Clinical Nutrition 40 (2021) 3578e3584

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Clinical Nutrition
journal homepage: http://www.elsevier.com/locate/clnu

Original article

Validation of GLIM malnutrition criteria for diagnosis of malnutrition

in ICU patients: An observational study
Miriam Theilla a, b, c, *, Sornwichate Rattanachaiwong d, Ilya Kagan a, b, Merav Rigler a, b,
Itai Bendavid a, b, Pierre Singer a, b
a
Department of General Intensive Care and Institute for Nutrition Research, Israel
b
Nutrition Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
c
Steyer School of Health Professions, Nursing Department, Sackler School of Medicine, Tel Aviv University, Israel
d
Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

a r t i c l e i n f o s u m m a r y

Article history: Background & aims: Patients in the Intensive Care Unit (ICU) are at high risk of malnutrition. The only
Received 31 August 2020 validated malnutrition assessment tool is the Subjective Global Assessment (SGA). The Global Leadership
Accepted 15 December 2020 Initiative on Malnutrition (GLIM) is a new malnutrition assessment tool. The present study compares the
nutrition-related parameters of the following tools: GLIM tool, SGA, Phase Angle (PA), Low Fat-Free Mass
Keywords: Index (FFMI), and Patient- and Nutrition-Derived Outcome Risk Assessment score (PANDORA), in an
The global leadership initiative on
attempt to validate an objective tool.
malnutrition (GLIM)
Methods: Eighty-four ICU patients were included. The tools mentioned above were assessed for their
Patient- and nutrition-derived outcome risk
assessment (PANDORA score)
validity in diagnosing malnutrition. All patients were defined as suffering from acute disease and
Low fat-free mass index (low FFMI) received medical nutrition therapy. To evaluate whether there is a correlation between the GLIM criteria,
Global subjective assessment (SGA) SGA, PA, and low FFMI, we compared the SGA, PA, and low FFMI to the GLIM criteria using Spearman
Intensive care unit (ICU) patients correlation coefficients and a Chi-square test. Also, a ManneWhitney U test was used to test the mean
differences between the GLIM criteria and the PANDORA. The area under the curve (AUC) of the proposed
parameters was evaluated for diagnosis of malnutrition to seek cutoff points that yield good sensitivity
and specificity.
Results: Mean age was 50 ± 20 years, BMI 25.3 ± 5.1 kg/m2, APACHE II 20.5 ± 7.7, PANDORA score
32 ± 8.5. GLIM malnutrition criteria were significantly correlated with the gold standard SGA assessment
and with low FFMI, with PA (Phase Angle), and with the PANDORA score. The area under the curve, by
using the ROC curve analysis for GLIM criteria stratified by the SGA results, was 0.85 (P < 0.001).
Sensitivity was 85%, and specificity 79%. However, when comparing the low FFMI, PA, and PANDORA to
the GLIM criteria, the ROC curve analysis results were considered poor rank.
Conclusions: The SGA malnutrition assessment highly validated the GLIM criteria framework combined
with the two-criteria diagnosis of malnutrition with a high level of precision. The GLIM malnutrition
assessment seems to be acceptable in the ICU setting.
© 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

1. Introduction integration of two phenotypic and etiologic criteria [1]. Previously,

The Global Leadership Initiative on Malnutrition (GLIM) is a new
global consensus for diagnosing malnutrition, which identifies the
different core attributes of malnutrition. The new structure evalu-
ates undernutrition and risk of malnutrition based on the
* Corresponding author. Nursing Department, Steyer School of Health Pro-
fessions, Sackler Faculty of Medicine, Tel Aviv University, Health Professions
Building, Room 310, Ramat Aviv, 6997801, Israel. Fax: þ972 36409496.
E-mail address: theillamiriam@gmail.com (M. Theilla).
no worldwide agreement or consensus demonstrated a unified
method for determining malnutrition in all different patients and
medical institutions. To date, no gold standard is ideal for the
detection of malnutrition in all types of patients and institutions.
Each institution and hospital decides which nutritional assessment
is appropriate for them. The reasons for choosing a specific nutri-
tional assessment could be due to the particular patient population
at a particular institution, and it can even depend on the amount of
time and skill needed by the staff to make an assessment [2e6].
However the GLIM, which is considered a global consensus

