Prevalence and prognostic implications of malnutrition according to GLIM criteria in hospitalized heart failure patients: Reduced muscle mass and inflammation as predominant criteria identified in a prospective cohort study

Background: This study aims to evaluate the Global Leadership Initiative on Malnutrition (GLIM) criteria for nutrition assessment in hospitalized heart failure (HF) patients, consider the performance of various combinations of phenotypic and etiologic criteria, and assess their predictive validity for adverse health outcomes. Methods: A total of 216 patients, consecutively enrolled from June 2022 to October 2022, participated in this prospective cohort study and underwent assessments with 21 GLIM combinations. The 1-year all-cause mortality or HF-related readmission was used as the composite clinical outcome. For testing criterion validity, agreement and accuracy tests and Cox regression analyses were conducted. Results: The detected prevalence of malnutrition across 21 GLIM criteria combinations reached 26.9%. The GLIM combinations containing reduced muscle mass, inflammation, and/or reduced food intake showed acceptable sensitivity and satisfactory predictive validity (with HRs ranging from 2.043 [95% CI: 1.087–3.837], P = 0.026 to 3.367 [95% CI: 1.652 – 6.863], P = 0.001). Conclusion: Malnutrition identified by the GLIM criteria was associated with 1-year all-cause mortality or HF-related readmission. Muscle mass is the core GLIM phenotype criterion for identifying hospitalized HF patients at higher risk of adverse outcomes, and it is strongly suggested that relevant assessment be conducted without omission. The occurrence of reduced food intake may fulfill the GLIM etiology criteria, and if testing is available, inflammation levels should be measured to confirm the etiologic criteria.