The Global Leadership Initiative on Malnutrition (GLIM) inflammation criteria to predict survival in patients with advanced cancer: A prospective cohort study

Chattarin Pumtako; Ross D Dolan; Marie Fallon; Erin S Sullivan; Claribel Pl Simmons; Aoife M Ryan; Josh McGovern; Derek G Power; Barry J Laird; Donald C McMillan

doi:10.1016/j.clnesp.2025.03.027

The Global Leadership Initiative on Malnutrition (GLIM) inflammation criteria to predict survival in patients with advanced cancer: A prospective cohort study

Chattarin Pumtako (Lead / Corresponding author)
, Ross D Dolan
, Marie Fallon
, Erin S Sullivan
, Claribel Pl Simmons
, Aoife M Ryan
, Josh McGovern
, Derek G Power
, Barry J Laird
, Donald C McMillan

Cancer Research

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

7 Downloads (Pure)

Abstract

BACKGROUND

The Global Leadership Initiative on Malnutrition (GLIM) criteria provides a framework for assessing cachexia in cancer patients. However, the role of systemic inflammation in this framework needs further exploration.

METHODS

This study analyzed a cohort of 388 advanced cancer patients from 18 oncological care settings. C-reactive protein (CRP), the modified Glasgow Prognostic Score (mGPS) and Neutrophil-to-Lymphocyte Ratio (NLR) were used to assess systemic inflammation. Associations between these inflammatory markers and Weight Loss (WL), Body Mass Index (BMI), Skeletal Muscle Index (SMI), and survival outcomes (OS) were evaluated using Chi-square and Kaplan-Meier survival analyses.

RESULTS

CRP was significantly associated with ECOG-PS (p < 0.01), and WL (p < 0.05). mGPS was significantly associated with ECOG-PS (p < 0.001), WL (p < 0.001), and BMI (p < 0.05). NLR was significantly associated with ECOG-PS (p < 0.05), WL (p < 0.001), and BMI (p < 0.05). CRP (p < 0.001), mGPS (p < 0.001), NLR (p < 0.001), WL (p < 0.001), and SMI (p < 0.05) were significantly associated with OS, but not BMI (p = 0.23). Combining CRP, mGPS, NLR, with WL, BMI, and SMI significantly improved OS prediction. WL was significantly associated with OS in patients with NLR<3 (p < 0.05) but not in CRP≤10 mg/L or mGPS = 0. SMI was significantly associated with OS in patients with mGPS = 0 (p < 0.05).

CONCLUSION

Systemic inflammation, as assessed by CRP, mGPS and NLR, significantly improves the relationship between phenotypic criteria and OS. These findings support the GLIM framework's inclusion of systemic inflammation as a critical factor. Given its strong predictive value, systemic inflammation should be prioritized in routine clinical assessments of cancer patients, with mGPS having greater prognostic value within the GLIM framework.

Original language	English
Pages (from-to)	344-352
Number of pages	9
Journal	Clinical Nutrition ESPEN
Volume	67
Early online date	28 Mar 2025
DOIs	https://doi.org/10.1016/j.clnesp.2025.03.027
Publication status	Published - Jun 2025

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 2 Zero Hunger
SDG 3 Good Health and Well-being

Keywords

Humans
Neoplasms/mortality
Male
Female
Prospective Studies
Malnutrition/diagnosis
Inflammation/diagnosis
C-Reactive Protein/analysis
Middle Aged
Aged
Body Mass Index
Cachexia/diagnosis
Neutrophils
Prognosis
Biomarkers/blood
Nutritional Status
Leadership
Nutrition Assessment
Weight Loss
Kaplan-Meier Estimate
Adult
Aged, 80 and over
Prognostic value
Phenotypic
GLIM
Etiologic
Cance cachexia
Systemic inflammation

ASJC Scopus subject areas

Endocrinology, Diabetes and Metabolism
Nutrition and Dietetics

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10.1016/j.clnesp.2025.03.027Licence: CC BY

Final Published VersionFinal published version, 2.29 MBLicence: CC BY

Cite this

Pumtako, C., Dolan, R. D., Fallon, M., Sullivan, E. S., Simmons, C. P., Ryan, A. M., McGovern, J., Power, D. G., Laird, B. J., & McMillan, D. C. (2025). The Global Leadership Initiative on Malnutrition (GLIM) inflammation criteria to predict survival in patients with advanced cancer: A prospective cohort study. Clinical Nutrition ESPEN, 67, 344-352. https://doi.org/10.1016/j.clnesp.2025.03.027

