Correlation between NRS-2002 combined with GLIM criteria and preoperative sarcopenia in patients with gastrointestinal malignancies：A prospective cohort study

Correlation between NRS-2002 combined with GLIM criteria and preoperative sarcopenia in patients with gastrointestinal malignancies：A prospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Correlation between NRS-2002 combined with GLIM criteria and preoperative sarcopenia in patients with gastrointestinal malignancies：A prospective cohort study Yeming Xu, Na Shi, Yuqiu Zhao, Qiannan Sun, Shuyang Gao, Mingbo Hua, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4005866/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background & Purpose Since the Global Leadership Initiative on Malnutrition (GLIM) criteria are based on expert consensus recommendations, more clinical practice is needed to be validated. Currently, there is a lack of Nutritional Risk Screening 2002(NRS-2002) combined with the GLIM used in the diagnosis of muscle loss and malnutrition. The aim is to investigate the correlation between NRS-2002 in combination with The GLIM criteria in patients with gastrointestinal malignancies with muscle loss (sarcopenia). Methods In this study, we selected 210 patients with gastrointestinal malignant tumors from June 2022 to July 2023 from X Hospital. The nutritional status of the patients was assessed using the NRS-2002 and the GLIM diagnostic criteria. Patients were categorized as nutritionally normal, at nutritional risk, moderately malnourished, or severely malnourished based on the NRS-2002 in conjunction with the GLIM criteria. Results The prevalence of sarcopenia differed among various nutritional status groups( p < 0.01). In the moderately malnourished group and the severely malnourished group, the prevalence of sarcopenia was 36% and 83%, respectively. A positive correlation was observed between malnourishment and the presence of sarcopenia, as indicated by NRS-2002 (p < 0.001). Results from binary logistic regression analysis revealed that gender, height, ASMI, nutritional risk, and malnutrition were all risk factors for the development of sarcopenia (p < 0.05). Conclusion The prevalence of preoperative sarcopenia in patients with gastrointestinal malignancies is high, and there is a correlation between the NRS-2002 combined with GLIM criteria and sarcopenia in gastrointestinal malignancies. NRS-2002 GLIM criteria Sarcopenia Gastrointestinal malignancies Malnutrition Figures Figure 1 Figure 2 1. Introduction Nutritional risks and malnutrition are prevalent among hospitalized patients, especially among those with gastrointestinal malignancies [ 1 ] . Gastrointestinal malignancies typically induce symptoms such as nausea, vomiting, or anorexia in patients, resulting in inadequate dietary intake and protein synthesis. This can lead to malnutrition and decreased skeletal muscle content [ 2 ] .Sarcopenia, characterized by an accelerated decline in skeletal muscle content and function, is a progressive, widespread skeletal muscle disease associated with an increased likelihood of adverse outcomes, including falls, physical disability, and death [ 3 ] . Studies have demonstrated that malnutrition is one of the causes of sarcopenia [ 3 – 5 ] . Additionally, the occurrence of sarcopenia also increase the likelihood of postoperative malnutrition in patients, raises hospitalization costs, and reduces overall survival rates, among other consequences [ 2 ] . Consequently, nutritional interventions and early detection of malnutrition are crucial for the prevention and treatment of sarcopenia. NRS-2002 is the most widely used nutritional risk screening tool for gastric cancer patients in clinical practice [ 6 ] . Since the release of the Global Leadership Initiative on Malnutrition (GLIM) to the public in 2018, it has been recommended by the Expert Consensus on Gastrointestinal Perioperative Nutritional Indicators for the diagnosis of malnutrition in gastric cancer patients [ 7 ] . Both evaluation methods are currently being used in gastrointestinal malignant tumors and have been applied [ 8 ] . However, there have been fewer studies conducted on the combined use of NRS-2002 and GLIM for screening and assessing nutritional risk in patients with gastrointestinal malignancies. Furthermore, there are no reported cases of the two methods being used in conjunction to treat sarcopenia in gastrointestinal malignancies. This study aims to investigate the correlation between NRS-2002 combined with GLIM and sarcopenia in patients with gastrointestinal malignancies, analyze the influencing factors contributing to its occurrence, and provide a foundation for implementing preventive, screening, and targeted nutritional intervention measures for patients with gastrointestinal malignancies. 