Global leadership initiative on malnutrition criteria using different muscle mass assessment methods in hemodialysis patients: Links to physical performance, quality of life, and clinical outcomes

Background/objectives Malnutrition is frequent in maintenance hemodialysis (MHD). We aimed to validate the Global Leadership Initiative on Malnutrition (GLIM) criteria using different muscle mass assessment methods and evaluate their associations with nutritional biomarkers, functional status, quality of life, and mortality. Subjects/methods This prospective study included 218 MHD outpatients (63% male; mean age 70.6 ± 12.2 years). Muscle mass was assessed using bioimpedance analysis (BIA), mid-arm muscle circumference (MAMC), and calf circumference (CC). Serum biomarkers, handgrip strength, gait speed, and nutritional scores (Malnutrition Inflammation Score [MIS], Geriatric Nutritional Risk Index [GNRI]) were obtained. Malnutrition was defined as MIS > 10. Associations with SF-36 scales and survival were analysed. Results Malnutrition prevalence was 26.1% with BIA-based GLIM, 25.2% with MAMC-based GLIM, and 27.1% with CC. BIA-based GLIM correlated with albumin, MIS, GNRI, phase angle, handgrip strength, and gait speed. MAMC-based GLIM showed similar associations except for gait speed. CC-based GLIM correlated with albumin and GNRI. Agreement with MIS was fair (κ = 0.31–0.35). All GLIM variants showed high specificity but low sensitivity. Only BIA- and MAMC-based GLIM were associated with reduced quality of life. BIA-based GLIM predicted higher mortality (HR 1.70, 95% CI 1.01–2.85), and CC-based GLIM showed a stronger association (HR 2.94, 95% CI 1.41–6.14). MAMC-based GLIM showed a nonsignificant trend. Conclusions GLIM demonstrated fair agreement with MIS, high specificity, and meaningful concurrent validity. MAMC- and CC-based GLIM provided practical alternatives to BIA. These findings support further validation of anthropometric GLIM variants in diverse MHD populations.