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Effectiveness of Global Leadership Initiative on Malnutrition and Subjective Global Assessment for diagnosing malnutrition and predicting wound healing in patients with diabetic foot ulcers
Published online by Cambridge University Press: 18 April 2024
Abstract
Malnutrition significantly hampers wound healing processes. This study aimed to compare the effectiveness of the Global Leadership Initiative on Malnutrition (GLIM) and Subjective Global Assessment (SGA) in diagnosing malnutrition and predicting wound healing in patients with diabetic foot ulcers (DFU). GLIM criteria were evaluated for sensitivity (SE), specificity (SP), positive predictive value, negative predictive value and kappa (κ) against SGA as the reference. Modified Poisson regression model and the DeLong test investigated the association between malnutrition and non-healing ulcers over 6 months. This retrospective cohort study included 398 patients with DFU, with a mean age of 66·3 ± 11·9 years. According to SGA and GLIM criteria, malnutrition rates were 50·8 % and 42·7 %, respectively. GLIM criteria showed a SE of 67·3 % (95 % CI 60·4 %, 73·7 %) and SP of 82·7 % (95 % CI 76·6 %, 87·7 %) in identifying malnutrition, with a positive predictive value of 80·0 % and a negative predictive value of 71·1 % (κ = 0·50) compared with SGA. Multivariate analysis demonstrated that malnutrition, as assessed by SGA, was an independent risk factor for non-healing (relative risk (RR) 1·84, 95 % CI 1·45, 2·34), whereas GLIM criteria were associated with poorer ulcer healing in patients with estimated glomerular filtration rate ≥ 60 ml/min/1·73m2 (RR: 1·46, 95 % CI 1·10, 1·94). SGA demonstrated a superior area under the receiver’s operating characteristic curve for predicting non-healing compared with GLIM criteria (0·70 (0·65–0·75) v. 0·63 (0·58–0·65), P < 0·01). These findings suggest that both nutritional assessment tools effectively identify patients with DFU at increased risk, with SGA showing superior performance in predicting non-healing ulcers.
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- Research Article
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- © The Author(s), 2024. Published by Cambridge University Press on behalf of The Nutrition Society
Footnotes
†
These authors contributed equally to this work.
References
Xu, Z & Ran, X (2016) Diabetic foot care in China: challenges and strategy. Lancet Diabetes Endocrinol 4, 297–298.CrossRefGoogle Scholar
Singh, N, Armstrong, DG & Lipsky, BA (2005) Preventing foot ulcers in patients with diabetes. JAMA 293, 217–228.CrossRefGoogle ScholarPubMed
Gazzaruso, C, Gallotti, P, Pujia, A, et al. (2021) Predictors of healing, ulcer recurrence and persistence, amputation and mortality in type 2 diabetic patients with diabetic foot: a 10-year retrospective cohort study. Endocrine 71, 59–68.CrossRefGoogle ScholarPubMed
Armstrong, DG, Boulton, AJM & Bus, SA (2017) Diabetic foot ulcers and their recurrence. N Engl J Med 376, 2367–2375.CrossRefGoogle ScholarPubMed
Zhang, SS, Tang, ZY, Fang, P, et al. (2013) Nutritional status deteriorates as the severity of diabetic foot ulcers increases and independently associates with prognosis. Exp Ther Med 5, 215–222.CrossRefGoogle ScholarPubMed
Basiri, R, Spicer, MT, Levenson, CW, et al. (2020) Nutritional supplementation concurrent with nutrition education accelerates the wound healing process in patients with diabetic foot ulcers. Biomedicines 8, 263.CrossRefGoogle ScholarPubMed
Armstrong, DG, Hanft, JR, Driver, VR, et al. (2014) Effect of oral nutritional supplementation on wound healing in diabetic foot ulcers: a prospective randomized controlled trial. Diabetic Med: J Br Diabetic Assoc 31, 1069–1077.CrossRefGoogle ScholarPubMed
Basiri, R, Spicer, M, Levenson, C, et al. (2022) Improving dietary intake of essential nutrients can ameliorate inflammation in patients with diabetic foot ulcers. Nutrients 14, 2393.CrossRefGoogle ScholarPubMed