https://doi.org/10.1016/j.clnu.2020.12.021
0261-5614/© 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
M. Theilla, S. Rattanachaiwong, I. Kagan et al.
diagnostic criterion of malnutrition, has not been validated for use
in Intensive Care Unit (ICU) patients. We compared the GLIM
criteria to nutrition-related parameters of the following tools:
Subjective Global Assessment (SGA) as a gold standard, PA (Phase
Angle), low FFMI (Fat Free Mass Index), and PANDORA (Patient- and
Nutrition-Derived Outcome Risk Assessment score), with respect to
their ability to predict malnutrition in severely ill patients.
The PANDORA is used in hospitalized patients. The score pre-
dicts mortality based on seven parameters: age, nutrient intake in
the last 24 h, body mass index (BMI), mobility, fluid status, and the
main diagnostic criteria group [7], based on the nutrition Day
survey. We included this score as one of the tools compared to the
GLIM despite not having been validated in critically ill patients.
Another parameter that has a significant influence on nutri-
tional status is the FFMI (kg/m2). The measurement is performed by
using bioelectrical impedance analysis (BIA) [8]. The results are
useful in evaluating body composition, and more precisely, lean
body mass [9]. The recommended cutoff values for muscle mass
reductions are FFMI values under 17 kg/m2 for men and under
15 kg/m2 for women in the normal BMI range [10]. Studies show
that more active subjects were likely to have a high FFMI [11].
Moreover, Kyle and colleagues (2004) demonstrated that physical
activity maintains FFMI scores. Though in physically active adults
compared to sedentary subjects, the BMI is more accountable for a
low FFMI, low FFMI is correlated with undernutrition [9]. The FFMI
and body fat mass index are recognized as independent markers of
nutrition status [12]. Studies demonstrate an association between
low FFMI and low excess body fat and increased likelihood of
nutrition and health in hospitalized patients [12].
Phase angle (PA) as obtained by bioelectrical impedance analysis
has been proposed as an indicator of membrane integrity and body
cell mass, as it is influenced by changes in cell membrane perme-
ability due to inflammation and represents nutrition status. It has
been shown to predict malnutrition as well as mortality in various
settings including intensive care [13]. In healthy populations the PA
is significantly higher in males compared to females and shows a
decline with age [14]. A cutoff point below the 15th percentile was
proposed for the normal PA value adjusted by age and sex [15] as a
low PA to identify malnutrition [14].
Studies have reported that the Subjective Global Assessment
(SGA) is a reliable assessment tool for diagnosing malnutrition in
ICU patients [16,17]. The SGA is a well-established validated tool
that is considered the gold standard for clinicians for determining
the nutritional status of hospitalized patients [18e20]. Studies
found long range correlations between nutrition status and a
higher prevalence of complications, such as length of hospital stay,
recovery, mortality, and costs [21,22]. Although nutritional assess-
ment in the ICU is often complicated and hard to perform [4], it is
necessary to use a homogeneous assessment for all hospitalized
and severely ill patients in order to improve the quality of care in
ICU patients. The current study aimed to compare and validate the
new malnutrition screening tool, i.e., the GLIM malnutrition
criteria, with the SGA, Phase Angle, FFMI, and PANDORA, in criti-
cally ill patients.
2. Material and methods
2.1. Sample
We conducted an observational study among patients (N ¼ 84)
admitted to the ICU of the Rabin Medical Center (Israel) - a multi-
disciplinary unit in a university-affiliated tertiary care medical
center, from November 2017 to June 2018. A power analysis was
performed to determine the sample size using Arifin's sample size
calculator [23] based on the kappa value reported by Ravasco and
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Clinical Nutrition 40 (2021) 3578e3584
colleagues [24]. Concordance analysis between anthropometry
measurements showed agreement of 88.6%, k ¼ 0.77, P ¼ 0.0001,
and the resulting required sample size was n ¼ 81 to provide two-
tailed power (1 - b): 80% and an a value of 0.05. The Rabin Medical
Center's institutional ethical review board approved the study. Data
was anonymized for analysis. Inclusion criteria were adult patients
(aged 18 years). They were recruited within 24 h from ICU
admission and Global Subjective Assessment (SGA) screening re-
sults were performed during admission. Exclusion criteria were
patients with any condition that interferes with conducting
bioelectrical impedance analysis measurements (skin damage at
the site where the electrodes will be applied, major limb amputa-
tion, pregnancy).
2.2. Tools
Demographics and evaluation of disease and health were drawn
from the patient's data documented in the electronic medical re-
cord (iMDsoft, Meta vision, Israel), and included gender, age, body
