Combining GLIM phenotypic criteria improves survival prediction in cancer-associated malnutrition

To evaluate the diagnostic agreement among GLIM phenotypic criteria, compare prevalence estimates based on individual and combined criteria, and assess their prognostic value for mortality in oncology patients.

A retrospective cohort study was conducted in adult patients with active solid tumors referred for nutritional assessment at a tertiary hospital. GLIM phenotypic criteria were assessed using multiple tools, including calf circumference, fat-free mass index (FFMI), appendicular skeletal muscle mass index (ASMI), and handgrip strength. Agreement was evaluated using Cohen's Kappa and intraclass correlation coefficients. Malnutrition prevalence and its association with mortality were analyzed using inclusive (any criterion met) and restrictive (all criteria met) combinations. Cox regression models adjusted for tumor type, metastatic stage, time since diagnosis, and prolonged hospitalizations were used to estimate hazard ratios.

The study included 209 patients (mean age 65 years, SD 14; 28.7% female). The median follow-up was 24.1 months (IQR 15.0). Agreement among phenotypic criteria was generally low (Kappa <0.4), except for FFMI and ASMI (ICC = 0.847). Inclusive strategies showed higher malnutrition prevalence (up to 75.6%) but limited prognostic value. Restrictive strategies demonstrated stronger associations with mortality. The combination of BMI, weight loss, FFMI, and ASMI yielded the highest prognostic value (HR 2.98; 95% CI: 1.47-6.01; AUC 0.83). Simpler combinations, such as BMI + FFMI, also showed clinical relevance.

Restrictive GLIM-based strategies using multiple phenotypic criteria improve mortality prediction in oncology patients. FFMI and ASMI emerge as the most robust individual parameters.