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Summary of our research
[Background]
Malnutrition in hospitalized patients is linked to delayed functional recovery and higher mortality; early screening and intervention are therefore recommended. The GLIM criteria provide an international, standardized framework for diagnosing malnutrition, yet large-scale evaluations of their real-world implementation and prognostic utility have been limited. In June 2024, implementation of GLIM assessment was encouraged within Japan's DPC system, creating an opportunity to examine feasibility and prognostic validity.
[Study Details]
This study evaluated the relationship between implementation of the GLIM criteria and short-term outcomes under the DPC acute-care payment system, using a nationwide retrospective cohort of 174,439 adult inpatients from ~1,700 hospitals (admitted June-August 2024). The primary outcomes were 30- and 60-day mortality. Adjusted Cox models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). Patients classified as malnourished by GLIM had significantly higher risk than the non-malnourished group: 30-day mortality HR = 1.46 (95% CI, 1.33-1.60) and 60-day mortality HR = 1.46 (95% CI, 1.34-1.59). Moreover, patients with "not conducted" or "not recorded" GLIM assessments also showed elevated mortality risk, suggesting that the implementation and quality of the nutritional assessment process itself may influence outcomes.
[Future Directions]
Positioning reliable GLIM implementation as a quality indicator for nutritional care is crucial. Under the DPC system, incentive design, multidisciplinary collaboration, and reducing data-entry burden will be key to successful implementation
Researcher information
SHIMIZU Akio
Department of Rehabilitation, Mie University Hospital, Assistant Professor
Specialized area：
Dysphagia rehabilitation; Clinical nutrition management
Current research field：
・Database-based investigations of the association between nutritional status and clinical outcomes
・Proposals for dysphagia-rehabilitation interventions using 3D food printing