weight, height, BMI, as well as the Acute Physiology and Chronic
Health Evaluation (APACHE II). Although all ICU patients are at high
risk of malnutrition for various reasons such as acute disease or are
often suffering from a proinflammatory state that leads to meta-
bolic stress [25] we used the MUST (Malnutrition Universal
Screening Tool) to identify patients at risk, primarily 24 h from ICU
admission. We also performed all the nutritional assessments
mentioned in this study. We compared the final staging and
severity of malnutrition in each nutritional assessment used and in
each participant in the study.
The Global Leadership Initiative on Malnutrition (GLIM) was
evaluated using the scheme for diagnosing malnutrition in adults
by the global nutrition community project [1]. In the current study
we performed all the components of the GLIM assessment, which
include the phenotypic criterion and etiologic criterion that were
performed according to the GLIM recommendations [1]. The weight
loss percentage was obtained from the patients within 24 h of
admission, or if the patient was unable to communicate, the data
were taken from a family member by the attending physician. They
were requested to answer the question of whether there had been
weight loss of >5% within the past six months or >10% beyond six
months. We measured current weight and height. Height was
based on ulna length [26] and weight was measured by the ICU
department's electronic bed weight scale. BMI was considered low
according to age for patients less than 70 years if <20 and for pa-
tients over 70 years if <22. All the patients in the current study
were Caucasian. The state of muscle mass was obtained by
measuring all the patients with the body impedance measurement
BIA (Bodystat 1000, Bodystat). The amount of reduced food intake
was not available in the current study. However, all participants
were acutely ill patients and were suffering from critical diseases.
All of them met one point in the etiologic criterion. For diagnosing
patients as having malnutrition, they should fulfill at least one
phenotypic criteria and one etiologic criteria. Phenotypic metrics
for grading severity are Stage 1 (moderate) and Stage 2 (severe).
The SGA is a clinical technique for assessing nutrition condi-
tions. The nutrition status was classified by using the SGA ques-
tionnaire, a well-validated tool published by Detsky et al., in 1987
[27]. The same nutrition specialist performed a subjective global
assessment using a questionnaire that assessed all patients. If the
patient was unable to provide such information, the information
was taken from the family member attending the patient. In our
study, we completed the SGA according to the description provided
by Detsky and colleagues [27]. Each patient was classified by the
nutrition specialist's subjective judgment as SGA A, B, or C, with A
meaning no malnutrition, B - moderately malnourished, and C -
M. Theilla, S. Rattanachaiwong, I. Kagan et al.
severely malnourished. The patient's clinical history and gastroin-
testinal symptoms, as well as functional ability, were obtained from
the patient in the first 24 h of admission. A physical examination
was conducted by the same physician to assess the level of muscle
wasting, subcutaneous tissue loss, and edema.
The PANDORA score provided by the same physician was based
on the nutrition Day project variable [7] and established on 7
markers with 31 component types. Age, BMI, main patient group,
and affected organs upon admission were obtained from the elec-
tronic data. The functioning level was determined by asking the
patient or the family. Food consumption by the patients was
determined by asking the nurses, however most of the patients
received enteral nutrition. The physician performed the fluid status
condition and calculated the PANDORA score.
We used separate statistical analyses for low FFMI and for PA to
diagnose malnutrition. Muscle mass estimation was identified by
using FFMI, managed by using a single 50 kHz frequency. The
measurement is indirect, BIA (Bodystat 1000, Bodystat (Isles of
Man) Limited, British Isles). The cutoff values for low muscle mass
are FFMI values under 17 kg/m2 for men and 15 kg/m2 for women
[10]. In the current study we included a PA value below 4.5 to
identify malnutrition patients. Studies show different cutoff points
of PA to define malnutrition. Overall, a PA value below 4.5e5
usually indicates malnutrition, with a sensitivity of 70e80% in the
non-ICU population [28,29]. Electronic medical records were used
to preserve all the patients' data (iMDsoft, Metavision, Israel).
2.3. Statistical analysis
Statistics were calculated by using SPSS version 25 (SPSS, Inc., an
IBM Company, Chicago, IL). The clinical variables consisted of the
patient's demographic variables and the Acute Physiology and
Chronic Health Evaluation (APACHE II). They were expressed as
mean, standard deviation (SD), and percentages, as appropriate. In
addition, the empirical distribution of the data was compared to the
theoretical distribution by using the Chi-square test or a nonpara-