Cheng, Q, Hu, J, Yang, P, et al. (2017) Sarcopenia is independently associated with diabetic foot disease. Sci Rep 7, 8372.CrossRefGoogle ScholarPubMed
Barshes, NR, Mindru, C, Ashong, C, et al. (2016) Treatment failure and leg amputation among patients with foot osteomyelitis. Int J Lower Extremity Wounds 15, 303–312.CrossRefGoogle ScholarPubMed
Jeyaraman, K, Berhane, T, Hamilton, M, et al. (2019) Mortality in patients with diabetic foot ulcer: a retrospective study of 513 cases from a single Centre in the Northern Territory of Australia. BMC Endocr Disord 19, 1.CrossRefGoogle ScholarPubMed
Detsky, AS, McLaughlin, JR, Baker, JP, et al. (1987) What is subjective global assessment of nutritional status? JPEN J Parenter Enter Nutr 11, 8–13.CrossRefGoogle ScholarPubMed
Sheean, PM, Peterson, SJ, Gurka, DP, et al. (2010) Nutrition assessment: the reproducibility of subjective global assessment in patients requiring mechanical ventilation. Eur J Clin Nutr 64, 1358–1364.CrossRefGoogle ScholarPubMed
Allard, JP, Keller, H, Jeejeebhoy, KN, et al. (2016) Malnutrition at hospital admission-contributors and effect on length of stay: a prospective cohort study from the Canadian Malnutrition Task Force. JPEN J Parenter Enter Nutr 40, 487–497.CrossRefGoogle ScholarPubMed
Campbell, KL, Ash, S, Bauer, JD, et al. (2007) Evaluation of nutrition assessment tools compared with body cell mass for the assessment of malnutrition in chronic kidney disease. J Ren Nutr: Offic J Council Renal Nutr Natl Kidney Found 17, 189–195.CrossRefGoogle ScholarPubMed
Ribeiro, HS, Maurício, SF, Antônio da Silva, T, et al. (2018) Combined nutritional assessment methods to predict clinical outcomes in patients on the waiting list for liver transplantation. Nutrition (Burbank, Los Angeles County, Calif) 47, 21–26.CrossRefGoogle ScholarPubMed
Cederholm, T, Jensen, GL, Correia, M, et al. (2019) GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle 10, 207–217.CrossRefGoogle ScholarPubMed
Lauwers, P, Hendriks, JMH, Van Bouwel, S, et al. (2021) Malnutrition according to the 2018 GLIM criteria is highly prevalent in people with a diabetic foot ulcer but does not affect outcome. Clin Nutr ESPEN 43, 335–341.CrossRefGoogle Scholar
López-Valverde, ME, Aragón-Sánchez, J & Víquez-Molina, G (2023) Handgrip strength but not malnutrition according to global leadership initiative on malnutrition criteria is a risk factor for mortality in hospitalized patients with ischemic diabetic foot ulcers. Adv Wound Care 12, 127–134.CrossRefGoogle Scholar
Ince, P, Abbas, ZG, Lutale, JK, et al. (2008) Use of the SINBAD classification system and score in comparing outcome of foot ulcer management on three continents. Diabetes Care 31, 964–967.CrossRefGoogle ScholarPubMed
Cockcroft, DW & Gault, MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16, 31–41.CrossRefGoogle ScholarPubMed
Poredos, P, Stanek, A, Catalano, M, et al. (2024) Ankle-Brachial Index: diagnostic tool of peripheral arterial disease and predictor of cardiovascular risk-an update of current knowledge. Angiology 33197241226512. (Epublication ahead of print version 04 January 2024).CrossRefGoogle ScholarPubMed
Lipsky, BA, Berendt, AR, Cornia, PB, et al. (2013) 2012 infectious diseases society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. J Am Podiatric Med Assoc 103, 2–7.Google Scholar
Lohman, TG (1981) Skinfolds and body density and their relation to body fatness: a review. Hum Biol 53, 181–225.Google ScholarPubMed
Lohman, TG, Roche, AF & Martorell, R (1998) Anthropometric Standardization Reference Manual, Abridged ed. Champaign, IL: Human Kinetics Books.Google Scholar
Cheng, HS, See, LC & Shieh, YH (2001) Estimating stature from knee height for adults in Taiwan. Chang Gung Med J 24, 547–556.Google ScholarPubMed
Kondrup, J, Allison, SP, Elia, M, et al. (2003) ESPEN guidelines for nutrition screening 2002. Clin Nutr (Edinburgh, Scotland) 22, 415–421.CrossRefGoogle ScholarPubMed
Yin, L, Lin, X, Li, N, et al. (2021) Evaluation of the global leadership initiative on malnutrition criteria using different muscle mass indices for diagnosing malnutrition and predicting survival in lung cancer patients. JPEN J Parenter Enter Nutr 45, 607–617.CrossRefGoogle ScholarPubMed
