Usefulness of the global leadership initiative on malnutrition -GLIM- criteria to identify malnutrition in older adults: systematic review and meta-analyses

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AIM: Malnutrition is highly prevalent among older subjects, yet no universal method for its identification has been established. This study aimed to evaluate the concurrent and predictive validity of the GLIM criteria in older adults. METHODS: A systematic review and meta-analysis were conducted in five databases involving older adults (≥60 years). Concurrent validity utilizes reference nutritional assessment tools, while predictive validity focuses on key outcomes, including mortality, hospitalization, and healthcare costs. RESULTS: The search yielded 683 references. Thirteen hospital-based studies from four continents (n = 9164) met the inclusion criteria. GLIM implementation commonly used the MNA-SF for screening, while muscle mass was assessed with calf circumference, BIA, or DXA. The global prevalence of malnutrition, as reported by GLIM, ranged from 14.1% to 71.9%. A meta-analysis of four studies (n = 1221) showed that malnutrition diagnosis by GLIM criteria demonstrated a pooled sensitivity of 0.79 (95% CI: 0.69-0.86) and specificity of 0.88 (95% CI: 0.81-0.93), with moderate heterogeneity and no publication bias. Predictive validity analyses showed that malnutrition diagnosed by GLIM was associated with higher in-hospital and post-discharge mortality, lower ADL scores at discharge and follow-up, and longer hospital stays. Malnutrition was also associated with an increased risk of hospital complications and higher healthcare costs. No validation studies were found in nursing homes or community-dwelling older adults. CONCLUSION: The GLIM criteria appear suitable for identifying malnutrition in clinical settings and predicting key adverse outcomes. However, their application in community-dwelling and nursing home populations remains inconclusive until further evidence becomes available.