2. Subjects and methods 2.1. Participants Patients with gastrointestinal malignant tumors at the Gastrointestinal Center of X Hospital in X Province were selected as study subjects from January 2022 to July 2023. The sample size was determined using the formula: n = Z 2 α / 2 × p (1- p )/ δ ༒ . A preliminary investigation involving a small sample of 50 cases revealed a sarcopenia prevalence of 26%(p = 26%), with δ = 0.06. The calculated sample size was 182 cases, and considering a 15% attrition rate, the final sample size for inclusion was set at 210 cases. Inclusion criteria were as follows: 1) Age ≥ 18 years; 2) Confirmation of malignancy in the stomach, colon, or rectum through pathological biopsy; 3) Scheduled for laparoscopic radical surgery; 4) Ability to communicate efficiently with all four limbs; 5) Informed consent for participation in this study. Exclusion criteria included: 1) Unstable life conditions of the patients; 2) Presence of severe chest or abdominal fluid; 3) Inability to comply with other procedures such as screening, evaluation, and testing. 2.2. Ethics The study has received approval from the Ethics Committee of the School of X University, with the ethics number is (X). In addition, patient informed consent has been obtained for the study. 2.3. Diagnosis and screening for sarcopenia Eligible patients were screened with reference to the Asian Working Group for Sarcopenia (AWGS) evaluation process: 1) Muscle strength test: Subjects were required to stand and perform a grip test using their dominant hand. For males, a grip strength < 28 kg, and for females, a grip strength < 18 kg, were considered indicative of reduced grip strength; 2) Skeletal muscle index measurement;: patients’ ASMI was measured using the AiNST-CNDS (202007011) body composition analyzer. A male ASMI < 7.0 kg/m 2 and a female ASMI < 5.7 kg/m 2 were considered to be low skeletal muscle mass; 3) Body function test: assessment was performed using a 6-meter step rate measurement, and a step rate of < 1m/s was considered a decrease in somatic function. All participants underwent assessments for skeletal muscle mass and grip strength. Those demonstrating diminished skeletal muscle mass and grip strength were formally diagnosed with sarcopenia. 2.4. Nutritional Risk Screening and Diagnosis of Malnutrition Patients were initially screened using the Nutritional Risk Screening 2002 (NRS-2002). The NRS-2002 comprises three components [ 9 ] : disease state, nutritional impairment, and age, resulting in a total score on a scale of 0–2 for the no nutritional risk group, 3–4 for the low nutritional risk group, and 5–7 for the high nutritional risk group. Patients identified as being at nutritional risk, with an NRS-2002 score of ≥ 3, underwent reassessment of their nutritional status based on the 2018 Global Leadership Initiative on Malnutrition (GLIM) criteria. The GLIM diagnostic criteria consist of three phenotypic criteria (non-volitional body mass loss, low body mass index, and muscle loss) and two etiologic criteria (reduced food intake or impaired digestion and absorption, inflammation, or disease burden [ 10 ] ). Moderate malnutrition is diagnosed when the patient meets the criteria of a 5%-10% loss of body mass in 6 months, a BMI 10% of body weight in 6 months or > 20% in more than 6 months; BMI < 18.5 kg/m2 for those under 70 years of age or < 20 kg/m2 for those over 70 years of age, with severe muscle loss [ 11 ] . 2.5. Detection of biochemical indicators The patient self-administered 5 ml of fasting venous blood in the morning on the day prior, day one, day five, and day seven of the subsequent days. Nutritional status was observed immediately and over an extended period through the quantification of Total Protein (TP), Albumin (ALB), and Retinol-Binding Protein (RBP). 2.6. Physical examination We measured height, body mass index (BMI), waist-to-hip ratio (WHR), visceral fat area (VFA), obesity degree (OD), body cell mass (BCM), arm muscle circumference (AMC), and basal metabolic rate (BMR) in all patients. 2.7. Statistical analyses We utilized SPSS 27.0 software for the statistical analysis of this data. Measured data conforming to a normal distribution were expressed as (x ± s), and non-normally distributed data were expressed as M (P25, P75). Count data were presented as percentages (%), and comparisons were conducted using ANOVA, Z-test, and Cardiovascular test. Spearman’s rank correlation analysis was applied to examine the correlation between nutritional status and basic information and physical examination indexes. Nutritional indexes at different time points for the patients underwent repeated measurements ANOVA. Binary logistic regression analysis was employed to analyze the risk factors for the prevalence of sarcopenia in patients with gastrointestinal malignant tumors with different nutritional risks and statuses, with a significance level set at α = 0.05. 