Maeda, K, Koga, T, Nasu, T, et al. (2017) Predictive accuracy of calf circumference measurements to detect decreased skeletal muscle mass and European society for clinical nutrition and metabolism-defined malnutrition in hospitalized older patients. Ann Nutr Metab 71, 10–15.CrossRefGoogle ScholarPubMed
Keller, H, de van der Schueren, MAE, Jensen, GL, et al. (2020) 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 44, 992–1003.CrossRefGoogle Scholar
Power, L, Mullally, D, Gibney, ER, et al. (2018) A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings – a MaNuEL study. Clin Nutr ESPEN 24, 1–13.CrossRefGoogle ScholarPubMed
Olveira, G, Tapia, MJ, Ocón, J, et al. (2013) The subjective global assessment predicts in-hospital mortality better than other nutrition-related risk indexes in noncritically ill inpatients who receive total parenteral nutrition in Spain (prospective multicenter study). J Acad Nutr Diet 113, 1209–1218.CrossRefGoogle Scholar
Brito, JE, Burgel, CF, Lima, J, et al. (2021) GLIM criteria for malnutrition diagnosis of hospitalized patients presents satisfactory criterion validity: a prospective cohort study. Clin Nutr 40, 4366–4372.CrossRefGoogle ScholarPubMed
Theilla, M, Rattanachaiwong, S, Kagan, I, et al. (2021) Validation of GLIM malnutrition criteria for diagnosis of malnutrition in ICU patients: an observational study. Clin Nutr 40, 3578–3584.CrossRefGoogle ScholarPubMed
Shahbazi, S, Hajimohammadebrahim-Ketabforoush, M, Vahdat Shariatpanahi, M, et al. (2021) The validity of the global leadership initiative on malnutrition criteria for diagnosing malnutrition in critically ill patients with COVID-19: a prospective cohort study. Clin Nutr ESPEN 43, 377–382.CrossRefGoogle ScholarPubMed
Mitani, A, Iwai, T, Shichinohe, T, et al. (2021) The combined usage of the global leadership initiative on malnutrition criteria and controlling nutrition status score in acute care hospitals. Ann Nutr Metab 77, 178–184.CrossRefGoogle ScholarPubMed
Allard, JP, Keller, H, Gramlich, L, et al. (2020) GLIM criteria has fair sensitivity and specificity for diagnosing malnutrition when using SGA as comparator. Clin Nutr 39, 2771–2777.CrossRefGoogle ScholarPubMed
Tan, S, Wang, J, Zhou, F, et al. (2022) Validation of GLIM malnutrition criteria in cancer patients undergoing major abdominal surgery: a large-scale prospective study. Clin Nutr 41, 599–609.CrossRefGoogle ScholarPubMed
Huo, Z, Chong, F, Yin, L, et al. (2022) Accuracy of the GLIM criteria for diagnosing malnutrition: a systematic review and meta-analysis. Clin Nutr 41, 1208–1217.CrossRefGoogle ScholarPubMed
Zhang, K-P, Tang, M, Fu, Z-M, et al. (2021) Global leadership initiative on malnutrition criteria as a nutrition assessment tool for patients with cancer. Nutrition 91–92, 111379.CrossRefGoogle ScholarPubMed
Kaluźniak-Szymanowska, A, Krzymińska-Siemaszko, R, Wieczorowska-Tobis, K, et al. (2022) Optimal assessment of nutritional status in older subjects with the chronic obstructive pulmonary disease-a comparison of three screening tools used in the GLIM Diagnostic Algorithm. Int J Environ Res Public Health 19, 1025.CrossRefGoogle ScholarPubMed
Santos, BC, Fonseca, ALF, Ferreira, LG, et al. (2022) Different combinations of the GLIM criteria for patients awaiting a liver transplant: poor performance for malnutrition diagnosis but a potentially useful prognostic tool. Clin Nutr 41, 97–104.CrossRefGoogle ScholarPubMed
Landi, F, Onder, G, Russo, A, et al. (2014) Calf circumference, frailty and physical performance among older adults living in the community. Clin Nutr 33, 539–544.CrossRefGoogle ScholarPubMed
Barazzoni, R, Jensen, GL, Correia, MITD, et al. (2022) Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition (GLIM) diagnosis of malnutrition. Clin Nutr 41, 1425–1433.CrossRefGoogle ScholarPubMed
Yuan et al. supplementary material
Yuan et al. supplementary material
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