Background:The Global Leadership Initiative on Malnutrition(GLIM)criteria were published to build a global consensus on nutritional diagnosis.Reduced muscle mass is a phenotypic criterion with strong evidence to suppo...Background:The Global Leadership Initiative on Malnutrition(GLIM)criteria were published to build a global consensus on nutritional diagnosis.Reduced muscle mass is a phenotypic criterion with strong evidence to support its inclusion in the GLIM consensus criteria.However,there is no consensus regarding how to accurately measure and define reduced muscle mass in clinical settings.This study aimed to investigate the optimal reference values of skeletal muscle mass index for diagnosing sarcopenia and GLIM-defined malnutrition,as well as the prevalence of GLIM-defined malnutrition in hospitalized cirrhotic patients.Methods:This retrospective study was conducted on 1002 adult patients with liver cirrhosis between January 1,2018,and February 28,2022,at Beijing You-An Hospital,Capital Medical University.Adult patients with a clinical diagnosis of liver cirrhosis and who underwent an abdominal computed tomography(CT)examination during hospitalization were included in the study.These patients were randomly divided into a modeling group(cohort 1,667 patients)and a validation group(cohort 2,335 patients).In cohort 1,optimal cut-off values of skeletal muscle index at the third lumbar skeletal muscle index(L3-SMI)were determined using receiver operating characteristic analyses against in-hospital mortality in different gender groups.Next,patients in cohort 2 were screened for nutritional risk using the Nutritional Risk Screening 2002(NRS-2002),and malnutrition was diagnosed by GLIM criteria.Additionally,the reference values of reduced muscle mass in GLIM criteria were derived from the L3-SMI values from cohort 1.Multivariate logistic regression analysis was used to analyze the association between GLIM-defined malnutrition and clinical outcomes.Results:The optimal cut-off values of L3-SMI were 39.50 cm 2/m 2 for male patients and 33.06 cm 2/m 2 for female patients.Based on the cut-off values,31.63%(68/215)of the male patients and 23.3%(28/120)of the female patients had CT-determined sarcopenia in cohort 2.The prevalence of GLIM-defined malnutrition in cirrhotic patients was 34.3%(115/335)and GLIM-defined malnutrition was an independent risk factor for in-hospital mortality in patients with liver cirrhosis(Wald=6.347,P=0.012).Conclusions:This study provided reference values for skeletal muscle mass index and the prevalence of GLIM-defined malnutrition in hospitalized patients with liver cirrhosis.These reference values will contribute to applying the GLIM criteria in cirrhotic patients.展开更多
Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyng...Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyngeal mucositis is currently unknown.This study investigated the incidence of malnutrition and radiation pharyngeal mucositis in patients with HNC during radiotherapy and analyzed the impact of the nutritional status on radiation pharyngeal mucositis.Methods Consecutive patients with HNC receiving radiotherapy were recruited for this longitudinal observational study.Data were collected at baseline(T_(1)),midtreatment(T_(2)),and at the end of treatment(T3).The Common Terminology Criteria for Adverse Events version 4.0 and the Global Leadership Initiative on Malnutrition criteria were used to assess pharyngeal mucositis and the nutritional status,respectively.Results