@article{af53f95bf09d4c9ebb8112e0230c5840,

title = "The Global Leadership Initiative on Malnutrition (GLIM) inflammation criteria to predict survival in patients with advanced cancer: A prospective cohort study",

abstract = "BACKGROUND The Global Leadership Initiative on Malnutrition (GLIM) criteria provides a framework for assessing cachexia in cancer patients. However, the role of systemic inflammation in this framework needs further exploration.METHODS This study analyzed a cohort of 388 advanced cancer patients from 18 oncological care settings. C-reactive protein (CRP), the modified Glasgow Prognostic Score (mGPS) and Neutrophil-to-Lymphocyte Ratio (NLR) were used to assess systemic inflammation. Associations between these inflammatory markers and Weight Loss (WL), Body Mass Index (BMI), Skeletal Muscle Index (SMI), and survival outcomes (OS) were evaluated using Chi-square and Kaplan-Meier survival analyses.RESULTS CRP was significantly associated with ECOG-PS (p < 0.01), and WL (p < 0.05). mGPS was significantly associated with ECOG-PS (p < 0.001), WL (p < 0.001), and BMI (p < 0.05). NLR was significantly associated with ECOG-PS (p < 0.05), WL (p < 0.001), and BMI (p < 0.05). CRP (p < 0.001), mGPS (p < 0.001), NLR (p < 0.001), WL (p < 0.001), and SMI (p < 0.05) were significantly associated with OS, but not BMI (p = 0.23). Combining CRP, mGPS, NLR, with WL, BMI, and SMI significantly improved OS prediction. WL was significantly associated with OS in patients with NLR<3 (p < 0.05) but not in CRP≤10 mg/L or mGPS = 0. SMI was significantly associated with OS in patients with mGPS = 0 (p < 0.05).CONCLUSIONSystemic inflammation, as assessed by CRP, mGPS and NLR, significantly improves the relationship between phenotypic criteria and OS. These findings support the GLIM framework's inclusion of systemic inflammation as a critical factor. Given its strong predictive value, systemic inflammation should be prioritized in routine clinical assessments of cancer patients, with mGPS having greater prognostic value within the GLIM framework.",

keywords = "Humans, Neoplasms/mortality, Male, Female, Prospective Studies, Malnutrition/diagnosis, Inflammation/diagnosis, C-Reactive Protein/analysis, Middle Aged, Aged, Body Mass Index, Cachexia/diagnosis, Neutrophils, Prognosis, Biomarkers/blood, Nutritional Status, Leadership, Nutrition Assessment, Weight Loss, Kaplan-Meier Estimate, Adult, Aged, 80 and over, Prognostic value, Phenotypic, GLIM, Etiologic, Cance cachexia, Systemic inflammation",

author = "Chattarin Pumtako and Dolan, \{Ross D\} and Marie Fallon and Sullivan, \{Erin S\} and Simmons, \{Claribel Pl\} and Ryan, \{Aoife M\} and Josh McGovern and Power, \{Derek G\} and Laird, \{Barry J\} and McMillan, \{Donald C\}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s)",

year = "2025",

month = jun,

doi = "10.1016/j.clnesp.2025.03.027",

language = "English",

volume = "67",

pages = "344--352",

journal = "Clinical Nutrition ESPEN",

issn = "2405-4577",

publisher = "Elsevier",

}

Pumtako, C, Dolan, RD, Fallon, M, Sullivan, ES, Simmons, CP, Ryan, AM, McGovern, J, Power, DG, Laird, BJ & McMillan, DC 2025, 'The Global Leadership Initiative on Malnutrition (GLIM) inflammation criteria to predict survival in patients with advanced cancer: A prospective cohort study', Clinical Nutrition ESPEN, vol. 67, pp. 344-352. https://doi.org/10.1016/j.clnesp.2025.03.027

The Global Leadership Initiative on Malnutrition (GLIM) inflammation criteria to predict survival in patients with advanced cancer: A prospective cohort study. / Pumtako, Chattarin (Lead / Corresponding author); Dolan, Ross D; Fallon, Marie et al.
In: Clinical Nutrition ESPEN, Vol. 67, 06.2025, p. 344-352.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The Global Leadership Initiative on Malnutrition (GLIM) inflammation criteria to predict survival in patients with advanced cancer

