# The Global Leadership Initiative on Malnutrition (GLIM) Tool for Nutritional Assessment of Adult Patients After Sleeve Gastrectomy: Is It the Recommended Tool?

## TL;DR

This study evaluates whether the GLIM tool accurately assesses malnutrition in patients after sleeve gastrectomy, finding it less reliable than the SGA method.

## Contribution

The study provides the first validation of the GLIM tool for post-sleeve gastrectomy nutritional assessment.

## Key findings

- Malnutrition was diagnosed in 48.9% of patients using GLIM and 42.6% using SGA.
- GLIM showed poor agreement with SGA (κ = 0.104) and low accuracy (AUC = 0.533).
- Sensitivity and specificity of GLIM were both 55%, indicating limited diagnostic value.

## Abstract

Background/Objectives: Malnutrition frequently occurs following bariatric surgery and can lead to higher morbidity rates, hospitalizations, and extended hospital stays. Nutritional assessment tools such as the Global Leadership Initiative on Malnutrition (GLIM) are not validated for diagnosis of malnutrition following bariatric surgery. This study aimed to assess the validity of GLIM criteria in evaluating the nutritional status of post-sleeve gastrectomy patients compared to the Subjective Global Assessment (SGA). Methods: A total of 47 adult patients who underwent sleeve gastrectomy (SG) from 6 months to 2 years prior were evaluated using the GLIM and SGA. Additionally, multiple pass 24 h recall was collected for two days, and macronutrient analyses were conducted using ESHA software (version 11.11.x). Agreement between both tools was determined using Kappa (κ) statistics, and the Receiver Operating Characteristics (ROC) curve was used to establish sensitivity and specificity. Results: The study found that malnutrition was diagnosed in 48.9% and 42.6% of patients according to the GLIM and SGA criteria, respectively. The GLIM criteria exhibited inadequate accuracy (AUC = 0.533; 95% CI, 0.38–0.72) with a sensitivity and specificity of 55.0% and 55.6%, respectively. The agreement between both tools was determined to be poor (κ = 0.104). Conclusions: GLIM did not show sufficient agreement with SGA. Consequently, the criteria of GLIM may need revision for better diagnosis of malnutrition in post-sleeve gastrectomy patients.