There were 348 HNC patients who completed all assessments.The pharyngeal mucositis of patients with HNC was aggravated during radiotherapy(χ^(2)=553.521,P<0.001).At T3,56.0%of patients had moderate or severe pharyngeal mucositis.The proportion of patients with malnutrition increased significantly during treatment(21.3%at T_(1)vs 46.8%at T_(2)vs 76.1%at T3,χ^(2)=209.768,P<0.001).Both a multivariable analysis of generalized estimating equations and a logistic regression analysis showed that pharyngeal mucositis was associated with malnutrition.Conclusions Malnutrition was common in patients with HNC during radiotherapy,and it was closely related to pharyngeal mucositis.Joint interventions targeting nutrition and symptom management should be considered for patients with HNC.展开更多
目的基于全球营养领导层诊断营养不良标准(global leadership initiative on malnutrition,GLIM)分析老年住院患者的营养状况。方法选择2021年3月至2022年3月在四川大学华西上锦医院住院的5236例老年患者(年龄≥65岁)为研究对象,采用营...目的基于全球营养领导层诊断营养不良标准(global leadership initiative on malnutrition,GLIM)分析老年住院患者的营养状况。方法选择2021年3月至2022年3月在四川大学华西上锦医院住院的5236例老年患者(年龄≥65岁)为研究对象,采用营养风险筛查2002评分并遵循GLIM标准步骤分析老年住院患者营养状况。结果老年住院患者营养风险发生率为30.29%,GLIM标准下营养不良发生率为15.64%。根据GLIM标准分为营养不良组和非营养不良组。营养不良组血红蛋白、白蛋白、甘油三酯、胆固醇、体重指数均低于非营养不良组,差异有统计学意义(P均<0.05);非营养不良组住院时间较营养不良组更短、住院花费更少,差异有统计学意义(P均<0.001)。结论GLIM标准适用于对老年住院患者的营养状况进行诊断。老年住院患者营养不良发生率较高,应重视老年住院患者营养状况。展开更多
Background The Global Leadership Initiative on Malnutrition(GLIM)recently developed a new set of diagnostic criteria for identifying patients with malnutrition.Because the GLIM criteria were only introduced a little o...Background The Global Leadership Initiative on Malnutrition(GLIM)recently developed a new set of diagnostic criteria for identifying patients with malnutrition.Because the GLIM criteria were only introduced a little over 3 years ago,additional validation and reliability testing are needed in a variety of populations.Methods We performed an observational,multicenter cohort study.From July 2013 to October 2018,lung cancer patients were recruited from the Daping Hospital of Army Medical University and the First Hospital of Jilin University as part of the INSCOC project.Previously-established cut-off values for the calf circumference(CC,male<30 cm,female<29.5 cm)were applied as the reduced muscal mass of phenotypic criteria to establish the GLIM diagnosis.Multivariate Cox regression analyses were performed to analyze the association between the GLIM criteria and survival.Results A total of 1219 patients with lung cancer were studied as subjects.Their age was 58.81±9.92 years old,and 820 were male and 399 were female.According to the GLIM diagnostic criteria using the CC as a muscle mass measurement,303 patients(24.9%)were categorized as malnourished,142 patients(23.1%)in the adult group(18≤age<60)and 161 patients(26.7%)in the older group(age≥60 years).The patients with malnutrition had a higher incidence of anemia than the nourished patients(P=0.012).The QLQ-C30 score and KPS score indicating that the malnourished patients had a consistently worse quality of life compared to the nourished group(all P<0.001).The median survival of the malnutrition group was 42(95%CI:34-50)months,which was much shorter than the 62(95%CI:57-66)months in the nourished group(P<0.001).In the adult group,the median survival decreased from 65(95%CI:55-72)months in nourished group to 34(95%CI:25-48)months in the patients with malnutrition(P<0.001).In the older group,it decreased from 61(95%CI:55-67)months to 48(95%CI:39-59)months(P=0.001).A Cox regression analysis showed that GLIM-diagnosed malnutrition was associated with an increased risk of death among adult group(HR=1.670,95%CI:1.29-2.16),older group(HR=1.332,95%CI:1.05-1.69)and overall(HR=1.453,95%CI:1.22-1.72).Conclusion All of these results demonstrate that GLIM-diagnosed malnutrition is associated with a poorer survival for all lung cancer patients,independent of age.展开更多
