Evaluation of the GLIM Criteria for Diagnosing Malnutrition in Newly Diagnosed Adult Cancer Patients at a Tertiary Hospital in Ethiopia: A Concurrent Criterion Validity Study.

Abstract

Background Cancer-associated malnutrition is a major determinant of patient outcomes, yet it remains underrecognized, underdiagnosed and undertreated, particularly in low- and middle-income countries (LMICs). This study primarily evaluated the diagnostic accuracy of Global Leadership Initiative on Malnutrition (GLIM) criteria. The secondary objective was to determine the prevalence and associated factors of malnutrition among newly diagnosed adult cancer patients. Methods A cross-sectional study was conducted among 231 newly diagnosed cancer patients between June and December 2024. Malnutrition was assessed using the original GLIM method from 2019, including the two-step approach (screening and diagnosis). Diagnostic performance was evaluated against other screening tools using kappa statistics, the area under the curve (AUC) of receiver operating characteristic (ROC) curve analysis, sensitivity, specificity, and predictive values. Bivariate and multivariable logistic regressions were performed to identify factors associated with malnutrition. Data were analyzed using SPSS version 26. Results The mean age of the study participants was 46 years, with mean body mass index (BMI) of 20.85kg/m 2 . According to GLIM criteria (without screening), 49.8% (95% CI: 43.2%; 56.4%) were malnourished, including 31.6% (95% CI: 25.70%; 38.0%) moderately and 18.2% (95% CI: 13.4%; 23.8%) severely malnourished. The GLIM criteria (without screening) demonstrated high sensitivity (80.47%), substantial agreement (kappa =0.68), and good diagnostic accuracy (AUC= 0.84) when compared with the Patient-Generated Subjective Global Assessment (PG-SGA), which served as a semi-gold standard comparator. Advanced age (AOR: 1.03; 95%CI: 1.01, 1.05), longer illness duration (AOR: 1.05; 95%CI: 1.01, 1.10) and palliative treatment intent (AOR: 2.66; 95%CI: 1.53, 4.61) were significant associated with malnutrition. Conclusions Nearly half of newly diagnosed cancer patients were found to be malnourished according to the GLIM criteria. The tool demonstrated excellent sensitivity, substantial agreement, and strong diagnostic accuracy when compared with the PG-SGA. Routine screening and diagnosis of malnutrition using GLIM criteria should be integrated into cancer care at the time of diagnosis.