PD007 - DERIVATION AND PROGNOSTIC VALIDATION OF SEVERE REDUCTION CUTOFFS FOR ASMI AND FFMI IN GLIM SEVERITY GRADING

PD007

DERIVATION AND PROGNOSTIC VALIDATION OF SEVERE REDUCTION CUTOFFS FOR ASMI AND FFMI IN GLIM SEVERITY GRADING

S. Takagi^1,2,*, K. Maeda^3,4, T. Inoue^4,5, S. Miyahara⁴, S. Satake^1,4,6, H. Akatsu^4,7, N. Mori^2,3, H. Arai⁸

¹Department of Nutrition Management, National Center for Geriatrics and Gerontology, Obu, ²Department of Palliative and Supportive Medicine, Aichi Medical University, ³Nutrition Therapy Support Center, Aichi Medical University Hospital, Nagakute, ⁴Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, ⁵Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, ⁶Department of Frailty Research, ⁷Center for Frailty and Locomotive Syndrome, ⁸National Center for Geriatrics and Gerontology, Obu, Japan

Rationale: The Global Leadership Initiative on Malnutrition (GLIM) recommends instrument-based assessment of reduced muscle mass, but severity-grading cutoffs for appendicular skeletal muscle mass index (ASMI) and fat-free mass index (FFMI) are not established. We aimed to derive cutoffs for severe reductions in muscle mass (SRMM) in older patients and to validate their prognostic significance in a nationwide hospitalized cohort.

Methods: Using a Japanese frailty clinic registry, we analyzed participants with reduced muscle mass. Candidate SRMM cutoffs for ASMI and FFMI were identified by receiver operating characteristic analysis for 1-year hospitalization and refined by comparing thresholds associated with stepwise increases in hospitalization risk. In the validation study, estimated ASMI and FFMI were obtained from a nationwide claims database, and participants were categorized as normal, moderate reduction, or SRMM. Mortality was examined using Kaplan-Meier analysis and Cox proportional hazards models adjusted for age, sex, comorbidities, and frailty status.

Results: In the development cohort (n=1,035; mean age 76.5 years), SRMM cutoffs were ASMI by dual-energy X-ray absorptiometry (DXA) <6.4 kg/m² in men and <5.0 kg/m² in women, ASMI by bioelectrical impedance analysis (BIA) <6.4 kg/m² in men and <5.0 kg/m² in women, and FFMI <16.0 kg/m² in men and <13.4 kg/m² in women. In the validation cohort (n=242,464; mean age 69.9 years), SRMM was consistently associated with higher mortality risk: ASMI (DXA), hazard ratio (HR) 2.04 (95% confidence interval 1.97–2.12); ASMI (BIA), HR 1.95 (1.86–2.03); and FFMI, HR 2.01 (1.94–2.09) (all P<0.001).

Conclusion: These ASMI- and FFMI-based SRMM cutoffs may support GLIM severity grading and improve prognostic risk stratification in clinical practice.

Disclosure of Interest: None declared