Abstract
Objectives
The Global Leadership Initiative on Malnutrition (GLIM) has proposed a consensus scheme
for classifying malnutrition. This study examined the prevalence of malnutrition according
to GLIM criteria and evaluated if these criteria were associated with adverse outcomes
in community-dwelling older adults.
Design
This was a prospective cohort study.
Setting and Participants
Community-dwelling Chinese men and women aged ≥65 years in Hong Kong.
Methods
A health check including questionnaire interviews and physical measurements was conducted
at baseline and 14-year follow-up. Participants were classified as malnourished at
baseline according to the GLIM criteria based on 2 phenotypic components (low body
mass index and reduced muscle mass) and 1 etiologic component (inflammation). Adverse
outcomes including sarcopenia, frailty, falls, mobility limitation, hospitalization,
and mortality were assessed at 14-year follow-up. Adjusted multiple logistic regression
and Cox proportional hazards model were performed to examine the associations between
malnutrition and adverse outcomes and presented as odds ratio (OR) or hazard ratio
(HR) and 95% confidence interval (CI).
Results
Data of 3702 participants [median age: 72 years (IQR 68–76)] were available at baseline.
Malnutrition was present in 397 participants (10.7%). Malnutrition was significantly
associated with higher risk of sarcopenia (n = 898, OR 2.25; 95% CI 1.04–4.86), frailty
(Fried (n = 971, OR 2.83; 95% CI 1.47–5.43), FRAIL scale (n = 985, OR 2.30; 95% CI
1.06–4.98)) and all-cause mortality (n = 3702, HR: 1.62; 95% CI 1.39–1.89). There
was no significant association between malnutrition and falls (n = 987, OR 1.09; 95%
CI 0.52–2.31), mobility limitation (n = 989, OR 0.98; 95% CI 0.36–2.67), and hospitalization
(n = 989, OR 1.37; 95% CI 0.67–2.77).
Conclusions and Implications
Among community-dwelling Chinese older adults, malnutrition according to selected
GLIM criteria was a predictor of sarcopenia, frailty, and mortality at 14-year follow-up;
whereas no association was found for falls, mobility limitation, and hospitalization.
Clinicians may consider applying the GLIM criteria to identify malnourished community-dwelling
older adults.
Keywords
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References
- Prognostic impact of disease-related malnutrition.Clin Nutr. 2008; 27: 5-15
- Malnutrition in the elderly: A narrative review.Maturitas. 2013; 76: 296-302
- Nutritional status in older persons according to healthcare setting: A systematic review and meta-analysis of prevalence data using MNA((R)).Clin Nutr. 2016; 35: 1282-1290
- GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community.Clin Nutr. 2019; 38: 1-9
- GLIM criteria using hand grip strength adequately predict six-month mortality in cancer inpatients.Nutrients. 2019; 11: 2043
- GLIM criteria has fair sensitivity and specificity for diagnosing malnutrition when using SGA as comparator.Clin Nutr. 2019; 39: 2771-2777
- The relationship between existing nutritional indicators and Global Leadership Initiative on Malnutrition (GLIM) criteria: A one-institution cross-sectional analysis.Clin Nutr. 2020; 39: 3099-3104
- Reference body mass index values and the prevalence of malnutrition according to the Global Leadership Initiative on Malnutrition criteria.Clin Nutr. 2020; 39: 180-184
- GLIM criteria at hospital admission predict 8-year all-cause mortality in elderly patients with type 2 diabetes mellitus: Results from VIDA study.JPEN J Parenter Enteral Nutr. 2020; 44: 1492-1500
- Prevalence of malnutrition comparing the GLIM criteria, ESPEN definition and MST malnutrition risk in geriatric rehabilitation patients: RESORT.Clin Nutr. 2020; 39: 3504-3511
- Malnutrition as a strong predictor of the onset of sarcopenia.Nutrients. 2019; 11: 2883
- Bone mineral density and the risk of peripheral arterial disease in men and women: results from Mr. and Ms Os, Hong Kong.Osteoporos Int. 2005; 16: 1933-1938
- Relationship of subjective and objective social status with psychological and physiological functioning: preliminary data in healthy white women.Health Psychol. 2000; 19: 586-592
- Dementia diagnosis in developing countries: A cross-cultural validation study.Lancet. 2003; 361: 909-917
- Development and validation of a geriatric depression screening scale: A preliminary report.J Psychiatr Res. 1982; 17: 37-49
- Chinese elderly and the GDS short form: A preliminary study.Clinical Gerontologist. 1993; 14: 37-42
- The Physical Activity Scale for the Elderly (PASE): Development and evaluation.J Clin Epidemiol. 1993; 46: 153-162
- Appendicular skeletal muscle mass: Measurement by dual-photon absorptiometry.Am J Clin Nutr. 1990; 52: 214-218
- Sarcopenia in Asia: Consensus report of the Asian Working Group for Sarcopenia.J Am Med Dir Assoc. 2014; 15: 95-101
- Frailty in older adults: Evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans.J Nutr Health Aging. 2012; 16: 601-608
- Mortality in malnourished older adults diagnosed by ESPEN and GLIM criteria in the SarcoPhAge study.J Cachexia Sarcopenia Muscle. 2020; 11: 1200-1211
- Risk factors for malnutrition in older adults: A systematic review of the literature based on longitudinal data.Adv Nutr. 2016; 7: 507-522
