Comparison of six nutritional screening tool-based Global Leadership Initiative on Malnutrition criteria models for predicting activities of daily living in older patients with subacute stroke: A single-center retrospective cohort study.

BACKGROUND: The Global Leadership Initiative on Malnutrition (GLIM) recommends a two-step diagnostic process consisting of initial screening for malnutrition risk followed by diagnostic assessment. We evaluated the association between GLIM-defined malnutrition identified using six alternative first-step screening tools and Functional Independence Measure (FIM)-motor scores at discharge in older patients with subacute stroke. METHODS: This retrospective cohort study involved patients aged ≥70 years who were admitted to a convalescent rehabilitation ward after subacute stroke. Malnutrition risk was assessed using six tools: the Mini Nutritional Assessment-Short Form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening 2002 (NRS-2002), Geriatric Nutritional Risk Index (GNRI), Controlling Nutritional Status (CONUT), and Prognostic Nutritional Index (PNI). Malnutrition was diagnosed based on the GLIM criteria. The outcome was the FIM-motor score at discharge. Associations between GLIM-defined malnutrition based on each screening tool and FIM-motor scores were examined using hierarchical multiple regression analysis. RESULTS: Among the 152 patients included in the analysis, the prevalence of GLIM-defined malnutrition ranged from 28.3% (PNI) to 40.8% (NRS-2002). Malnutrition, as defined by GLIM and based on MNA-SF, MUST, NRS-2002, and GNRI, was significantly associated with lower FIM-motor scores at discharge. The model incorporating MUST revealed the strongest association with FIM-motor scores at discharge (β = -0.11, P = 0.007, ΔR2 = 0.012). CONCLUSION: GLIM-defined malnutrition was negatively associated with FIM-motor scores at discharge in older patients with subacute stroke. The GLIM model incorporating MUST may be particularly useful for identifying malnutrition associated with FIM-motor scores at discharge.