• Ana Luisa Ferreira Fonseca, Bárbara Chaves Santos, Lucilene Rezende Anastácio, Ramon Gonçalves Pereira, CorreiaMaria Isabel Toulson DavissonMITDSurgery PostGraduate Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil., Agnaldo Soares Lima, Yani Gláucia Gomide Mizubuti, Samanta Catherine Ferreira, and Lívia Garcia Ferreira.
• Nutrition and Health Graduate Program, Universidade Federal de Lavras, Lavras, Brazil.
• Nutrition. 2023 Oct 1; 114: 112093112093.

ObjectivesThe Global Leadership Initiative on Malnutrition (GLIM) is a framework aiming to standardize malnutrition diagnosis. However, it still needs to be validated, in particular for patients with chronic liver disease. This study aimed to validate the GLIM criteria in patients with liver cirrhosis awaiting liver transplant (LTx).MethodsThis was a retrospective observational study carried out with adult patients on the waiting list for LTx, consecutively evaluated between 2006 and 2021. The phenotypic criteria were unintentional weight loss, low body mass index, and reduced muscle mass (midarm muscle circumference [MAMC]). The etiologic criteria were high Model for End-Stage Liver Disease (MELD) and MELD adjusted for serum sodium (MELD-Na) scores, the Child-Pugh score, low serum albumin, and low food intake and/or assimilation. Forty-three GLIM combinations were tested. Sensitivity (SE), specificity (SP), positive and negative predictive values, and machine learning (ML) techniques were used. Survival analysis with Cox regression was carried out.ResultsA total of 419 patients with advanced liver cirrhosis were included (median age, 52.0 y [46-59 y]; 69.2% male; 68.8% malnourished according to the Subjective Global Assessment [SGA]). The prevalence of malnutrition by the GLIM criteria ranged from 3.1% to 58.2%, and five combinations had SE or SP >80%. The MAMC as a phenotypic criterion with MELD and MELD-Na as etiologic criteria were predictors of mortality. The MAMC and the presence of any phenotypic criteria associated with liver disease parameters and low food intake or assimilation were associated with malnutrition prediction in ML analysis.ConclusionsThe MAMC and liver disease parameters were associated with malnutrition diagnosis by SGA and were also predictors of 1-y mortality in patients with liver cirrhosis awaiting LTx.Copyright © 2023 Elsevier Inc. All rights reserved.

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