- High prevalence of physical frailty among community-dwelling malnourished older adults-A systematic review and meta-analysis.J Am Med Dir Assoc. 2017; 18: 374-382
- Health outcomes of sarcopenia: A systematic review and meta-analysis.PLoS One. 2017; 12: e0169548
- Sarcopenia and its association with falls and fractures in older adults: A systematic review and meta-analysis.J Cachexia Sarcopenia Muscle. 2019; 10: 485-500
- Quick and simple FRAIL scale predicts incident activities of daily living (ADL) and instrumental ADL (IADL) disabilities: A systematic review and meta-analysis.J Am Med Dir Assoc. 2018; 19: 1063-1068
- Frailty and the prediction of negative health outcomes: A meta-analysis.J Am Med Dir Assoc. 2016; 17: 1163.e1-1163.e17
- Factors influencing transitions between frailty states in elderly adults: The Progetto Veneto Anziani Longitudinal Study.J Am Geriatr Soc. 2017; 65: 179-184
- Prospective associations of low muscle mass and function with 10-year falls risk, incident fracture and mortality in community-dwelling older adults.J Nutr Health Aging. 2017; 21: 843-848
- Sarcopenia and falls in community-dwelling elderly subjects in Japan: Defining sarcopenia according to criteria of the European Working Group on Sarcopenia in Older People.Arch Gerontol Geriatr. 2014; 59: 295-299
- Relationship between postmenopausal osteoporosis and the components of clinical sarcopenia.Maturitas. 2013; 75: 175-180
- Sarcopenia =/= dynapenia.J Gerontol A Biol Sci Med Sci. 2008; 63: 829-834
- Nutritional status, body mass index, and the risk of falls in community-dwelling older adults: A systematic review and meta-analysis.J Am Med Dir Assoc. 2019; 20: 569-582.e7
- Risk factors for injurious falls in older adults: The role of sex and length of follow-up.J Am Geriatr Soc. 2019; 67: 246-253
- Global Leadership Initiative on Malnutrition (GLIM): Guidance on validation of the operational criteria for the diagnosis of protein-energy malnutrition in adults.JPEN J Parenter Enteral Nutr. 2020; 44: 992-1003
- Nutritional status and associations with falls, balance, mobility and functionality during hospital admission.J Nutr Health Aging. 2011; 15: 388-391
- The prevalence and health burden of malnutrition in Belgian older people in the community or residing in nursing homes: results of the NutriAction II study.Aging Clin Exp Res. 2019; 31: 175-183
- Malnutrition risk and its association with adverse outcomes in a Belgian cohort of community-dwelling adults aged 80 years and over.Acta Clin Belg. 2020; : 1-8
- The 'Mini Nutritional Assessment' (MNA) and the 'Determine Your Nutritional Health' Checklist (NSI Checklist) as predictors of morbidity and mortality in an elderly Danish population.Br J Nutr. 1999; 81: 31-36
- The effect of the duration of follow-up in mortality analysis: the temporal pattern of different predictors.J Gerontol B Psychol Sci Soc Sci. 2004; 59: S181-S189
- Systemic inflammation predicts all-cause mortality: A glasgow inflammation outcome study.PLoS One. 2015; 10: e0116206
- Social and economic factors and malnutrition or the risk of malnutrition in the elderly: A systematic review and meta-analysis of observational studies.Nutrients. 2020; 12: 737
- Socioeconomic inequalities in frailty and frailty components among community-dwelling older citizens.PLoS One. 2017; 12: e0187946
- Social determinants of death among the elderly: A systematic literature review.Revista Brasileira de Epidemiologia. 2014; 17: 178-193
Further Reading
- Bone mineral density and the risk of peripheral arterial disease in men and women: results from Mr. and Ms Os, Hong Kong.Osteoporos Int. 2005; 16: 1933-1938
- Relationship of subjective and objective social status with psychological and physiological functioning: preliminary data in healthy white women.Health Psychol. 2000; 19: 586-592
- Dementia diagnosis in developing countries: A cross-cultural validation study.Lancet. 2003; 361: 909-917
- Development and validation of a geriatric depression screening scale: A preliminary report.J Psychiatr Res. 1982; 17: 37-49
- Chinese elderly and the GDS short form: A preliminary study.Clinical Gerontologist: The Journal of Aging and Mental Health. 1993; 14: 37-42
- The Physical Activity Scale for the Elderly (PASE): Development and evaluation.J Clin Epidemiol. 1993; 46: 153-162
- Appendicular skeletal muscle mass: Measurement by dual-photon absorptiometry.Am J Clin Nutr. 1990; 52: 214-218
- Health Equity in England: The Marmot Review ten years on.Institute of Health Equity, London2020
- Associations between dietary patterns and demographics, lifestyle, anthropometry and blood pressure in Chinese community-dwelling older men and women.J Nutr Sci. 2012; 1: e20
- A Prospective Cohort Study to Examine the Association Between Dietary Patterns And Sarcopenia In Chinese Community-Dwelling Older People In Hong Kong.J Am Med Dir Assoc. 2016; 17: 336-342
- How dietary patterns are related to inflammaging and mortality in community-dwelling older Chinese adults in Hong Kong - A prospective analysis.J Nutr Health Aging. 2019; 23: 181-194
- Self-perceived social status and health in older Hong Kong Chinese women compared with men.Women Health. 2008; 48: 209-234
Article info
Publication history
Published online: November 02, 2020
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
