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Response to the Comments on “Malnutrition in Relation to Muscle Mass, Muscle Quality, and Muscle Strength in Hospitalized Older Adults”

      We thank Drs Tasci and Naharci for their interest in our recent manuscript.
      • Xie L.
      • Jiang J.
      • Fu H.
      • et al.
      Malnutrition in relation to muscle mass, muscle quality, and muscle strength in hospitalized older adults.
      First, according to the Global Leadership Initiative on Malnutrition (GLIM) consensus, the diagnosis of malnutrition should include at least 1 phenotypic criterion (either weight loss, low body mass index, or “reduced muscle mass”) and 1 etiologic criterion (either reduced food intake, assimilation disease burden, or inflammatory condition).
      • Cederholm T.
      • Jensen G.L.
      • Correia M.I.T.D.
      • et al.
      GLIM criteria for the diagnosis of malnutrition—a consensus report from the global clinical nutrition community.
      In our study, we defined malnutrition based on this algorithm. However, we did not include reduced muscle mass as a phenotypic criterion to define malnutrition because one of our aims was to explore the association between malnutrition and muscle mass. Many previous studies applied a similar strategy (ie, without using the reduced muscle mass criterion) to determine GLIM-defined malnutrition.
      • Przekop Z.
      • Milewska M.
      • Szostak-Węgierek D.
      • et al.
      GLIM-defined malnutrition in patients with head and neck cancer during the qualification visit for home enteral nutrition.
      ,
      • Cederholm T.
      • Barazzoni R.
      A year with the GLIM diagnosis of malnutrition—does it work for older persons?.
      According to a recent scoping review of the GLIM, approximately 25% (19/79) of previous studies did not use the reduced muscle mass criterion.
      • Correia M.I.T.D.
      • Tappenden K.A.
      • Malone A.
      • et al.
      Utilization and validation of the Global Leadership Initiative on Malnutrition (GLIM): a scoping review.
      Although this strategy might theoretically induce the risk of misclassifying malnutrition,
      • Cederholm T.
      • Barazzoni R.
      A year with the GLIM diagnosis of malnutrition—does it work for older persons?.
      it may also increase the feasibility of GLIM-defined malnutrition as no device is needed to measure muscle mass.
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      Linked Article

      • Comment on “Malnutrition in Relation to Muscle Mass, Muscle Quality, and Muscle Strength in Hospitalized Older Adults”
        Journal of the American Medical Directors AssociationVol. 23Issue 5
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          In a recent JAMDA article, Xie et al1 reported that patients with a malnutrition diagnosis assessed by the Global Leadership Initiative on Malnutrition (GLIM) had significantly lower skeletal muscle radiodensity, an indicator of muscle quality, and lower handgrip strength in both genders. Additionally, women, but not men, with a malnutrition diagnosis had significantly higher intermuscular adipose tissue (IMAT), another indicator of muscle quality, than women with normal nutrition; moreover, in contrast to women, men with malnutrition had significantly lower skeletal muscle index (SMI), an indicator of muscle mass.
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