3. Results 3.1. Baseline information on study participants This study included a total of 210 preoperative patients with gastrointestinal malignancies, comprising 127 males and 83 females, with ages ranging from 35 to 88 years. The average age was (66.93 ± 9.50) years. Significant differences were observed in BMI, ASMI, HGS, VFA, OD, BCM, and AMC between the two groups (p < 0.05), as presented in Table I. 3.2. Variations in nutritional indicators over time between two patient groups The results of the independent samples t-test showed no significant difference in the preoperative levels of TP, ALB, and RBP between the two groups of patients (p > 0.05). However, the postoperative sarcopenia group exhibited significantly lower nutritional levels compared to both the preoperative group and the group without sarcopenia (p < 0.05), as detailed in Table 2. A repeated measures analysis of variance, using time as the within-group variable and group as the between-group variable, was conducted. The results revealed statistically significant differences in the time effect and group effect of nutritional indicators TP and ALB between the two groups (p < 0.05). These findings indicate that, at different time points, the variations in TP and ALB nutritional indicators between patients in different groups are statistically significant. The perioperative trends in TP and ALB changes in the two groups are influenced by the grouping, as depicted in Table 3. 3.3. Analysis of the link between nutritional state, sarcopenia, and body composition data There was a positive correlation between the nutritional status of the patients and the presence or absence of sarcopenia as assessed by NRS-2002 (p < 0.001). Additionally, a negative correlation was observed with BMI, ASMI, HGS, VFA, and AC, as depicted in Fig. 1 . 3.4. Analysis of risk factors for preoperative sarcopenia in patients with gastrointestinal malignancies In this study, binary logistic regression analysis was conducted with the occurrence of sarcopenia in patients with gastrointestinal malignancies (no = 1, yes = 1) as the dependent variable, and the variables with p < 0.05 in the univariate analysis as the independent variables. The results indicated a H-L test p-value of 0.637 and an Omnibus test of model coefficients x2 of 179.067, p < 0.001, demonstrating a good fit for the equation. Nutritional grading (Normal nutrition = 1, malnutrition = 2, severe malnutrition = 3; with normal nutrition as a reference), gender (male = 1, female = 2; with male as a reference), height, and ASMI were identified as risk factors for preoperative sarcopenia, as outlined in Table 3. 3.5. The prevalence of sarcopenia in different nutritional conditions There was a statistically significant difference observed in the prevalence of sarcopenia among different nutritional groups (χ2 = 112.107, p < 0.001). The prevalence of sarcopenia in the normal nutritional group was found to be 0.8% (1 out of 124), in the moderate malnutrition group was 36% (18 out of 50), and in the severe malnutrition group was 83% (30 out of 36), as depicted in Fig. 2 . 4. Discussion NRS-2002 combined with GLIM criteria Higher prevalence of malnutrition and sarcopenia in patients with gastrointestinal malignancies. The results of this study revealed that the incidence of preoperative malnutrition in patients with gastrointestinal malignancies, as assessed by NRS-2002 combined with GLIM criteria, was 40.95%, of which the incidence of moderate malnutrition was 23.80% and the incidence of severe malnutrition was 17.14%. In the cohort of 210 patients with gastrointestinal malignancies, the incidence of sarcopenia was 23.33%. Within this group, the occurrence of sarcopenia was 0.8% in the normal nutrition group and 36% and 83% in the moderate and severe malnutrition groups, respectively. These rates were higher than those observed in the general cancer population [ 12 ] . A meta-analysis indicates that malnutrition and decreased skeletal muscle mass are risk factors for sarcopenia, directly influencing the prognosis of patients with malignancies [ 13 ] . Currently, the NRS-2002 scale, recommended by the European Society for Parenteral and Enteral Nutrition, is widely used as a nutritional screening tool in clinical settings. [ 14 – 16 ] . Since the introduction of the GLIM standard by global nutrition