Nutrition. 2025 Dec 15;144:113055. doi: 10.1016/j.nut.2025.113055. Online ahead of print.
ABSTRACT
OBJECTIVES: In this study we systematically assessed the diagnostic accuracy, calibration, and clinical utility of three study tools-the Nutritional Risk Screening 2002 (NRS2002), the Geriatric Nutritional Risk Index (GNRI), and the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF)-against the Global Leadership Initiative on Malnutrition (GLIM) criteria for identifying malnutrition in elderly patients with gastrointestinal malignancy. The aim was to determine their potential as pragmatic surrogates for the full GLIM diagnostic process.
METHODS: 412 patients (aged ≥ 60 y) with gastrointestinal malignancies from two hospitals in Shanghai were enrolled in this multicenter cross-sectional study. Diagnostic performance was assessed using GLIM criteria as the reference standard, evaluating the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Calibration was tested with the Hosmer-Lemeshow test, clinical net benefit was analyzed through decision curve analysis, and cross-center consistency was measured using the I² statistic.
RESULTS: The NRS2002 exhibited superior overall performance, characterized by high diagnostic accuracy (AUC = 0.85), the highest sensitivity (81%), excellent cross-center stability (I² = 0%), no significant calibration deviation (P = 0.415), and a clinical net benefit across a 0-96% risk threshold. The PG-SGA SF showed a comparable AUC (0.86), yet was accompanied by high specificity (87%), lower sensitivity (70%), significant calibration bias (P < 0.001), and notable inter-center heterogeneity (I² = 81.5%). The GNRI presented weaker diagnostic accuracy (AUC = 0.79) and significant calibration error (P = 0.039), though it maintained good cross-center stability (I² = 0%). All tools achieved an AUC > 0.70 across key clinical subgroups.
CONCLUSION: The NRS2002 is recommended as the primary surrogate diagnostic tool for GLIM-defined malnutrition in elderly patients with gastrointestinal malignancies, due to its balanced diagnostic accuracy and robust performance across settings. The GNRI offers an alternative based on objective parameters, while the PG-SGA SF is suitable for confirming malnutrition in low-risk outpatients. Future research should be focused on multicenter validation and examining the prognostic associations of these tools.
PMID:41520387 | DOI:10.1016/j.nut.2025.113055