metric test, the ManneWhitney U test. To assess whether there was
a correlation between the GLIM criteria, the SGA, and low FFMI, we
compared the SGA and low FFMI to the GLIM criteria using the chi-
square test. The accuracy of the GLIM criteria in distinguishing
malnutrition cases from typical cases was evaluated using a
Receiver Operating Characteristic (ROC) curve analysis and
compared to the SGA, PA, and low FFMI. We performed a
ManneWhitney U test for the mean differences between the GLIM
criteria and the PANDORA.
Furthermore, we calculated the area under the receiver oper-
ating characteristic (ROC) curve of the GLIM with the SGA, PA, low
FFMI, and PANDORA. The area under the ROC curve is a function of
the ability of a predictor to differentiate between patients with and
without malnutrition. An area under the curve of 0.8e0.9 is
considered a high-rank results test and between 0.5 and 0.6 is
considered a poor test. The area under the curve is a function of the
sensitivity, and the ability of tests to recognize the true state of
subjects suffering from malnutrition is more essential than finding
patients who do not suffer from malnutrition. The highest cutoff
point for the test was characteristically located at the point at
which the sensitivity and specificity were simultaneously maxi-
mized. A p-value of <0.05 was considered significant for all the
assessment tests.
3. Results
We recruited 84 ICU patients. The mean age was 50 ± 20 years,
BMI 25.3 ± 5.1 kg/m2, APACHE II score was 20.5 ± 7.7, PANDORA
score 32 ± 8.5 (see data in Table 1). Spearman correlation
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Clinical Nutrition 40 (2021) 3578e3584
coefficients showed a significant correlation between GLIM
malnutrition criteria and SGA, low FFMI, and PA (Phase Angle)
(R ¼ 0.531, p  0.01; R ¼ 0.544, p  0.005; R ¼ 0.345, p  0.05,
respectively) (see Table 2).
The validity results and the area under the curve from the ROC
evaluation for SGA as the gold standard for identifying moderate
and severe malnutrition compared to the GLIM criteria have a
sensitivity of 85% and a specificity of 79%. The total area under the
curve for the GLIM was 0.85 (P < 0.001) and 0.79 (Fig. 1). The SGA
identified 44 patients as not suffering from malnutrition, while the
GLIM identified 35 of them as not suffering from malnutrition. The
specificity index is defined as, assuming that the SGA has identified
someone who is not malnourished, the chance that the GLIM will
also identify him as malnourished. The answer is specificity ¼ 35/
44*100 ¼ 79.5%. In contrast, in 20.5% of the patients, the identifi-
cation of the GLIM will be incorrect. The implication is that in 20.5%
of the cases, the GLIM would determine someone as malnourished
even though he is not malnourished, according to the SGA. The SGA
identified 40 patients as malnourished, while the GLIM identified
34 malnourished patients. The sensitivity index is defined as -
considering that the SGA has identified someone as malnourished,
the chance that the GLIM will also show him to be malnourished.
The answer is sensitivity ¼ 34/40*100 ¼ 85%. Namely, the GLIM
identified malnutrition in 85% of the cases. However, in 15% of the
cases the GLIM would be wrong compared to the SGA. Generally,
the GLIM was correlated with the SGA in 82% of the cases. From 84
patients, the two tools were compatible for 69 patients, 69/
84*100 ¼ 82%.
Pearson Chi-Square was used to indicate the strength of the
effect size. The effect size was R ¼ 0.64. c2(1) ¼ 34.93, p < 0.001.
The ROC analysis for the GLIM criteria evaluated by the low FFMI
and PA, was significantly correlated, p < 0.001 and p < 0.01,
respectively. The low FFMI sensitivity was 100% and specificity was
58% (Fig. 2). However, the rate of false alarms was 42%. In the PA
analysis, the sensitivity was 67% and specificity 66% (Fig. 2).
For identifying malnutrition by the GLIM criteria and by the
PANDORA score, the ManneWhitney U test showed a significant
correlation between the GLIM malnutrition criteria and the
PANDORA score, Z ¼ 2.67; R ¼ 0.29; p ¼ 0.008. However, the effect
size of R ¼ 0.29 is considered a low-strength effect. The results of
the ROC curve analyses for GLIM criteria stratified by the PANDORA
score were sensitivity 79% and specificity 39% (Fig. 3). Although the
PANDORA score includes nutritional parameters, its primary use is
to evaluate mortality. Therefore, these results are not surprising.
4. Discussion
The present study aimed to examine and validate the new
malnutrition screening tool, i.e., the GLIM malnutrition criteria, in
critically ill patients. The research finding showed that the GLIM
malnutrition screening tool compared to the gold standard SGA
assessment had a high sensitivity of 85% and specificity of 79%.
Table 1
Patient characteristics in the study.
N ¼ 84 Mean SD(±)
Gender 58 male 26 Female
Age (years) 50.5 20.9
BMI(kg/m)2 25.3 5.8
SOFA score 6.3 3.9
APACHE II score 20.5 7.7
Phase angle 4.5 1.7
PANDORA score 32.4 8.5
ICU LOS 6.5 10.4
M. Theilla, S. Rattanachaiwong, I. Kagan et al. Clinical Nutrition 40 (2021) 3578e3584