leaders in 2019, it has become a valid tool for nutritional assessment and survival prediction in patients with gastrointestinal malignancies [ 17 – 19 ] . In this study, we assessed the malnutrition of patients through a two-step process in order to improve the positive screening rate of the malnutrition of patients with malignancies and to provide an effective reference for the early screening of sarcopenia in patients with gastrointestinal malignancies. Patients with gastrointestinal malignancies who are malnourished under the NRS-2002 combined with the GLIM criteria should be subjected to comprehensive nutritional management [ 4 ] . Studies have shown that the nutritional support rate of patients with malignant tumors is only 17.69% [ 20 ] , so it is urgent to strengthen the nutritional intervention for malignant tumors. The study results indicated no statistically significant difference in preoperative levels of TP, ALB, and RBP between the two patient groups (p > 0.05). However, the nutritional level in the postoperative sarcopenia group was significantly lower compared to both the preoperative and sarcopenia-free groups. It is noteworthy that clinical nutrition pharmacists played an important role in the nutritional care of patients in this study. For patients at nutritional risk or malnourished, the clinical pharmacists provided nutritional advice to clinicians and prescribed parenteral nutritional aids according to the patient's specific situation. [ 21 , 22 ] . The results show that standardized nutritional assessment and intervention can effectively improve the nutritional status of patients. The ESPEN Practice Guidelines for Surgical Nutrition Therapy 2021 recommend prescribing nutritional supplements to patients undergoing major abdominal surgery if they have a negative preoperative risk screen or malnutrition diagnosis. For patients with nutritional risk or malnutrition, Oral Nutritional Supplements (ONS) are provided first, and patients are informed about how to take enteral nutritional supplements, Enteral Nutrition (EN), or parenteral nutrition if ONS is not an option. Experiences at home and abroad have shown that the establishment and operation of nutritional support groups or multidisciplinary teams help rationalize the management of nutritional interventions and effectively reduce the incidence of complications and medical costs in nutritional support [ 23 , 24 ] . Malnutrition is one of the important factors leading to sarcopenia [ 4 ] . Duerksen et al. [ 25 ] found that with every 1-point increase in nutritional status score, a patient's risk of developing sarcopenia increased by 1.478 times. The European Working Group on Sarcopenia in Older People states that patients with low muscle mass or low muscle quality are diagnosed with sarcopenia. Severe sarcopenia is diagnosed when a decrease in muscle mass, along with reduced muscle quality, results in a significant decrease in muscle strength and concomitant low physical functioning [ 26 ] . A study by Tachiki et al [ 27 ] showed that grip strength measurements were significantly and positively correlated with body mass index and ASMI, which is often recommended for the assessment of sarcopenia. Therefore, early screening for nutritional risk is essential for patients with gastrointestinal tumors, and during the screening process, attention should be paid to the NRS-2002 score, BMI, ASMI, grip strength, and other indicators related to sarcopenia in order to promptly identify those who are at risk for sarcopenia. In this study, we observed significant differences in BMI, ASMI, HGS, VFA, and AC among different malnutrition classes. These findings suggest that as the patient's malnutrition class increases, their nutritional status worsens, leading to reduced muscle mass, strength, and metabolism. Consequently, there is an increased likelihood of developing sarcopenia [ 4 , 28 , 29 ] . The current investigation, utilizing binary logistic regression and controlling for gender, revealed that nutritional risk and malnutrition were distinct risk factors for sarcopenia, height, and BMI. The risk of sarcopenia in patients with low nutritional risk was 2.889 times higher than in patients with normal nutrition (95% CI: 1.272–6.562, p < 0.05). For patients with high nutritional risk, the risk of sarcopenia increased to 24.267 times higher than those with normal nutrition (95% CI: 7.076–83.220, p < 0.001). Additionally, the risk of developing sarcopenia in patients with severe malnutrition was 11.323 times higher than in patients with normal nutrition (95% CI: 2.456–52.183, p < 0.001). These findings suggest that as nutritional risk and the level of malnutrition increase, the