目的应用全球营养领导层倡议的营养不良诊断标准(global leadership initiative on malnutrition,GLIM)回顾性调查我国肺癌住院患者的营养不良现患率。方法在2014年全国多中心前瞻性调查数据库中筛选肺癌患者共623例进行回顾性分析,应...目的应用全球营养领导层倡议的营养不良诊断标准(global leadership initiative on malnutrition,GLIM)回顾性调查我国肺癌住院患者的营养不良现患率。方法在2014年全国多中心前瞻性调查数据库中筛选肺癌患者共623例进行回顾性分析,应用不含肌肉量减少指标的GLIM标准进行营养不良的诊断,分析肺癌患者营养不良的患病率,探索GLIM诊断的营养不良与人体测量、实验室指标的相关性。结果在623例肺癌患者中,经营养风险筛查2002评分筛查具有营养风险患者33.5%(209例),GLIM标准营养不良的现患率为17.8%(111例)。GLIM标准诊断的营养不良组与无营养不良组的年龄、体重、体重指数、上臂围、小腿围、握力、血红蛋白、白蛋白、总蛋白、前白蛋白比较差异有统计学意义(均为P<0.05)。结论肺癌患者的营养风险及营养不良发生率较高,应规范对肺癌患者进行营养风险筛查,同时可采用GLIM标准对其进行营养不良诊断。展开更多
目的回顾性调查我国胃癌住院患者的营养不良患病率,探索全球营养领导层倡议营养不良诊断标准(global leadership initiative on malnutrition,GLIM)的适用性。方法数据来源于中华医学会肠外肠内营养分会老年营养支持学组主持的“全国住...目的回顾性调查我国胃癌住院患者的营养不良患病率,探索全球营养领导层倡议营养不良诊断标准(global leadership initiative on malnutrition,GLIM)的适用性。方法数据来源于中华医学会肠外肠内营养分会老年营养支持学组主持的“全国住院患者营养状况动态变化的多中心调查研究”数据库,对筛选出的563例胃癌患者进行回顾性分析,应用非自主性体重减轻、低体重指数和肌肉量下降作为GLIM诊断标准中表型指标进行营养不良的诊断,分析GLIM诊断标准在胃癌患者营养不良中的应用。结果563例胃癌患者中经GLIM标准诊断营养不良203例。经倾向性评分1:1匹配后的396例患者中,其中男性242例(61.1%),女性154例(38.9%)。营养不良组(203例)与无营养不良组(193例)比较,人体测量指标中体重、体重指数、右小腿围、右手握力差异有统计学意义(P<0.05)。实验室指标中总胆固醇、血红蛋白、白蛋白、总蛋白差异有统计学意义(P<0.05)。营养不良组患者住院时间为(15.74±6.815)d,无营养不良组患者住院时间为(14.64±7.02)d,差异无统计学意义(χ^(2)=1.592,P=0.112)。若GLIM诊断的表型指标中去掉肌肉量减少指标,营养不良组住院时间为(16.15±7.04)d,无营养不良组住院时间为(14.28±6.70)d,差异有统计学意义(χ^(2)=0.442,P=0.007)。结论胃癌患者营养不良患病率较高,以国外的小腿围切点值来作为GLIM诊断标准中的表现型指标不一定适用于中国人群,尚需进一步临床大数据研究以确定适合中国人的肌肉减少指标和切点值。展开更多
目的应用全球营养领导层倡议营养不良诊断标准(global leadership initiative on malnutrition,GLIM)调查国内老年肿瘤患者住院期间营养状态的动态变化情况。方法从中华医学会肠外肠内营养分会老年营养支持学组主持的“全国住院患者营...目的应用全球营养领导层倡议营养不良诊断标准(global leadership initiative on malnutrition,GLIM)调查国内老年肿瘤患者住院期间营养状态的动态变化情况。方法从中华医学会肠外肠内营养分会老年营养支持学组主持的“全国住院患者营养状况动态变化的多中心调查研究”18个城市的34家医院数据库中摘取854例老年肿瘤患者资料,进行整理分析。对比研究入院及出院时、不同类别的老年肿瘤患者人体测量、营养风险、营养不良的变化情况。结果入院及出院时营养风险筛查2002量表评分≥3分发生率为63.23%和69.44%,经GLIM诊断的总营养不良发生率变分别为42.74%和42.86%;将营养不良进行分级可见出院时中度营养不良较入院时由24.12%减少至10.07%,重度营养不良较入院时由18.62%增加至32.79%,差异有统计学意义。人体测量及实验室指标在GLIM标准下的营养不良与无营养不良组之间比较,差异有统计学意义。结论老年肿瘤患者营养不良发生率较高,GLIM标准适合用于老年肿瘤患者的营养不良诊断,抗肿瘤治疗可能增加营养不良严重程度。老年肿瘤患者应进行营养风险筛查及GLIM标准对营养不良进行诊断与分级,住院期间应动态观察营养状态的变化。展开更多
基金supported by grants from the National Natural Science Foundation of China(No.82170643)Internal Project of Beijing Youan Hospital Capital Medical University(No.YNKTLC2021005)
文摘Background:The Global Leadership Initiative on Malnutrition(GLIM)criteria were published to build a global consensus on nutritional diagnosis.Reduced muscle mass is a phenotypic criterion with strong evidence to support its inclusion in the GLIM consensus criteria.However,there is no consensus regarding how to accurately measure and define reduced muscle mass in clinical settings.This study aimed to investigate the optimal reference values of skeletal muscle mass index for diagnosing sarcopenia and GLIM-defined malnutrition,as well as the prevalence of GLIM-defined malnutrition in hospitalized cirrhotic patients.Methods:This retrospective study was conducted on 1002 adult patients with liver cirrhosis between January 1,2018,and February 28,2022,at Beijing You-An Hospital,Capital Medical University.Adult patients with a clinical diagnosis of liver cirrhosis and who