LB100 - BEYOND STANDARD SCREENING: HIGH CLINICAL RISK PROFILE IDENTIFIES INFLAMMATION-DRIVEN MALNUTRITION MISSED BY THE GLIM ALGORITHM

LB100

BEYOND STANDARD SCREENING: HIGH CLINICAL RISK PROFILE IDENTIFIES INFLAMMATION-DRIVEN MALNUTRITION MISSED BY THE GLIM ALGORITHM

A. Kaluźniak-Szymanowska^1,*, E. Deskur-Śmielecka¹, R. Krzymińska-Siemaszko¹, A. Styszyński¹, S. Tobis², M. Lewandowicz-Czarnecka¹, J. Chudek³, T. Kostka⁴, M. Mossakowska⁵, K. Piotrowicz⁶, H. Kujawska-Danecka⁷, K. Wieczorowska-Tobis¹

¹Department of Palliative Medicine, ²Department of Occupational Therapy, Poznan University of Medical Sciences, Poznan, ³Faculty of Medical Sciences in Katowice, Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, Katowice, ⁴Department of Geriatrics, Medical University of Lodz Healthy Ageing Research Centre, Lodz, ⁵Study on Aging and Longevity, International Institute of Molecular and Cell Biology, Warsaw, ⁶Faculty of Medicine, Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, ⁷Department of Rheumatology, Clinical Immunology, Geriatrics and Internal Medicine, Medical Univeristy of Gdansk, Gdansk, Poland

Rationale: The GLIM (Global Leadership Initiative on Malnutrition) algorithm mandates nutritional screening as a gatekeeper. We hypothesized that relying strictly on this preliminary step, utilizing tools like MNA-SF (Mini Nutritional Assessment-Short Form), inadvertently misses older adults with inflammation-driven disease-related malnutrition and preserved or higher body mass index (BMI). 

Methods: A cross-sectional analysis of 5,614 community-dwelling older adults from the representative PolSenior2 study was conducted. We compared clinical profiles of individuals fulfilling full GLIM criteria (screening-positive) with a "missed" cohort: those meeting 1 or more phenotypic and 1 or more etiologic GLIM criterion but classified as normal by MNA-SF (12 points or more). 

Results: Among 1,136 participants with GLIM-diagnosed malnutrition, 30.5% (n=347) were missed by the initial screening step. Compared to screening-positive patients, this missed cohort had a significantly higher BMI (27.0 ± 4.2 vs 26.2 ± 5.6, p=0.013) and less frequently reported unintentional weight loss (36.1% vs 66.8%, p<0.001) or reduced food intake (30.0% vs 69.6%, p<0.001). Notably, their malnutrition was predominantly driven by acute or chronic inflammatory disease, which was present in 83.0% of the missed cohort compared to 64.5% of the screening-positive group (p<0.001). 

Conclusion: The mandatory screening step in the GLIM pathway creates a diagnostic blind spot for older adults with inflammation-driven malnutrition and higher BMI. Bypassing standard screening tools to proceed directly to full GLIM assessment in patients with high clinical risk (e.g., chronic inflammation) could prevent underdiagnosis and accelerate targeted nutritional care. 

Disclosure of Interest: None declared