risk of developing sarcopenia in patients with gastrointestinal tumors also increases. This phenomenon may be attributed to the following reasons: (1) Gastrointestinal tumor patients often undergo preoperative fasting to meet intestinal cleansing requirements for surgical treatment, potentially leading to insufficient energy and protein intake. (2) Reduced exercise capacity and lower protein intake in patients with GI tumors could result in a reduced effect of direct stimulation of skeletal muscle protein synthesis. Patients with gastrointestinal malignant tumors who are at nutritional risk commonly experience persistent body mass loss and a sudden decrease in energy intake [ 30 ] . Therefore, in clinical practice, healthcare professionals should carry out nutritional risk screening as early as possible and focus on gastrointestinal malignancies patients with nutritional risk. Healthcare professionals should supplement patients with malnutrition with essential amino acids in a timely manner to promote protein synthesis and metabolism in the body, safeguard or promote the balance of protein metabolism, and reduce or prevent the reduction of muscle protein mass. 5. Conclusion The combination of NRS-2002 and GLIM criteria is correlated with preoperative sarcopenia in gastrointestinal malignant tumors. Using these two criteria together can effectively increase the positive screening rate of sarcopenia. It enables clinical staff to conduct early nutritional screening and assessment, identifying the high-risk group of sarcopenia patients through BIA measurements of their BMI, ASMI, and other indices. This approach will facilitate targeted and effective preoperative nutrition and exercise management. However, this study has some limitations, including not investigating the patients' dietary status and education level, factors that may impact the study results The study employed a bioelectrical impedance analyzer (BIA) for testing, and dual-energy X-ray absorptiometry, known for its higher precision, was not utilized. Furthermore, this study was a single-center cross-sectional study with a small sample size and an incomplete collection of indicators. Further multicenter cohort studies are needed in the future. Declarations Conflicts of Interest : The authors declare that they have no conflict of interest with materials presented here. Declaration of Competing Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Competing interests No conflicting financial interests exist between authors. Funding Project: Yangzhou Innovation Capacity Building Program Key Laboratory of Basic and Clinical Transformation of Digestive Diseases/Metabolism (YZ2020159) Acknowledgements All of the writers contributed to the manuscript's conception and design, Xu Yeming and Shi Na jointly designed the idea and framework of the article and complete writing of the article. Zhao Yuqiu and Gao Shuyang were responsible for collecting and analyzing the data of all patients in this study. Hua Mingbo and Wang Tianxiu disposed by using the statistical software is responsible for the data part of the article. The final version of the article was evaluated by Wang Daorong and Sun Qiannan, and all authors read and approved the final manuscript. References BARKER L A, GOUT B S, CROWE T C. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system [J]. Int J Environ Res Public Health, 2011, 8(2): 514–27. XIE H, WEI L, LIU M, et al. Preoperative computed tomography-assessed sarcopenia as a predictor of complications and long-term prognosis in patients with colorectal cancer: a systematic review and meta-analysis [J]. Langenbecks Arch Surg, 2021, 406(6): 1775–88. CRUZ-JENTOFT A J, SAYER A A. Sarcopenia [J]. Lancet, 2019, 393(10191): 2636–46. SIEBER C C. Malnutrition and sarcopenia [J]. Aging Clin Exp Res, 2019, 31(6): 793–8. KALUŹNIAK-SZYMANOWSKA A, KRZYMIŃSKA-SIEMASZKO R, DESKUR-ŚMIELECKA E, et al. Malnutrition, Sarcopenia, and Malnutrition-Sarcopenia Syndrome in Older Adults with COPD [J]. Nutrients, 2021, 14(1). DU Y P, LI L L, HE Q, et al. [Nutritional risk screening and nutrition assessment for gastrointestinal cancer patients] [J]. Zhonghua Wei Chang Wai Ke Za Zhi, 2012, 15(5): 460–3. GASCóN-RUIZ M, CASAS-DEZA D, TORRES-RAMóN I, et al. Comparation of different malnutrition screening tools according to GLIM criteria in cancer outpatients [J]. Eur J Clin Nutr, 2022, 76(5): 698–702. WIE G A, CHO Y A, KIM S Y, et al. Prevalence and risk factors of malnutrition among cancer patients according to tumor location and stage in the National Cancer Center in Korea [J]. Nutrition, 2010, 26(3): 263–8. KONDRUP J, RASMUSSEN H H, HAMBERG O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials [J]. Clin Nutr, 2003, 22(3): 321–36. CEDERHOLM T, JENSEN G L, CORREIA M, et al. