GLIM-defined malnutrition, simplified muscle mass indicators, and short-term clinical outcomes in hospitalized older adults

<title>Abstract</title> <p>Background To evaluate the nutritional status of hospitalized elderly patients using the Global Leadership Initiative on Malnutrition (GLIM) criteria, compare its diagnostic agreement with the European Society for Clinical Nutrition and Metabolism (ESPEN) criteria, and examine the factors associated with malnutrition and its impact on falls, activities of daily living (ADL) decline, and infections, to inform improved nutritional management in geriatric inpatients. Methods This was an observational follow-up study. All patients underwent a comprehensive geriatric assessment, which included interviews and physical examinations, and relevant laboratory data were collected. The study assessed the diagnostic value of calf circumference (CC), upper arm circumference (UAC), and hand grip strength (HGS) in relation to the GLIM criteria for nutritional status, and further examined the association between baseline nutritional status and adverse outcomes using both univariate and multivariate logistic regression analyses. Results Among the 155 elderly inpatients,GLIM identified a higher prevalence of malnutrition than ESPEN (45.81% vs 29.03%), with moderate agreement (kappa = 0.559, P &lt; 0.000). In the second step of the GLIM criteria, when the fat-free body mass index (FFMI) was used as the reference standard for muscle mass loss, the areas under the ROC curves (AUC) of the three different muscle mass loss assessment tools, namely CC, UAC and HGS, were 0.679, 0.667 and 0.622 respectively (all P &lt; 0.01), indicating that they have modest diagnostic efficacy. Analysis showed that depression is a risk factor for malnutrition in the elderly, while a higher body mass index and a higher cognitive level, as evaluated by the Mini-Mental State Examination (MMSE), are protective factors against malnutrition. In addition, multivariate logistic regression analysis revealed that male and higher hemoglobin levels (Hb) were protective factors for the decline in activities of daily living, while higher serum creatinine (Scr) levels were risk factors for infection. Conclusion GLIM appears to be a practical framework for identifying malnutrition in hospitalized older adults and captures more at-risk patients than ESPEN Simple bedside measures such as CC, UAC, and HGS may provide clinically feasible alternatives for reduced muscle mass assessment where body composition analysis is unavailable.</p>