underwent an abdominal computed tomography(CT)examination during hospitalization were included in the study.These patients were randomly divided into a modeling group(cohort 1,667 patients)and a validation group(cohort 2,335 patients).In cohort 1,optimal cut-off values of skeletal muscle index at the third lumbar skeletal muscle index(L3-SMI)were determined using receiver operating characteristic analyses against in-hospital mortality in different gender groups.Next,patients in cohort 2 were screened for nutritional risk using the Nutritional Risk Screening 2002(NRS-2002),and malnutrition was diagnosed by GLIM criteria.Additionally,the reference values of reduced muscle mass in GLIM criteria were derived from the L3-SMI values from cohort 1.Multivariate logistic regression analysis was used to analyze the association between GLIM-defined malnutrition and clinical outcomes.Results:The optimal cut-off values of L3-SMI were 39.50 cm 2/m 2 for male patients and 33.06 cm 2/m 2 for female patients.Based on the cut-off values,31.63%(68/215)of the male patients and 23.3%(28/120)of the female patients had CT-determined sarcopenia in cohort 2.The prevalence of GLIM-defined malnutrition in cirrhotic patients was 34.3%(115/335)and GLIM-defined malnutrition was an independent risk factor for in-hospital mortality in patients with liver cirrhosis(Wald=6.347,P=0.012).Conclusions:This study provided reference values for skeletal muscle mass index and the prevalence of GLIM-defined malnutrition in hospitalized patients with liver cirrhosis.These reference values will contribute to applying the GLIM criteria in cirrhotic patients.
基金This research was supported by the National Key Research and Development Project of China(No.2017YFC1309204)the Medical Nutrition Clinical Research Project of China International Medical Foundation(No.Z-2017-24-2110).
文摘Objective Radiation mucositis,especially pharyngeal mucositis,severely affects the oral intake of patients of head and neck cancer(HNC)during radiotherapy.Whether the nutritional status affects the severity of pharyngeal mucositis is currently unknown.This study investigated the incidence of malnutrition and radiation pharyngeal mucositis in patients with HNC during radiotherapy and analyzed the impact of the nutritional status on radiation pharyngeal mucositis.Methods Consecutive patients with HNC receiving radiotherapy were recruited for this longitudinal observational study.Data were collected at baseline(T_(1)),midtreatment(T_(2)),and at the end of treatment(T3).The Common Terminology Criteria for Adverse Events version 4.0 and the Global Leadership Initiative on Malnutrition criteria were used to assess pharyngeal mucositis and the nutritional status,respectively.Results There were 348 HNC patients who completed all assessments.The pharyngeal mucositis of patients with HNC was aggravated during radiotherapy(χ^(2)=553.521,P<0.001).At T3,56.0%of patients had moderate or severe pharyngeal mucositis.The proportion of patients with malnutrition increased significantly during treatment(21.3%at T_(1)vs 46.8%at T_(2)vs 76.1%at T3,χ^(2)=209.768,P<0.001).Both a multivariable analysis of generalized estimating equations and a logistic regression analysis showed that pharyngeal mucositis was associated with malnutrition.Conclusions Malnutrition was common in patients with HNC during radiotherapy,and it was closely related to pharyngeal mucositis.Joint interventions targeting nutrition and symptom management should be considered for patients with HNC.