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community [J]. Clin Nutr, 2019, 38(1): 1–9. BARAZZONI R, JENSEN G L, CORREIA M, et al. Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition (GLIM) diagnosis of malnutrition [J]. Clin Nutr, 2022, 41(6): 1425–33. OFLAZOGLU U, ALACACIOGLU A, VAROL U, et al. Prevalence and related factors of sarcopenia in newly diagnosed cancer patients [J]. Support Care Cancer, 2020, 28(2): 837–43. LIGTHART-MELIS G C, LUIKING Y C, KAKOUROU A, et al. Frailty, Sarcopenia, and Malnutrition Frequently (Co-)occur in Hospitalized Older Adults: A Systematic Review and Meta-analysis [J]. J Am Med Dir Assoc, 2020, 21(9): 1216–28. HERSBERGER L, BARGETZI L, BARGETZI A, et al. Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial [J]. Clin Nutr, 2020, 39(9): 2720–9. CAO J, XU H, LI W, et al. Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer [J]. Curr Probl Cancer, 2021, 45(1): 100638. ZHANG Z, PEREIRA S L, LUO M, et al. Evaluation of Blood Biomarkers Associated with Risk of Malnutrition in Older Adults: A Systematic Review and Meta-Analysis [J]. Nutrients, 2017, 9(8). ZHANG Z, WAN Z, ZHU Y, et al. Prevalence of malnutrition comparing NRS2002, MUST, and PG-SGA with the GLIM criteria in adults with cancer: A multi-center study [J]. Nutrition, 2021, 83: 111072. DE GROOT L M, LEE G, ACKERIE A, et al. Malnutrition Screening and Assessment in the Cancer Care Ambulatory Setting: Mortality Predictability and Validity of the Patient-Generated Subjective Global Assessment Short form (PG-SGA SF) and the GLIM Criteria [J]. Nutrients, 2020, 12(8). ZHANG X, TANG M, ZHANG Q, et al. The GLIM criteria as an effective tool for nutrition assessment and survival prediction in older adult cancer patients [J]. Clin Nutr, 2021, 40(3): 1224–32. CHEN Z, HONG B, HE J J, et al. Examining the impact of early enteral nutritional support on postoperative recovery in patients undergoing surgical treatment for gastrointestinal neoplasms [J]. World J Gastrointest Surg, 2023, 15(10): 2222–33. SIMMANCE N, CORTINOVIS T, GREEN C, et al. Introducing novel advanced practice roles into the health workforce: Dietitians leading in gastrostomy management [J]. Nutr Diet, 2019, 76(1): 14–20. COOK F, RODRIGUEZ J M, MCCAUL L K. Malnutrition, nutrition support and dietary intervention: the role of the dietitian supporting patients with head and neck cancer [J]. Br Dent J, 2022, 233(9): 757–64. RIO A, CAWADIAS E. Nutritional advice and treatment by dietitians to patients with amyotrophic lateral sclerosis/motor neurone disease: a survey of current practice in England, Wales, Northern Ireland and Canada [J]. J Hum Nutr Diet, 2007, 20(1): 3–13. ZHOU X, QIU F, WAN D, et al. Nutrition support for critically ill patients in China: role of the pharmacist [J]. Asia Pac J Clin Nutr, 2019, 28(2): 246–51. DUERKSEN D R, LAPORTE M, JEEJEEBHOY K. Evaluation of Nutrition Status Using the Subjective Global Assessment: Malnutrition, Cachexia, and Sarcopenia [J]. Nutr Clin Pract, 2021, 36(5): 942–56. CEDERHOLM T, BOSAEUS I, BARAZZONI R, et al. Diagnostic criteria for malnutrition - An ESPEN Consensus Statement [J]. Clin Nutr, 2015, 34(3): 335–40. TACHIKI T, KOUDA K, DONGMEI N, et al. Muscle strength is associated with bone health independently of muscle mass in postmenopausal women: the Japanese population-based osteoporosis study [J]. J Bone Miner Metab, 2019, 37(1): 53–9. SAYER A A, CRUZ-JENTOFT A. Sarcopenia definition, diagnosis and treatment: consensus is growing [J]. Age Ageing, 2022, 51(10). DHILLON R J, HASNI S. Pathogenesis and Management of Sarcopenia [J]. Clin Geriatr Med, 2017, 33(1): 17–26. GUO Z Q, YU J M, LI W, et al. Survey and analysis of the nutritional status in hospitalized patients with malignant gastric tumors and its influence on the quality of life [J]. Support Care Cancer, 2020, 28(1): 373–80. Tables Table 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4005866","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":276174825,"identity":"dcf0d803-f1ba-4155-b5e9-2fd80594a15e","order_by":0,"name":"Yeming Xu","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Yeming","middleName":"","lastName":"Xu","suffix":""},{"id":276174826,"identity":"f571c784-b128-48eb-84af-e0316025ae69","order_by":1,"name":"Na Shi","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Na","middleName":"","lastName":"Shi","suffix":""},{"id":276174827,"identity":"4b0cc0f4-4cf0-4a5e-b690-961302ab3c09","order_by":2,"name":"Yuqiu Zhao","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Yuqiu","middleName":"","lastName":"Zhao","suffix":""},{"id":276174828,"identity":"20221e67-965c-4c4d-998b-73a05df6986d","order_by":3,"name":"Qiannan