Clinical Application of the Global Leadership Initiative on Malnutrition Using a Combination of Different Muscle Mass Indices in Patients with Gastric Cancer: A Multicenter, Cross-Sectional, Observational Cohort Study

Abstract Background: Malnutrition is associated with poor prognosis and prevalent in gastric cancer patients. However, there is no standardized method for evaluating malnutrition; the Global Leadership Initiative on Malnutrition (GLIM) aimed to establish a standard criteria for evaluating malnutrition. However, the cutoff point for muscle reduction remains unclear, and its clinical value has not yet been verified. Hence, we aimed to examine the relationship between combinations of different muscle measurement indices and the survival of gastric cancer patients to determine the accurate method for diagnosing sarcopenia, establish the standard GLIM criteria, and explore its clinical value. Methods: This multicenter and observational cohort study included 1,406 gastric cancer patients. The accurate prediction combination was determined using the cutoff point for muscle loss by predicting the survival risk according to the GLIM criteria established using a combination of muscle mass indicators. Least absolute shrinkage and selection operator regression analysis was used to screen the independent risk factors for survival with the construction of a Cox regression model. The R software was used to establish the nomogram of individual survival prediction and to verify the clinical significance of malnutrition diagnosed based on the GLIM criteria. Results: The risk ratio of patients with malnutrition based on the leg circumference and weight-corrected grip strength was the highest (hazard ratio [HR]=2.159, 95% confidence interval [CI]=1.800, 2.588 in severely malnourished patients). Malnutrition occurred in 54.5% of patients diagnosed with gastric cancer based on the GLIM criteria. Malnutrition is an independent risk factor for unfavorable survival in gastric cancer patients; its nomogram model can accurately predict the survival of gastric cancer. Conclusion : Muscle loss is one of the components of the GLIM criteria and is determined by measuring the leg circumference and weight-corrected grip strength. The GLIM criteria are effective in diagnosing malnutrition and predicting the survival in gastric cancer patients.