the rate of malnutrition to 72.5%. The combination of "weight loss and cancer" showed better performance than other combinations.
CONCLUSIONS
GLIM could be a convenient alternative to sPG-SGA in nutrition assessment for patients with cancer. The combination of "weight loss and cancer" was better than other combinations. Considering the higher risk for malnutrition in patients with cancer, NRS-2002 screening may not be needed before GLIM.
目的
自全球营养不良倡议（GLIM）启动以来，人们迫切需要对新的标准进行验证，尤其是在癌症患者中。本研究旨在评估和验证 GLIM 标准在癌症患者中的应用。
方法
本多中心队列研究将 GLIM 与评分患者主观整体评估（sPG-SGA）进行比较。应用 1 年生存率、多变量 Cox 回归分析、κ 值、灵敏度、特异性、受试者工作特征（ROC）曲线和时间依赖性 ROC 分析来确定 GLIM 的性能。
结果
在研究的 3777 名患者中，分别有 50.9%和 49.1%或 36.3%和 63.7%的患者根据 GLIM 或 sPG-SGA 被定义为营养良好和营养不良。GLIM 与 sPG-SGA 相比，具有中度一致性（κ=0.54，P<0.001），灵敏度和特异性分别为 70.5%和 88.3%。在营养不良患者中，1 年生存率无差异（76.9%比 76.4%，P=0.711），但在营养良好患者中差异显著（85.8%比 90.3%，P<0.001）。在排除 GLIM 之前进行营养风险筛查（NRS）-2002 筛查后，上述差异消除（88.1%比 90.3%，P=0.078）。在 GLIM 之前排除 NRS-2002 筛查不会改变 GLIM 结合 NRS-2002 筛查的营养良好或营养不良患者的 1 年生存率（76.9%比 78.9%，P=0.099；85.8%比 88.1%，P=0.092），尽管它显著提高了营养不良的发生率至 72.5%。“体重减轻和癌症”的组合比其他组合表现更好。
结论
GLIM 可作为癌症患者营养评估的 sPG-SGA 替代方法。“体重减轻和癌症”的组合优于其他组合。考虑到癌症患者发生营养不良的风险较高，在 GLIM 之前可能不需要进行 NRS-2002 筛查。
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