Table 2
A review of the items included in the SGA and PANDORA score compared to the GLIM criteria for screening and assessment of malnutrition.

GLIM (Cederholm et al., 2019) PANDORA score (Hiesmayr et al., 2015) SGA (Detsky et al., 1987)

Etiologies
Change in dietary intake ✓ ✓
Disease burden/inflammation ✓ ✓
Symptoms
Anorexia ✓
Weakness ✓ ✓
Signs/Phenotype
Weight loss ✓
BMI ✓ ✓
Lean mass/muscle mass
Fat mass ✓
Fluid retention/ascites ✓ ✓
Functional capacity ✓
Age ✓

GLIM- Global Leadership Initiative on Malnutrition; PANDORA- The Patient- And Nutrition-Derived Outcome Risk Assessment Score; SGA ¼ Subjective Global
Assessment; BMI-Body mass index.

Fig. 1. Receiver-operating characteristic (ROC) curve plot of the true positive rate (sensitivity) rate against the false positive rate (1-specificity) at GLIM criteria cut off values
compared with SGA.

However, despite the GLIM, malnutrition criteria were significantly
correlated with the low FFMI, PA (Phase Angle), and PANDORA
score. Their sensitivity and specificity by using the ROC curve
analysis were insufficient.
Many nutritional assessment tools have been reported. A review
published by Jones (2002) proposed that the effectiveness of all the
nutritional assessments has not been examined homogeneously.
The use of different assessment tools in various studies reduces the
ability to evaluate the diverse methods [30]. The GLIM malnutrition
criteria evolved around the need for a global consensus in order to
screen for malnutrition in hospitalized and other patients [31]. It
was essential to validate the new tool in a different population,
such as ICU hospitalized patients. The current study appears to be
one of the first to use GLIM malnutrition criteria combined with
phenotypic and etiologic criteria in ICU patients.
The Global Leadership Initiative for GLIM inspection validated
nutritional assessments and ranked the parameters. The highest
rank of criteria accepted by the consensus on nutritional status is
the criteria of weight loss, low body mass index (BMI), reduced
muscle mass, reduced food intake, and disease burden or inflam-
mation [1].
The Subjective Global Assessment (SGA) method is a validated,
well known, and reliable tool for assessing malnutrition and pre-
dicting outcomes in ICU patients [32]. Studies have shown that
62%e70% of undernourished in-patients were not detected as
malnourished [33,34]. Particularly in critically ill patients, per-
forming a nutritional assessment is not easy. This may explain why
nutritional assessment in critically ill patients is not performed
regularly [32]. The parameters included in the SGA (weight loss,
food intake, the disease, the GI symptoms, body composition) are
almost the same in the phenotypic and etiologic evaluation of the
GLIM and may explain the similar incidence rates in the GLIM and
SGA. The incidence of malnutrition among patients in the ICU was
48% according to the SGA, and according to the GLIM 41%. Our re-
sults are similar to those of other studies that present rates of
malnutrition between 20% and 60% using the SGA assessment

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M. Theilla, S. Rattanachaiwong, I. Kagan et al. Clinical Nutrition 40 (2021) 3578e3584

Fig. 2. Receiver-operating characteristic (ROC) curve plot of the true positive rate (sensitivity) rate against the false positive rate (1-specificity) at GLIM criteria cut off values
compared with low FFMI and PA.

Fig. 3. Receiver-operating characteristic (ROC) curve plot of the true positive rate (sensitivity) rate against the false positive rate (1-specificity) at GLIM criteria cut off values
compared with the PANDORA score.

