Estimation of malnutrition prevalence using the GLIM criteria in critically ill patients and results of concurrent and predictive validation
DOI:
https://doi.org/10.55892/jrg.v8i18.1855Keywords:
Malnutrition, Critically Ill Patients, GLIM, Concurrent Validity, Predictive Validity, Nutritional Assessment, Clinical Prognosis, Mortality, Length ofAbstract
Malnutrition in critically ill patients is an aggravating factor in clinical prognosis, increasing mortality and prolonging hospital stay. The Global Leadership Initiative on Malnutrition (GLIM) tool has been proposed as a standardized method for nutritional diagnosis; however, its concurrent and predictive validity still lacks robust studies. This study aimed to estimate the prevalence of malnutrition in critically ill patients using the GLIM and to assess its concurrent and predictive validity. An integrative review was conducted based on articles published between 2021 and 2024 in the PubMed, SciELO, and LILACS databases, considering studies that compared the GLIM with established methods such as the Subjective Global Assessment (SGA). The results showed that the prevalence of malnutrition in critically ill patients, according to the GLIM criteria, was 53.75%. Regarding concurrent validity, studies indicated a sensitivity above 80% for severe malnutrition cases but variable specificity. Predictive validity demonstrated an association between malnutrition identified by GLIM and longer hospital stays, higher costs, and increased mortality. However, no studies comparing the GLIM with the AND-ASPEN tool were found, indicating a gap in the literature. It is concluded that, although the GLIM appears to be a promising approach for diagnosing malnutrition in critically ill patients, it still can be more refined to address critically ill patient. Further studies are required to validate its methodological criteria and define more precise cut-off points, ensuring greater clinical applicability and diagnostic reliability
Downloads
References
BEDOCK, Dorothée et al. Prevalence and severity of malnutrition in hospitalized COVID-19 patients. Clinical Nutrition ESPEN, v. 40, p. 214-219, 2020. Disponível em: https://doi.org/10.1016/j.clnesp.2020.09.018.
BEGHETTO, M. G.; MANNA, B.; CANDAL, A.; MELLO, E. D.; POLANCZYK, C. A. Triagem nutricional em adultos hospitalizados. Revista de Nutrição, v. 21, n. 5, p. 589-601, 2008.
BORGI, R.; MEALE, M. M. S.; FRANÇA, J. I. D.; PEREIRA, M. A. G.; DAMIÃO, A. O. M. C. Efficacy of nutritional intervention in hospitalized malnourished patients: A subanalysis of the BRAINS study. Revista de Nutrição Clínica, v. 30, n. 1, p. 3-8, 2015.
BRASIL. Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Ciência e Tecnologia. Diretrizes metodológicas: Sistema GRADE – Manual de graduação da qualidade da evidência e força de recomendação para tomada de decisão em saúde. Brasília: Ministério da Saúde, 2014. 72 p. ISBN 978-85-334-2186-8.
BRITO, J. E. et al. GLIM criteria for malnutrition diagnosis of hospitalized patients presents satisfactory criterion validity: A prospective cohort study. Clinical Nutrition, v. 40, n. 6, p. 4366–4372, 2021. Disponível em: https://doi.org/10.1016/j.clnu.2021.01.009.
CEDERHOLM, T. et al. Diagnostic criteria for malnutrition – An ESPEN Consensus Statement. Clinical Nutrition, v. 34, n. 3, p. 335-340, 2015.
CEDERHOLM, T. et al. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clinical Nutrition, v. 38, n. 1, p. 1–9, 2018. Disponível em: https://doi.org/10.1016/j.clnu.2018.08.002.
GHOLI, Zahra et al. Malnutrition elevates delirium and ICU stay among critically ill older adult COVID-19 patients. Frontiers in Medicine, v. 11, 1259320, 2024. Disponível em: https://doi.org/10.3389/fmed.2024.1259320.
GÓMEZ-URANGA, Angie et al. Nutritional and Functional Impact of Acute SARS-CoV-2 Infection in Hospitalized Patients. Journal of Clinical Medicine, v. 11, n. 9, p. 2424, 2022. Disponível em: https://doi.org/10.3390/jcm11092424.
GONZÁLEZ, M. C.; CORREIA, M. I. T. D.; HEYMSFIELD, S. B. Um réquiem para o IMC no ambiente clínico. Current Opinion in Clinical Nutrition & Metabolic Care, v. 20, p. 314-321, 2017. Disponível em: https://doi.org/10.1097/MCO.0000000000000395.