T2 - A prospective cohort study

AU - Pumtako, Chattarin

AU - Dolan, Ross D

AU - Fallon, Marie

AU - Sullivan, Erin S

AU - Simmons, Claribel Pl

AU - Ryan, Aoife M

AU - McGovern, Josh

AU - Power, Derek G

AU - Laird, Barry J

AU - McMillan, Donald C

PY - 2025/6

Y1 - 2025/6

N2 - BACKGROUND The Global Leadership Initiative on Malnutrition (GLIM) criteria provides a framework for assessing cachexia in cancer patients. However, the role of systemic inflammation in this framework needs further exploration.METHODS This study analyzed a cohort of 388 advanced cancer patients from 18 oncological care settings. C-reactive protein (CRP), the modified Glasgow Prognostic Score (mGPS) and Neutrophil-to-Lymphocyte Ratio (NLR) were used to assess systemic inflammation. Associations between these inflammatory markers and Weight Loss (WL), Body Mass Index (BMI), Skeletal Muscle Index (SMI), and survival outcomes (OS) were evaluated using Chi-square and Kaplan-Meier survival analyses.RESULTS CRP was significantly associated with ECOG-PS (p < 0.01), and WL (p < 0.05). mGPS was significantly associated with ECOG-PS (p < 0.001), WL (p < 0.001), and BMI (p < 0.05). NLR was significantly associated with ECOG-PS (p < 0.05), WL (p < 0.001), and BMI (p < 0.05). CRP (p < 0.001), mGPS (p < 0.001), NLR (p < 0.001), WL (p < 0.001), and SMI (p < 0.05) were significantly associated with OS, but not BMI (p = 0.23). Combining CRP, mGPS, NLR, with WL, BMI, and SMI significantly improved OS prediction. WL was significantly associated with OS in patients with NLR<3 (p < 0.05) but not in CRP≤10 mg/L or mGPS = 0. SMI was significantly associated with OS in patients with mGPS = 0 (p < 0.05).CONCLUSIONSystemic inflammation, as assessed by CRP, mGPS and NLR, significantly improves the relationship between phenotypic criteria and OS. These findings support the GLIM framework's inclusion of systemic inflammation as a critical factor. Given its strong predictive value, systemic inflammation should be prioritized in routine clinical assessments of cancer patients, with mGPS having greater prognostic value within the GLIM framework.

AB - BACKGROUND The Global Leadership Initiative on Malnutrition (GLIM) criteria provides a framework for assessing cachexia in cancer patients. However, the role of systemic inflammation in this framework needs further exploration.METHODS This study analyzed a cohort of 388 advanced cancer patients from 18 oncological care settings. C-reactive protein (CRP), the modified Glasgow Prognostic Score (mGPS) and Neutrophil-to-Lymphocyte Ratio (NLR) were used to assess systemic inflammation. Associations between these inflammatory markers and Weight Loss (WL), Body Mass Index (BMI), Skeletal Muscle Index (SMI), and survival outcomes (OS) were evaluated using Chi-square and Kaplan-Meier survival analyses.RESULTS CRP was significantly associated with ECOG-PS (p < 0.01), and WL (p < 0.05). mGPS was significantly associated with ECOG-PS (p < 0.001), WL (p < 0.001), and BMI (p < 0.05). NLR was significantly associated with ECOG-PS (p < 0.05), WL (p < 0.001), and BMI (p < 0.05). CRP (p < 0.001), mGPS (p < 0.001), NLR (p < 0.001), WL (p < 0.001), and SMI (p < 0.05) were significantly associated with OS, but not BMI (p = 0.23). Combining CRP, mGPS, NLR, with WL, BMI, and SMI significantly improved OS prediction. WL was significantly associated with OS in patients with NLR<3 (p < 0.05) but not in CRP≤10 mg/L or mGPS = 0. SMI was significantly associated with OS in patients with mGPS = 0 (p < 0.05).CONCLUSIONSystemic inflammation, as assessed by CRP, mGPS and NLR, significantly improves the relationship between phenotypic criteria and OS. These findings support the GLIM framework's inclusion of systemic inflammation as a critical factor. Given its strong predictive value, systemic inflammation should be prioritized in routine clinical assessments of cancer patients, with mGPS having greater prognostic value within the GLIM framework.

KW - Humans

KW - Neoplasms/mortality

KW - Male

KW - Female

KW - Prospective Studies

KW - Malnutrition/diagnosis

KW - Inflammation/diagnosis

KW - C-Reactive Protein/analysis

KW - Middle Aged

KW - Aged

KW - Body Mass Index

KW - Cachexia/diagnosis

KW - Neutrophils

KW - Prognosis

KW - Biomarkers/blood

KW - Nutritional Status

KW - Leadership

KW - Nutrition Assessment

KW - Weight Loss

KW - Kaplan-Meier Estimate

KW - Adult

KW - Aged, 80 and over

KW - Prognostic value

KW - Phenotypic

KW - GLIM

KW - Etiologic

KW - Cance cachexia

KW - Systemic inflammation

UR - https://www.scopus.com/pages/publications/105001025442

U2 - 10.1016/j.clnesp.2025.03.027

DO - 10.1016/j.clnesp.2025.03.027

M3 - Article

C2 - 40139388

SN - 2405-4577

VL - 67

SP - 344

EP - 352

JO - Clinical Nutrition ESPEN

JF - Clinical Nutrition ESPEN

ER -

The Global Leadership Initiative on Malnutrition (GLIM) inflammation criteria to predict survival in patients with advanced cancer: A prospective cohort study

Abstract

UN SDGs

Keywords

ASJC Scopus subject areas

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