In a significant turn of events for the medical community, the Global Leadership Initiative on Malnutrition (GLIM) criteria have recently been highlighted for their potential role in the preoperative nutritional assessment of patients with primary lung cancer. This renewed interest has been sparked by a pivotal study conducted by researchers at Tokyo Medical and Dental University in Japan, keenly investigating the association between nutritional status using the GLIM criteria and surgical outcomes in lung cancer patients. The study’s findings, which were published in the February 2024 issue of Clinical Nutrition ESPEN, provide an insightful perspective on the importance of nutritional assessment in managing non-small cell lung cancer (NSCLC) patients.

Background of GLIM Criteria in Nutritional Assessment

The Global Leadership Initiative on Malnutrition developed an innovative method to evaluate malnutrition among patients. The GLIM criteria are a relatively new set of standards that aim to provide a more consistent and globally applicable approach to diagnosing malnutrition. Despite holding promise, the healthcare industry has yet to reach a consensus on the definitive application of these criteria, especially in the preoperative context of serious diseases such as lung cancer.

The Link Between Nutritional Status and Lung Cancer Surgery Outcomes

Lung cancer has long been known as an aggressive disease, and surgery remains a cornerstone in its management, particularly for localized NSCLC. However, the success of such procedures is not solely dependent on surgical expertise but also on the patient’s overall health, which includes their nutritional status. Malnutrition has been identified as a critical risk factor that can adversely impact patient recovery and long-term survival.

Objective and Methodology of the Study

Asakawa Ayaka and colleagues embarked on this research with the objective to rigorously explore whether the preoperative nutritional status of lung cancer patients, determined by the GLIM criteria, is indeed correlated with their postoperative outcomes. In their cohort study, patients diagnosed with non-small cell lung cancer and scheduled for lung resection underwent a comprehensive preoperative evaluation, including bioelectrical impedance analysis to estimate muscle mass, which is a key parameter within the GLIM criteria.

Findings and Interpretation

The study cohort included 198 patients, with the groups being dichotomized based on the GLIM criteria into “normal nutrition” (110 patients) and “malnutrition” (88 patients). A significant association emerged between malnutrition and poor overall survival post-surgery (p=0.025), underscoring the perils of inadequate nutrition in the surgical lung cancer population.

However, an interesting observation was the absence of a significant relationship between malnourishment and disease-free survival. This outcome invites further investigation into the nuanced roles that nutrition might play at various stages of cancer treatment and recovery.

Prognostic Implications

Diving deeper, the multivariate analysis conducted by the research team established the dire prognostic implications of malnutrition with a hazard ratio of 2.374 (p=0.020). This suggests that malnourished patients have more than twice the risk of poor overall survival compared to well-nourished individuals. Additionally, the study validated other known prognosticators: advanced pathological stage and postoperative complications were also significantly linked to decreased overall survival.

Preoperative Nutritional Interventions

Considering the potency of malnutrition as a prognostic factor for lung cancer surgery, the evident implication of the study is the necessity for timely preoperative nutritional and rehabilitative interventions. Such measures could potentially enhance the patients’ prognosis by addressing malnutrition well before they undergo the knife.

Study Limitations and Future Directions

Despite its informative outcomes, the study has certain limitations. The sample size, although adequate, could be expanded for future research to ascertain these findings’ generalizability. Additionally, since this investigation focused on a single cancer type and surgical procedure, further studies across different cancer profiles and treatments are warranted.

Expert Opinions

According to Dr. Ishibashi Hironori, one of the study’s co-authors, “The adoption of GLIM criteria could revolutionize our approach to the preoperative care of lung cancer patients. By systematizing the nutritional assessment, we may significantly improve surgical outcomes.” Meanwhile, Dr. Baba Shunichi emphasized the “need for more comprehensive preoperative routines that integrate nutrition as a core element of patient care.”

Healthcare Policy Implications

The implications of these findings could echo in healthcare policy, bringing nutritional screening to the forefront of preoperative care standards. Policies encouraging the application of the GLIM criteria could enhance patient outcomes and optimize healthcare resources by potentially reducing complication rates and hospital stays.

Conclusion

The research led by Asakawa Ayaka from the Department of Thoracic Surgery at Tokyo Medical and Dental University drives home the point that nutritional screening should not be an afterthought in cancer care. It should be a well-established part of the preoperative process, aiming to provide patients with the best chance at recovery and long-term survival following surgery.

DOI: 10.1016/j.clnesp.2023.11.025

References

1. Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle. 2019;10(1):207-217.
2. Health consequences of malnutrition in the surgical patient: the evidence and consensus on malnutrition’s definitions, pathophysiology, and sarcopenia. Surgery. 2021;169(6):1258-1267.
3. Nutritional Risk Screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2002;22(3):321-336.
4. The prognostic importance of weight loss in lung cancer patients: a meta-analysis of prognostic cohort studies. Nutr Cancer. 2013;65(7):911-920.
5. Association of postoperative complications with hospital costs and length of stay in a tertiary care center. J Gastrointest Surg. 2007;11(2):140-146.

Keywords

1. GLIM criteria malnutrition
2. Preoperative nutritional assessment
3. Non-small cell lung cancer surgery
4. Bioelectrical impedance analysis muscle mass
5. Surgical outcomes lung cancer

Declaration of competing interest:
The authors declare no conflicts of interest.