Prevalence and prognostic value of global leadership initiative on malnutrition (GLIM) phenotypic cachexia criteria in cancer patients: A systematic review and meta-analysis

Introduction: The Global Leadership Initiative on Malnutrition (GLIM) criteria provide a framework for evaluating cachexia in cancer patients, yet variability in diagnostic application hinders its use. The aim of the present study was to examine the prevalence and prognostic value of GLIM phenotypic criteria in patients with cachexia cancer. Methods: This review adhered to a pre-defined protocol. A comprehensive search of PubMed and EMBASE databases was conducted using specific keywords up to June 12, 2024. Titles and abstracts were screened for relevance, and eligible full-text studies focused on the phenotypic criteria of the GLIM framework and their impact on overall survival OS in adult cancer patients. Studies with fewer than 100 patients or lacking OS data were excluded. Results: Of 477 studies identified 82 met the inclusion criteria (114,458 patients). Lung cancer was the most studied tumour type, followed by gastrointestinal and head and neck cancers. Within the GLIM framework, the prevalence of weight loss (WL) > 5 %, BMI <18.5, BMI <20.0, and lower muscle mass (LMM) were 34.21 %,10.02 %, 9.51 %, and 41.89 %, respectively. Of the 82 studies, WL, BMI, and LMM were reported in 62 (75.6 %), 57 (69.5 %), and 16 (19.5 %) studies respectively and meta-analysis showed significant associations between phenotypic criteria and OS, with hazard ratios (HR) of 1.56 (1.24; 1.95), 1.18 (1.08; 1.28), and 2.03 (1.32; 3.12) respectively. Conclusion: The present systematic review and meta-analysis highlights the prevalence and prognostic value of GLIM phenotypic criteria in patients with advanced cancer. The limitations of BMI as a phenotypic criterion is clear. Future studies should prioritize and standardise WL measurement and muscle mass assessment within the GLIM framework.