Prevalence and prognostic impact of GLIM-defined malnutrition in hospitalized patients with cancer: a prospective cohort study.

INTRODUCTION: Evidence on the prognostic value of Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition in hospitalized patients with cancer from Latin America remains limited. This study aimed to determine the prevalence of GLIM-defined malnutrition in hospitalized patients with cancer and to evaluate its association with overall survival. METHODS: A prospective cohort study was conducted at a high-complexity referral institution in Bogotá, Colombia. Adults with a confirmed diagnosis of cancer who underwent nutritional assessment within the first 24 h of hospitalization between April 2019 and March 2021 were consecutively included. Malnutrition was diagnosed according to the GLIM criteria. Active cancer was considered sufficient to fulfil the GLIM etiologic criterion; consequently, classification within the cohort was determined by the phenotypic criteria. Overall survival was defined as the time from the first nutritional assessment to death from any cause, with administrative censoring in January 2025. Survival was analyzed using Kaplan-Meier estimates, univariable and multivariable Cox regression, multiple imputation, and time-stratified Cox models. RESULTS: Among 433 included patients, 72.7% were classified as malnourished. Because the etiologic criterion was met by all participants by virtue of active cancer, this prevalence reflects the distribution of phenotypic GLIM abnormalities. Malnutrition was more frequent among patients with hematologic and gastrointestinal malignancies. In univariable analyses, malnutrition was associated with higher mortality (HR 2.97, 95% CI 2.06-4.29; p < 0.001). In the primary multivariable model, moderate malnutrition (HR 1.67, 95% CI 1.08-2.59; p = 0.021), severe malnutrition (HR 3.02, 95% CI 2.01-4.55; p < 0.001), and gastrointestinal symptoms (HR 1.53, 95% CI 1.16-2.02; p = 0.003) remained independently associated with mortality. The prognostic effect of severe malnutrition was strongest within the first 12 months after baseline assessment (HR 7.49, 95% CI 3.68-15.24; p < 0.001). CONCLUSIONS: GLIM-defined malnutrition was highly prevalent and independently associated with poorer survival in hospitalized patients with cancer. Severe malnutrition showed a particularly strong association with early mortality.