文摘目的基于全球营养领导层诊断营养不良标准(global leadership initiative on malnutrition,GLIM)分析老年住院患者的营养状况。方法选择2021年3月至2022年3月在四川大学华西上锦医院住院的5236例老年患者(年龄≥65岁)为研究对象,采用营养风险筛查2002评分并遵循GLIM标准步骤分析老年住院患者营养状况。结果老年住院患者营养风险发生率为30.29%,GLIM标准下营养不良发生率为15.64%。根据GLIM标准分为营养不良组和非营养不良组。营养不良组血红蛋白、白蛋白、甘油三酯、胆固醇、体重指数均低于非营养不良组,差异有统计学意义(P均<0.05);非营养不良组住院时间较营养不良组更短、住院花费更少,差异有统计学意义(P均<0.001)。结论GLIM标准适用于对老年住院患者的营养状况进行诊断。老年住院患者营养不良发生率较高,应重视老年住院患者营养状况。
基金supported by the National Natural Science Foundation of China(No.81673167 to Hongxia Xu)the Chongqing Technology Innovation and Application Demonstration Project for Social Livelihood(cstc2018jscx-msybX0094 to Jie Liu).
文摘Background The Global Leadership Initiative on Malnutrition(GLIM)recently developed a new set of diagnostic criteria for identifying patients with malnutrition.Because the GLIM criteria were only introduced a little over 3 years ago,additional validation and reliability testing are needed in a variety of populations.Methods We performed an observational,multicenter cohort study.From July 2013 to October 2018,lung cancer patients were recruited from the Daping Hospital of Army Medical University and the First Hospital of Jilin University as part of the INSCOC project.Previously-established cut-off values for the calf circumference(CC,male<30 cm,female<29.5 cm)were applied as the reduced muscal mass of phenotypic criteria to establish the GLIM diagnosis.Multivariate Cox regression analyses were performed to analyze the association between the GLIM criteria and survival.Results A total of 1219 patients with lung cancer were studied as subjects.Their age was 58.81±9.92 years old,and 820 were male and 399 were female.According to the GLIM diagnostic criteria using the CC as a muscle mass measurement,303 patients(24.9%)were categorized as malnourished,142 patients(23.1%)in the adult group(18≤age<60)and 161 patients(26.7%)in the older group(age≥60 years).The patients with malnutrition had a higher incidence of anemia than the nourished patients(P=0.012).The QLQ-C30 score and KPS score indicating that the malnourished patients had a consistently worse quality of life compared to the nourished group(all P<0.001).The median survival of the malnutrition group was 42(95%CI:34-50)months,which was much shorter than the 62(95%CI:57-66)months in the nourished group(P<0.001).In the adult group,the median survival decreased from 65(95%CI:55-72)months in nourished group to 34(95%CI:25-48)months in the patients with malnutrition(P<0.001).In the older group,it decreased from 61(95%CI:55-67)months to 48(95%CI:39-59)months(P=0.001).A Cox regression analysis showed that GLIM-diagnosed malnutrition was associated with an increased risk of death among adult group(HR=1.670,95%CI:1.29-2.16),older group(HR=1.332,95%CI:1.05-1.69)and overall(HR=1.453,95%CI:1.22-1.72).Conclusion All of these results demonstrate that GLIM-diagnosed malnutrition is associated with a poorer survival for all lung cancer patients,independent of age.
