Impact of different markers of muscle mass on GLIM-based diagnosis of malnutrition in peritoneal dialysis

Abstract

BACKGROUND & AIMS: <AbstractText Label="BACKGROUND &amp; AIMS" NlmCategory="OBJECTIVE">The Global Leadership Initiative on Malnutrition (GLIM) is a new method for diagnosing disease related malnutrition with inflammation (DRMI) in patients on peritoneal dialysis (PD). It uses phenotypical and etiological criteria where for the phenotypical criteria several markers of muscle mass can be applied within the GLIM framework. This study aimed to compare the performance of calf circumference (CC), appendicular lean soft tissue index estimated by segmental multifrequency bioelectrical impedance analysis (ALSTI-BIA), mid-upper arm circumference (MUAC), and mid-arm muscle circumference (MAMC) as markers of muscle mass when diagnosing DRMI by GLIM in patients on PD. Additionally, we also evaluated the agreement, accuracy, sensitivity, and specificity between GLIM diagnosed by the four markers of muscle mass and the Malnutrition Inflammation Score (MIS), which is considered a reference method for diagnosing DRMI in individuals on dialysis.</AbstractText> METHODS: <AbstractText Label="METHODS" NlmCategory="METHODS">Cross-sectional study including incident patients on PD. Four markers of muscle mass were employed: CC - adjusted for body mass index (BMI), ALSTI-BIA, MUAC - adjusted for BMI, and MAMC.</AbstractText> RESULTS: <AbstractText Label="RESULTS" NlmCategory="RESULTS">Forty-seven incident patients on PD (58 ± 15 years, mean and standard deviation) with equal distribution of sex were included. The prevalence of DRMI assessed by MIS was 59.6 %. When using GLIM, the prevalence ranged from 57 to 70 % depending on the marker of muscle mass employed. The best agreement for the diagnose of DRMI was between MAMC and ALSTI-BIA (kappa test - r = 0.826; p &lt; 0.001). When using MIS as the reference method, the highest accuracy was shown for GLIM based on ALSTI-BIA (area under the curve 0.805).</AbstractText> CONCLUSION: <AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">GLIM criteria using BMI-adjusted CC had the highest prevalence of DRMI, while the highest accuracy was shown with ALSTI-BIA when using MIS as a reference method.</AbstractText>