Diagnostic Value of a Global Leadership Initiative on Malnutrition Criteria in Patients with Malignant Tumors: A Systematic Review and Meta-Analysis

Abstract Context Malnutrition is a common complication of malignant tumors, and accurate diagnosis and treatment are essential. Although the Global Leadership Initiative on Malnutrition (GLIM) criteria are widely accepted for the diagnosis of malnutrition in a variety of diseases, their diagnostic value in patients with malignant tumors is controversial. Objective We conducted a comprehensive analysis of studies of the GLIM criteria in patients with malignant tumors and performed a standardized meta-analysis to evaluate the diagnostic value of the GLIM criteria in this patient population. Data Sources We conducted a systematic search across the PubMed, Cochrane, Web of Science, and ClinicalTrials.gov databases to identify studies utilizing the GLIM criteria for diagnosing malnutrition in cancer patients during the period from the initial adoption of the criteria in 2020 through February 29, 2024. Data Extraction The meta-analysis was conducted in accordance with the PRISMA2020 statement. Using the Patient-Generated Subjective Global Assessment (PG-SGA) as a reference standard, we calculated the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) with 95% CI separately for the GLIM criteria. To assess the accuracy of the GLIM criteria, forest plots were drawn to summarize and present the data. The risk of bias and the methodological quality of the primary research were assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Data Analysis Fifty studies were identified following the initial search of the PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov databases. Fourteen studies including a total of 14 196 cancer patients met the selection criteria and were included in the meta-analysis. With the use of the PG-SGA as a reference standard, 7640 patients with malignant tumors were diagnosed with malnutrition (prevalence of 53.8%). The GLIM criteria had an overall sensitivity of 0.69 (95% CI: 0.62-0.75), specificity of 0.84 (95% CI: 0.75-0.91), PLR of 4.42 (95% CI: 2.71-7.2), NLR of 0.37 (95% CI: 0.30-0.45), DOR of 12.90 (95% CI: 6.68-21.21), and an AUC of 0.80 (95% CI: 0.77-0.84) compared to PG-SGA. Conclusions Compared with the PG-SGA, the GLIM criteria showed good diagnostic value in patients with cancer. The GLIM criteria can be considered acceptable in clinical practice and have the potential for wider application in the future. Systematic Review Registration PROSPERO registration No. CRD4202452675.1