文摘目的应用全球营养领导层倡议的营养不良诊断标准(global leadership initiative on malnutrition,GLIM)回顾性调查我国肺癌住院患者的营养不良现患率。方法在2014年全国多中心前瞻性调查数据库中筛选肺癌患者共623例进行回顾性分析,应用不含肌肉量减少指标的GLIM标准进行营养不良的诊断,分析肺癌患者营养不良的患病率,探索GLIM诊断的营养不良与人体测量、实验室指标的相关性。结果在623例肺癌患者中,经营养风险筛查2002评分筛查具有营养风险患者33.5%(209例),GLIM标准营养不良的现患率为17.8%(111例)。GLIM标准诊断的营养不良组与无营养不良组的年龄、体重、体重指数、上臂围、小腿围、握力、血红蛋白、白蛋白、总蛋白、前白蛋白比较差异有统计学意义(均为P<0.05)。结论肺癌患者的营养风险及营养不良发生率较高,应规范对肺癌患者进行营养风险筛查,同时可采用GLIM标准对其进行营养不良诊断。
文摘目的回顾性调查我国胃癌住院患者的营养不良患病率,探索全球营养领导层倡议营养不良诊断标准(global leadership initiative on malnutrition,GLIM)的适用性。方法数据来源于中华医学会肠外肠内营养分会老年营养支持学组主持的“全国住院患者营养状况动态变化的多中心调查研究”数据库,对筛选出的563例胃癌患者进行回顾性分析,应用非自主性体重减轻、低体重指数和肌肉量下降作为GLIM诊断标准中表型指标进行营养不良的诊断,分析GLIM诊断标准在胃癌患者营养不良中的应用。结果563例胃癌患者中经GLIM标准诊断营养不良203例。经倾向性评分1:1匹配后的396例患者中,其中男性242例(61.1%),女性154例(38.9%)。营养不良组(203例)与无营养不良组(193例)比较,人体测量指标中体重、体重指数、右小腿围、右手握力差异有统计学意义(P<0.05)。实验室指标中总胆固醇、血红蛋白、白蛋白、总蛋白差异有统计学意义(P<0.05)。营养不良组患者住院时间为(15.74±6.815)d,无营养不良组患者住院时间为(14.64±7.02)d,差异无统计学意义(χ^(2)=1.592,P=0.112)。若GLIM诊断的表型指标中去掉肌肉量减少指标,营养不良组住院时间为(16.15±7.04)d,无营养不良组住院时间为(14.28±6.70)d,差异有统计学意义(χ^(2)=0.442,P=0.007)。结论胃癌患者营养不良患病率较高,以国外的小腿围切点值来作为GLIM诊断标准中的表现型指标不一定适用于中国人群,尚需进一步临床大数据研究以确定适合中国人的肌肉减少指标和切点值。
文摘目的应用全球营养领导层倡议营养不良诊断标准(global leadership initiative on malnutrition,GLIM)调查国内老年肿瘤患者住院期间营养状态的动态变化情况。方法从中华医学会肠外肠内营养分会老年营养支持学组主持的“全国住院患者营养状况动态变化的多中心调查研究”18个城市的34家医院数据库中摘取854例老年肿瘤患者资料,进行整理分析。对比研究入院及出院时、不同类别的老年肿瘤患者人体测量、营养风险、营养不良的变化情况。结果入院及出院时营养风险筛查2002量表评分≥3分发生率为63.23%和69.44%,经GLIM诊断的总营养不良发生率变分别为42.74%和42.86%;将营养不良进行分级可见出院时中度营养不良较入院时由24.12%减少至10.07%,重度营养不良较入院时由18.62%增加至32.79%,差异有统计学意义。人体测量及实验室指标在GLIM标准下的营养不良与无营养不良组之间比较,差异有统计学意义。结论老年肿瘤患者营养不良发生率较高,GLIM标准适合用于老年肿瘤患者的营养不良诊断,抗肿瘤治疗可能增加营养不良严重程度。老年肿瘤患者应进行营养风险筛查及GLIM标准对营养不良进行诊断与分级,住院期间应动态观察营养状态的变化。
