AND-ASPEN and ESPEN consensus, and GLIM criteria for malnutrition identification in AECOPD patients: a longitudinal study comparing concurrent and predictive validity.

BACKGROUND/OBJECTIVES: Malnutrition in chronic obstructive pulmonary disease (COPD) patients is prevalent and usually assessed by body mass index (BMI), which can lead to misdiagnosis. The subjective global assessment (SGA) is the reference method for this diagnose in hospitalized patients. In the last decade, new tools have emerged Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition [AND-ASPEN], European Society for Clinical Nutrition and Metabolism [ESPEN], and Global Leadership Initiative on Malnutrition [GLIM]). Therefore, this study aimed to assess the concurrent and predictive validity of these tools in acute exacerbated COPD (AECOPD) patients. SUBJECTS/METHODS: Prospective cohort study with hospitalized AECOPD patients. Malnutrition was diagnosed by SGA (reference method), AND-ASPEN, ESPEN, and GLIM consensus. Hospital length of stay (LOS) and mortality were the outcomes evaluated. RESULTS: In 241 patients (46.5% males; 68.3 ± 10.2 years), malnutrition was found in 50.0% by SGA, 54.4% by AND-ASPEN, 20.2% by ESPEN, and 47.8% by GLIM. AND-ASPEN had the best accuracy (AUC = 0.837; 95% CI 0.783-0.841) and concordance (kappa = 0.674) with SGA and it was an independent predictor of prolonged LOS (OR = 1.73; 95% CI 1.01-3.37). ESPEN consensus did not agree with SGA, but was associated with prolonged LOS (OR = 2.57 95% CI, 1.27-5.20). The GLIM had good concordance (kappa = 0.533) and accuracy with SGA (AUC = 0.768; 95% CI 0.701-0.835), but was not associated with outcomes. CONCLUSIONS: The AND-ASPEN was the most accurate tool for diagnosing malnutrition in AECOPD patients and was an independent predictor of prolonged LOS.

SARC-CalF tool has no significant prognostic value in hospitalized patients: A prospective cohort study.

BACKGROUND: Screening of sarcopenia is proposed to identify patients who require the diagnosis of this condition. One of the proposed screening tools is Strength, Assistance with walking, Rise from a chair, Climb stairs, Fall and Calf Circumference (SARC-CalF). However, evidence for its applicability, especially in a hospital setting, is scarce. Therefore, this study aimed to evaluate the association between "suggestive signs of sarcopenia using SARC-CalF" and clinical outcomes. METHODS: Prospective cohort study with hospitalized patients aged ≥60 years was conducted, and they were evaluated within 48 h of admission using the SARC-CalF tool. Calf circumference and handgrip strength were measured, and the "timed get up and go" test was performed in all patients. The outcomes for testing the predictive validity of SARC-CalF were prolonged length of hospital stay, in-hospital death, hospital readmission, and mortality in 6 months. RESULTS: Of the 554 patients (55.22 ± 14.91 years old, 52.9% males) evaluated, 17.3% were classified as having "suggestive signs of sarcopenia using SARC-CalF." In univariate analysis, "suggestive signs of sarcopenia using SARC-CalF" was associated with in-hospital death (P = .002) and mortality in 6 months (P = .004). However, in the multivariate analysis, these associations were not significant. CONCLUSION: SARC-CalF was not an independent predictor of clinical outcomes during the hospitalization neither in the following 6 months of discharge.

Low Muscle Mass Is a Predictor of Malnutrition and Prolonged Hospital Stay in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Longitudinal Study.

BACKGROUND: Malnutrition in chronic obstructive pulmonary disease (COPD) patients is more prevalent during times of exacerbation. Fat-free mass index (FFMI), calf circumference (CC), and adductor muscle pollicis thickness (AMPT) can be used to identify reduced muscle mass and have been found to be good predictors of clinical outcomes in other conditions, but they have not been investigated in COPD. Therefore, this study evaluated low muscle mass as predictor of malnutrition, prolonged length of stay (LOS), and in-hospital death in COPD patients. METHODS: This prospective cohort study was carried out in hospitalized patients with COPD exacerbation. Malnutrition diagnosis was performed by Subjective Global Assessment, and muscle mass was assessed by FFMI, calculated using fat-free mass from bioelectrical impedance, CC, and AMPT. Clinical outcomes (LOS and in-hospital death) were collected from records. RESULTS: One hundred seventy-six patients were included (68.2 ± 10.4 years old, 56.2% women); 74.2% were classified as Global Initiative of Chronic Obstructive Lung Disease 2 or 3 and 58.2% as malnourished. The median LOS was 11 (7-19) days, and the incidence of death was 9.1%. Low FFMI and CC predicted malnutrition (low CC: odds ratio [OR], 4.6; 95% CI, 2.2-9.7 and low FFMI: OR, 8.8; 95% CI, 3.7-20.8) and were associated with prolonged LOS (low CC: OR, 2.3; 95% CI, 1.1-4.6 and low FFMI: OR, 2.5; 95% CI, 1.3-4.8). CONCLUSION: Simple, inexpensive, and noninvasive parameters of muscle mass-FFMI and CC-are good predictors of malnutrition and prolonged LOS in COPD patients experiencing exacerbation.