Sun","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Qiannan","middleName":"","lastName":"Sun","suffix":""},{"id":276174829,"identity":"0e64747e-7532-4f88-afa0-77bb2461b995","order_by":4,"name":"Shuyang Gao","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Shuyang","middleName":"","lastName":"Gao","suffix":""},{"id":276174830,"identity":"378d4e65-97d8-4944-8182-8babacb0d781","order_by":5,"name":"Mingbo Hua","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Mingbo","middleName":"","lastName":"Hua","suffix":""},{"id":276174831,"identity":"6a78fbe6-aec4-4ae6-8f03-231dc4641bf3","order_by":6,"name":"Tianxiu Wang","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Tianxiu","middleName":"","lastName":"Wang","suffix":""},{"id":276174832,"identity":"e8c306ca-0131-4e4b-a746-8f204b714d26","order_by":7,"name":"Daorong Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYFCCBAjFz9588AGDASlaJHuOJRuQpsVgho+aBFEaDI4nP3xcUXHHboMED1vlj4I78gzsh49uwKvlzDNjwzNnniVvl+49dpvH4JlhA09a2g18WsxuJJhJNrYdTraccy7tNoPBYcYGCR4zAlrSv4G1GNzIMSv8YXDYnggtOWBb7EBaGHgMDicS1GJ/5k2xYcOZwwmgQJYGakluI+QXyfb0jQ8bKg7bg6Ly448/h2372Q8fw6sFBhIbYCw2YpSDHUiswlEwCkbBKBiBAABDkVL1BMou5AAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Daorong","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-03-02 07:59:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4005866/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4005866/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52104322,"identity":"350b027c-b437-4920-afe9-09dbac88e49e","added_by":"auto","created_at":"2024-03-06 19:23:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":184548,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation between nutritional risk and grading of sarcopenia and physical examination related indicators\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4005866/v1/578c321c05987f7a3a2b4a6a.png"},{"id":52104318,"identity":"c893ccb9-aa44-4d8a-a878-5d3d923a7d06","added_by":"auto","created_at":"2024-03-06 19:23:59","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":53912,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of the prevalence of sarcopenia in patients with different nutritional status\u003c/p\u003e\n\u003cp\u003e1:Entrophia; 2: Moderate Malnutrition; 3: Severe Malnutrition\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4005866/v1/6dd671a0b4facbb4ed5b0082.png"},{"id":59818927,"identity":"6e1ce05d-d8df-483e-886a-565307e7652d","added_by":"auto","created_at":"2024-07-08 02:53:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":722930,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4005866/v1/0dd68b71-2d72-48cd-88a8-a4446a1c4527.pdf"},{"id":52104321,"identity":"017d9627-1a9a-4a92-ac94-498563858eb7","added_by":"auto","created_at":"2024-03-06 19:23:59","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":12181,"visible":true,"origin":"","legend":"","description":"","filename":"table1.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4005866/v1/0ed2a57b44f65356244e7839.xlsx"},{"id":52104319,"identity":"3ade8991-cba0-40a1-be9a-e397fc09e98b","added_by":"auto","created_at":"2024-03-06 19:23:59","extension":"xlsx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":10934,"visible":true,"origin":"","legend":"","description":"","filename":"table2.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4005866/v1/f71a3e89e37d2004ff6255d1.xlsx"},{"id":52104320,"identity":"44b0f7f8-8d75-412f-87c1-2631edbd1b92","added_by":"auto","created_at":"2024-03-06 19:23:59","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":9998,"visible":true,"origin":"","legend":"","description":"","filename":"table3.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4005866/v1/4f20f27ac166567c9f131288.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Correlation between NRS-2002 combined with GLIM criteria and preoperative sarcopenia in patients with gastrointestinal malignancies：A prospective cohort study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eNutritional risks and malnutrition are prevalent among hospitalized patients, especially among those with gastrointestinal malignancies\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Gastrointestinal malignancies typically induce symptoms such as nausea, vomiting, or anorexia in patients, resulting in inadequate dietary intake and protein synthesis. This can lead to malnutrition and decreased skeletal muscle content\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e.Sarcopenia, characterized by an accelerated decline in skeletal muscle content and function, is a progressive, widespread skeletal muscle disease associated with an increased likelihood of adverse outcomes, including falls, physical disability, and death \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Studies have demonstrated that malnutrition is one of the causes of sarcopenia\u003csup\u003e[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Additionally, the occurrence of sarcopenia also increase the likelihood of postoperative malnutrition in patients, raises hospitalization costs, and reduces overall survival rates, among other consequences\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Consequently, nutritional interventions and early detection of malnutrition are crucial for the prevention and treatment of sarcopenia.