[26,32,35]. In the current study, the sensitivity and specificity of the identifies patients as undernourished the GLIM will not identify
ROC analysis are the interest measures of the forecast. The GLIM, them as undernourished. The complement of 21% is 79%, which is
compared to the SGA, classified the patients as undernourished in the specificity. This finding is similar to recent research results [36]
85% of the cases. However, in 21% of the cases, when the SGA showing that the GLIM tool has good validity compared to the SGA.

3582
M. Theilla, S. Rattanachaiwong, I. Kagan et al.
The sensitivity is to categorize the malnourished patients correctly,
and it takes priority over miscategorize, which the patients are not
in malnutrition state (specificity).
Despite the fact that the PA value in other studies has been
shown to predict malnutrition [14], our findings were not
compatible with other studies. A possible reason for this is that the
PA is adjusted by different parameters, such as age, sex, etc. [15]. It
is remarkable to note that due to the fact that the PA value is related
to the hydration compartments, including permeability, integrity,
hydration between extracellular and intracellular spaces, PA mea-
surements become debatable in ICU patients [37]. In a large hos-
pital patient cohort study [38], the optimal PA cutoff value
associated with nutritional problems and nutritional assessments
such as the NRS-2002 and SGA was <5 for men and <4.6 for
women, which explains the use of higher PA cut off values [38].
Inspired by Kyle and colleagues [8], the FFMI component was used
to explore the different PA cutoff values in studies to identify
malnutrition or increased morbidity [39e41]. However, the FFMI is
not similar to the PA bioimpedance measurement. The FFMI uses
BFMIs and BMI for the assembly prediction equation to determine
the FFMI value. FFM and FFMI are useful markers of nutritional
status in healthy and ill subjects. However, the upper limits of FFMI
are not of clinical consequence because high levels of FFM do not
cause unfavorable health effects. FFMI enables us to monitor the
impact of different conditions such as age, health, and disease using
FFMI as absolute values [8].
van Venrooij and colleagues [42] showed a significant correla-
tion between lower FFMI before surgery with a higher incidence of
postoperative infections and an increase of ICU LOS [42]. In the
current study, we used the low FFMI to diagnose malnutrition. The
evaluations were made using a mathematical model accomplished
in the BIA equipment by the manufacturer. Sensitivity was ranked
very high (100% sensitivity), due to the fact that the FFMI is
embedded in the GLIM. However, the lower specificity of the GLIM
was somewhat surprising at 42%. In other words, the low FFMI
identified patients as not suffering from malnutrition. These results
may be explained by a study that shows a significant correlation
between high FFMI and decreased risk of malnutrition in hospi-
talized patients [12].
The PANDORA score is based on the nutrition Day survey, and
has been found to be an suitable tool for predicting mortality [43].
This may be the reason for the lower sensitivity and specificity in
the PANDORA assessment compared to the GLIM criteria. Also, the
PANDORA score was planned for hospital patients and not for ICU
patients. Another issue that may affect the lower results of the
PANDORA compared to the GLIM is that in the PANDORA we assess
the actual level of functioning, which is difficult to obtain in
bedridden ICU patients. It seems that the GLIM score assessment in
intensive care patients can be easily managed because in ICU pa-
tients the etiology is homogeneous. All the patients are in critical
condition, so they will receive one point for this criterion, and the
phenotype is precise. The GLIM score can be used both in hospital
departments and for intensive care patients.
5. Limitations
This is a retrospective observational research analysis. The
limitations included weaknesses in assessing confounders. We did
not estimate the energy requirement and food intake for each pa-
tient. Since all the patients in the current study were critically ill,
we categorized them as having a high severity of disease and
inflammation. They all received 1 point for the etiologic criterion.
This restriction of the inclusion parameters could affect the com-
parison of the nutritional assessments and potentially mislead and
influence the validity of the results. The PA and FFMI are imbedded
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Clinical Nutrition 40 (2021) 3578e3584
in the bioimpedance measurement, so may be examining the two
of them as an independent item is not appropriate. However, we
compared them to the GLIM criteria because some studies
demonstrated a correlation between the PA and the FFMI sepa-
rately from the level of malnutrition.
6. Conclusions
The ident SGA malnutrition assessment predicts the GLIM
criteria framework combined with the two-criteria diagnosis with a
high level of precision. The GLIM malnutrition assessment appears
to be acceptable in the ICU setting.
Funding
This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors.
Conflict of interest
The authors have no conflicts of interest to declare.
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