GUSTAVO, D. et al. A iniciativa de liderança global em critérios de desnutrição para o diagnóstico de desnutrição em pacientes internados na unidade de terapia intensiva: uma revisão sistemática e meta-análise. Clinical Nutrition, v. 42, p. 182-189, 2023. Disponível em: https://doi.org/10.1016/j.clnu.2022.12.007.
KANG, M. C. et al. Prevalence of malnutrition in hospitalized patients: A multicenter cross-sectional study. Journal of Korean Medical Science, v. 33, p. e10, 2018.
KELLER, H. et al. Global leadership initiative on malnutrition (GLIM): guidance on validation of the operational criteria for the diagnosis of protein-energy malnutrition in adults. Journal of Parenteral and Enteral Nutrition, v. 44, n. 6, p. 902-1003, 2020. Disponível em: https://doi.org/10.1002/jpen.1806.
MA, Wei et al. GLIM-defined malnutrition in patients with acute abdomen associated with poor prognosis and increased economic burden: A cross-sectional study. Nutrition in Clinical Practice, v. 39, n. 6, p. 1364-1374, 2024. Disponível em: https://doi.org/10.1002/ncp.11202.
MIRANDA, A. A. M. Influência do estado nutricional e da composição corporal na morbimortalidade de doentes candidatos à cirurgia major. Nutrire: Revista da Sociedade Brasileira de Alimentação e Nutrição, v. 38, n. 1, p. 67-82, 2013.
MUÑOZ FERNANDEZ, Shirley Steffany et al. Applicability of the GLIM criteria for the diagnosis of malnutrition in older adults in the emergency ward: A pilot validation study. Clinical Nutrition, v. 40, n. 11, p. 5447-5456, 2021. Disponível em: https://doi.org/10.1016/j.clnu.2021.09.024.
NORMAN, K. et al. Impacto prognóstico da desnutrição relacionada à doença. Clinical Nutrition, v. 27, n. 1, p. 5-15, 2008. Disponível em: https://doi.org/10.1016/j.clnu.2007.10.007.
POWER, Lauren et al. A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings – A MaNuEL study. Clinical Nutrition ESPEN, v. 24, p. 1-13, 2018. Disponível em: https://doi.org/10.1016/j.clnesp.2018.02.005. Acesso em: 25 jan. 2025.
SANZ-PARIS, Alejandro et al. Prevalence of malnutrition and 1-year all-cause mortality in institutionalized elderly comparing different combinations of the GLIM criteria. Journal of Parenteral and Enteral Nutrition, 2020. Disponível em: https://doi.org/10.1002/jpen.2029. Acesso em: 25 jan. 2025.
SANTANA, M. de M. A. et al. Inadequação calórica e proteica e fatores associados em pacientes graves. Revista de Nutrição, v. 29, n. 5, p. 645–654, 2016. Disponível em: https://doi.org/10.1590/1678-98652016000500003.
SHAHBAZI, Erfan et al. The validity of the Global Leadership Initiative on Malnutrition criteria for diagnosing malnutrition in critically ill COVID-19 patients: A prospective cohort study. Clinical Nutrition ESPEN, v. 43, p. 377-382, 2021. Disponível em: https://doi.org/10.1016/j.clnesp.2021.03.020. Acesso em: 25 jan. 2025.
THEILLA, Miriam et al. Validation of GLIM malnutrition criteria for diagnosis of malnutrition in ICU patients: An observational study. Clinical Nutrition, v. 40, n. 5, p. 3578-3584, 2021. Disponível em: https://doi.org/10.1016/j.clnu.2020.12.021.
VAHDAT SHARIATPANAHI, Zahra et al. Refeeding Syndrome and Its Related Factors in Critically Ill Coronavirus Disease 2019 Patients: A Prospective Cohort Study. Frontiers in Nutrition, v. 9, 830457, 2022. Disponível em: https://doi.org/10.3389/fnut.2022.830457.
WAITZBERG, D. L.; CAIAFFA, W. T.; CORREIA, M. I. T. D. Hospital Malnutrition: The Brazilian National Survey (IBRANUTRI): A study of 4000 patients. Nutrition, v. 17, n. 7-8, p. 573-580, 2001.