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Background & aims: Elderly cancer patients are at particularly high risk for malnutrition because both the disease and the old age threaten their nutritional status. The Global Leadership Initiative on Malnutrition (GLIM) released new universal criteria for diagnosing and grading malnutrition, but the validation of these criteria in elderly cancer population is not well documented. Our objective was to investigate the application of the GLIM criteria in nutrition assessment and survival prediction in elderly cancer patients. Methods: This retrospective cohort analysis was conducted on a primary cohort of 1192 cancer patients aged 65 years or older enrolled from a multi-institutional registry, and a validation cohort of 300 elderly cancer patients treated at the First Affiliated Hospital of Sun Yat-sen University. Patients considered at-risk for malnutrition based on the NRS-2002 were assessed using the GLIM criteria. The association between the nutritional status and patients' overall survival (OS) was then analyzed by the Kaplan-Meier method and a Cox model. A nomogram was also established that included additional independent clinical prognostic variables. To determine the predictive accuracy and discriminatory capacity of the nomogram, the C-index, receiver operating characteristic (ROC) curve and calibration curve were evaluated. Results: The percentage of patients considered “at-risk” for malnutrition was 64.8% and 67.3% for the primary and validation cohorts, respectively. GLIM-defined malnutrition was diagnosed in 48.4% of patients in the primary cohort and 46.0% in the validation cohort. In the primary cohort, patients at risk of malnutrition (NRS-2002 ≥ 3) showed a worse OS than those with a NRS-2002 < 3 (HR 1.34, 1.10-1.64; p = 0.003). Additionally, patients with GLIM-defined severe malnutrition (HR1.71, 1.37-2.14; p < 0.001) or moderate malnutrition (HR1.35, 1.09-1.66; p = 0.006) showed a significantly shorter OS compared to those without malnutrition. The nomogram incorporating the domains of the GLIM with other variables was accurate, especially for predicting the 1- and 2-year overall survival rates. Conclusions: The GLIM criteria can be used in elderly cancer patients not only to assess malnutrition, but also to predict survival outcome. The nomogram developed based on the GLIM domains can provide a more accurate prediction of the prognosis than existing systems.

Tese de Doutoramento em Ciências do consumo Alimentar e Nutrição apresentada à Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, sob orientação de Professora Doutora Maria Daniel Vaz de Almeida (Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto). Resumo da tese: As mudanças demográficas das últimas décadas apresentam um forte impacto global na sociedade, contribuindo para mudanças na estrutura familiar e redes informais, que constituem a primeira linha de apoio aos idosos. Como os idosos constituem um grupo populacional com elevada prevalência de doenças crónicas não-transmissíveis e um alto risco de desnutrição é necessário um melhor entendimento dos fatores determinantes do estado nutricional, estado de saúde e bem-estar. Esta tese resulta do Projeto Europeu "Food in later Life", que incluiu idosos, a viver livremente na comunidade, de oito países diferentes: Dinamarca, Alemanha, Itália, Polónia, Portugal, Espanha, Suécia e Reino Unido (UK). A amostra foi controlada por quotas para grupos de idade (65 a 74 anos, 75 anos ou mais), sexo (masculino, Feminino) e circunstâncias de vida (viver sozinho ou acompanhado). O estudo envolveu uma equipa multidisciplinar e usaram-se diferentes métodos na recolha de dados sobre os diferentes fatores que afetam a vida relacionada com a alimentação. A análise estatística foi realizada de acordo com os objetivos de cada artigo, incluindo análise de clusters para identificar os fatores de escolha alimentares e regressões logísticas para a definição de ritmos das ocasiões alimentares e para a identifícação dos determinantes do risco nutricional. Realizámos uma abordagem qualitativa na comparação intercultural do consumo de bebidas alcoólicas nos países europeus e para uma visão geral quanto às refeições ao longo do ciclo de vida dos idosos portugueses. Os resultados reforçam a necessidade de uma melhor compreensão dos determinantes das escolhas alimentares. Fatores de escolha diferentes parecem estar associados a condições sócio-demográficas, de saúde e de satisfação com a vida relacionada com a alimentação em populações idosas.(...) / Thesis abstract: The demographic changes occurred in the last decades have a strong impact in the society as a whole, contributing to changes in family structure and informal networks which constitute the first line of support for older people. As elderly constitute a population group with a high prevalence of non-communicable chronic diseases and high risk of malnutrition, a better understanding of the underlying factors that affect nutritional status, health status and well-being is crucial. The present thesis emerges from the European Project "Food in Later Life" which included older aged participants, free living in the community, from eight different countries: Denmark, Germany, ltaly, Poland, Portugal, Spaín, Sweden and United Kingdom (UK). The sample was quota controlled for age groups (65 to 74 years, 75 years or more), gender (male, female) and living circumstances (living alone or living with others). The study comprised a multidisciplinary team. A comprehensive methodology was used for data collection on the different factors that affect food related life. Statistical analysis was performed for the different purposes of each paper, namely a cluster analysis for food choice factors and logistic regressions for the definition of rhythms on eating occasions and for the identification of the determinants of nutritional risk. A qualitative approach was also included for a cross-cultural comparison of alcoholic beverages consumption in the European countries and for the overview of meals across the life cycle of the Portuguese participants. Our fíndings enhanced the need for a better understanding of the underlying determinants of the food choices. Different choices seemed to be associated to socio-demographic conditions, health and satisfaction with food related life in elderly populations.(...)