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Summary of our research
[Background]
Malnutrition is common in critically ill patients and is associated with mortality and prolonged hospitalization. The Global Leadership Initiative on Malnutrition (GLIM) criteria provide an international framework for diagnosing malnutrition. However, the extent to which GLIM nutritional status is documented and can be classified in routine intensive care unit (ICU) practice has remained unclear.
[Study Details]
We analyzed nationwide Japanese Diagnosis Procedure Combination (DPC) data from 51,580 adults admitted to an ICU between June 2024 and September 2025. The database-recorded GLIM nutritional assessment was grouped into four categories: malnutrition, non-malnutrition, not assessed (the overall determination was recorded as not assessable), and no documentation (neither the overall determination nor any of the five components was recorded). A classifiable GLIM nutritional status was recorded for 27,613 patients (53.5%), of whom 10.2% were recorded as malnourished. Among patients with a classifiable status, recorded malnutrition was associated with higher in-hospital mortality within 30 days of admission than non-malnutrition (adjusted hazard ratio 1.23; 95% confidence interval 1.08-1.41), higher overall in-hospital mortality (adjusted odds ratio 1.47; 95% confidence interval 1.28-1.68), and a 2.27-day longer hospital stay among survivors. In an additional four-category analysis, the not-assessed and no-documentation categories were also associated with higher 30-day in-hospital mortality than non-malnutrition.
[Future Directions]
This nationwide study describes important gaps in GLIM assessment and documentation in routine ICU care. Future research should link standardized bedside assessments with DPC records to distinguish clinical barriers to assessment from implementation and recording factors. Because this was an observational study, the findings show associations and do not establish causality.
Researcher information
Journal： Clinical Nutrition
Published： 2026/8/20
Title： Real-world implementation, documentation, and prognostic implications of routinely recorded nutritional assessment based on the Global Leadership Initiative on Malnutrition criteria in critically ill patients: A nationwide retrospective cohort study
DOI: https://doi.org/10.1016/j.clnu.2026.106765
Researcher information
SHIMIZU Akio
Assistant Professor, Department of Rehabilitation, Mie University Hospital
Department of Health Data Science, Yokohama City University Graduate School of Data Science
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