P190 - DISCREPANCIES IN GLIM-BASED MALNUTRITION DIAGNOSIS ARISING FROM MUSCLE MASS EVALUATION METHODS IN GASTROINTESTINAL CANCER SURGERY PATIENTS

P190

DISCREPANCIES IN GLIM-BASED MALNUTRITION DIAGNOSIS ARISING FROM MUSCLE MASS EVALUATION METHODS IN GASTROINTESTINAL CANCER SURGERY PATIENTS

T. Kurokawa^1,2,*, T. Sawano¹, Y. Kanemoto¹, A. Ozaki¹, K. Gonda¹, N. Kanzaki¹

¹Surgery, Jyoban Hospital of Tokiwa Foundation, ²Medical Epigenomics Research, Fukushima Medical University, Fukushima, Japan

Rationale: Preoperative nutritional status and muscle mass are key predictors of outcomes in gastrointestinal (GI) cancer surgery. The Global Leadership Initiative on Malnutrition (GLIM) criteria diagnose malnutrition by combining weight loss, low BMI, inflammation, and reduced muscle mass. However, results vary depending on the method used to assess muscle mass, such as bioelectrical impedance analysis (BIA) or CT-based skeletal muscle index (SMI) and psoas muscle index (PMI). These inconsistencies may affect perioperative decisions and nutritional planning, especially in cancer patients with sarcopenia. 

Methods: We retrospectively analyzed 67 patients who underwent laparoscopic gastric or colorectal cancer surgery between 2018 and 2022, among those with valid preoperative BIA data. GLIM-based malnutrition was assessed using four approaches: BMI alone, BMI with ASMI (BIA, AWGS 2019), CT-SMI, and CT-PMI. Agreement among methods was evaluated using cross-tabulations and McNemar’s test. We compared malnutrition prevalence and diagnostic differences.

Results: Malnutrition prevalence was 4% with BMI alone, 93% with BIA-ASMI, 81% with CT-SMI, and 27% with CT-PMI. Compared to BMI, BIA-ASMI identified 59 more cases (p<0.001). Significant disagreement occurred between BIA and CT-SMI (p=0.04), and BIA and CT-PMI (p<0.001). The assessment method substantially altered GLIM classification.

Conclusion: GLIM-based malnutrition diagnosis is strongly influenced by the method of muscle mass assessment. BIA-ASMI tends to overestimate malnutrition compared to CT-based indices, potentially leading to overtreatment. Standardized evaluation methods within GLIM are essential to ensure diagnostic accuracy and guide appropriate nutritional care. These findings support refining international guidelines for consistency and clinical relevance.

Disclosure of Interest: None declared