What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=834). Intervention: GLIM-defined malnutrition with low handgrip strength vs. Absence of malnutrition with normal handgrip strength. Primary outcome: 2-year all-cause mortality (HR 2.06, 95% CI 1.14-3.73, p=0.02).

What question did this study set out to answer?

The study aims to determine if assessing handgrip strength and fat mass index alongside GLIM improves mortality risk prediction in older adults with heart failure.

June 5, 2026

Combined GLIM‐defined malnutrition and sarcopenia and the risk of 2‐year mortality in adults with heart failure: A FRAGILE‐HF study post hoc analysis

Key Result

GLIM-defined malnutrition combined with low handgrip strength was associated with a higher risk of 2-year all-cause mortality in older heart failure patients (HR 2.06; 95% CI 1.14-3.73; P=0.02).

Key Points

The study aims to determine if assessing handgrip strength and fat mass index alongside GLIM improves mortality risk prediction in older adults with heart failure.
Post hoc analysis of patients aged 65 years and older from the multicenter FRAGILE-HF cohort.
Malnutrition was evaluated using GLIM criteria at hospital discharge.
Cox proportional hazards regression examined associations with 2-year all-cause mortality.
Patients with GLIM-defined malnutrition and low handgrip strength had a higher mortality (HR, 2.06; 95% CI, 1.14–3.73; P = 0.02).
Those with GLIM-defined malnutrition and low fat mass index also faced higher mortality (HR, 1.87; 95% CI, 1.25–2.80; P = 0.01).
Both groups showed significantly elevated risk compared to patients without malnutrition.

Study Design

Type

Cohort (n=834)

Multicenter

Yes

Structured PICO

Does the combination of GLIM-defined malnutrition with low handgrip strength or low fat mass index predict 2-year mortality in older adults with heart failure?

Population

834 patients aged ≥65 years with heart failure, evaluated for malnutrition and muscle/fat metrics at discharge, followed for 2 years.

Exposure

GLIM‐defined malnutrition combined with low handgrip strength (<28 kg in men, <18 kg in women) or low fat mass index (<4.62 kg/m2 in men, <5.86 kg/m2 in women) assessed at hospital discharge

Comparator

Absence of malnutrition with normal handgrip strength and absence of malnutrition with normal fat mass index

Outcome

2-year all-cause mortalityhard clinical

Assessing handgrip strength or fat mass index alongside GLIM criteria improves risk stratification for 2-year mortality in older patients with heart failure.

Main Result

Hazard Ratio: 2.06 (95% CI 1.14–3.73)

p-value: p=0.02

Abstract

Abstract Background Malnutrition is common in older patients with heart failure and predicts poor outcomes. However, the prognostic value of assessing muscle function and fat stores alongside GLIM remains unclear. We therefore tested whether assessing handgrip strength and fat mass index alongside GLIM improves risk stratification for mortality. Methods We conducted a post hoc analysis of patients ≥65 years in the multicenter observational FRAGILE‐HF cohort. Malnutrition was evaluated using GLIM criteria at hospital discharge. Handgrip strength and fat mass index were also measured at discharge; low handgrip strength was defined as <28 kg in men and <18 kg in women, and low fat mass index as <4.62 kg/m 2 in men and <5.86 kg/m 2 in women. Patients were classified into four groups by GLIM‐defined malnutrition and low handgrip strength and, separately, by GLIM‐defined malnutrition and low fat mass index. Associations with 2‐year all‐cause mortality were examined using Cox proportional hazards regression. Results Of 1332 patients, 834 were analyzed (median age, 81 years; 57.6% men). In four‐group analyses, GLIM‐defined malnutrition with low handgrip strength (HR, 2.06; 95% CI, 1.14–3.73; P = 0.02) and GLIM‐defined malnutrition with low fat mass index (HR, 1.87; 95% CI, 1.25–2.80; P = 0.01) had higher mortality than the corresponding reference groups (absence of malnutrition with normal handgrip strength and absence of malnutrition with normal fat mass index). Conclusion Assessing handgrip strength or fat mass index alongside GLIM identified subgroups at higher risk of 2‐year mortality.