\u003c/p\u003e \u003cp\u003eNRS-2002 is the most widely used nutritional risk screening tool for gastric cancer patients in clinical practice\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Since the release of the Global Leadership Initiative on Malnutrition (GLIM) to the public in 2018, it has been recommended by the Expert Consensus on Gastrointestinal Perioperative Nutritional Indicators for the diagnosis of malnutrition in gastric cancer patients\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Both evaluation methods are currently being used in gastrointestinal malignant tumors and have been applied\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. However, there have been fewer studies conducted on the combined use of NRS-2002 and GLIM for screening and assessing nutritional risk in patients with gastrointestinal malignancies. Furthermore, there are no reported cases of the two methods being used in conjunction to treat sarcopenia in gastrointestinal malignancies.\u003c/p\u003e \u003cp\u003eThis study aims to investigate the correlation between NRS-2002 combined with GLIM and sarcopenia in patients with gastrointestinal malignancies, analyze the influencing factors contributing to its occurrence, and provide a foundation for implementing preventive, screening, and targeted nutritional intervention measures for patients with gastrointestinal malignancies.\u003c/p\u003e"},{"header":"2. Subjects and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Participants\u003c/h2\u003e \u003cp\u003ePatients with gastrointestinal malignant tumors at the Gastrointestinal Center of X Hospital in X Province were selected as study subjects from January 2022 to July 2023. The sample size was determined using the formula: n\u0026thinsp;=\u0026thinsp;Z\u003csup\u003e2\u003c/sup\u003e\u003csub\u003eα\u003c/sub\u003e/\u003csub\u003e2\u003c/sub\u003e\u0026times;\u003cem\u003ep\u003c/em\u003e(1-\u003cem\u003ep\u003c/em\u003e)/\u003cem\u003eδ\u003c/em\u003e\u003csup\u003e༒\u003c/sup\u003e. A preliminary investigation involving a small sample of 50 cases revealed a sarcopenia prevalence of 26%(p\u0026thinsp;=\u0026thinsp;26%), with \u003cem\u003eδ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.06. The calculated sample size was 182 cases, and considering a 15% attrition rate, the final sample size for inclusion was set at 210 cases. Inclusion criteria were as follows: 1) Age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; 2) Confirmation of malignancy in the stomach, colon, or rectum through pathological biopsy; 3) Scheduled for laparoscopic radical surgery; 4) Ability to communicate efficiently with all four limbs; 5) Informed consent for participation in this study. Exclusion criteria included: 1) Unstable life conditions of the patients; 2) Presence of severe chest or abdominal fluid; 3) Inability to comply with other procedures such as screening, evaluation, and testing.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Ethics\u003c/h2\u003e \u003cp\u003e The study has received approval from the Ethics Committee of the School of X University, with the ethics number is (X). In addition, patient informed consent has been obtained for the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Diagnosis and screening for sarcopenia\u003c/h2\u003e \u003cp\u003eEligible patients were screened with reference to the Asian Working Group for Sarcopenia (AWGS) evaluation process: 1) Muscle strength test: Subjects were required to stand and perform a grip test using their dominant hand. For males, a grip strength\u0026thinsp;\u0026lt;\u0026thinsp;28 kg, and for females, a grip strength\u0026thinsp;\u0026lt;\u0026thinsp;18 kg, were considered indicative of reduced grip strength; 2) Skeletal muscle index measurement;: patients\u0026rsquo; ASMI was measured using the AiNST-CNDS (202007011) body composition analyzer. A male ASMI\u0026thinsp;\u0026lt;\u0026thinsp;7.0 kg/m\u003csup\u003e2\u003c/sup\u003e and a female ASMI\u0026thinsp;\u0026lt;\u0026thinsp;5.7 kg/m\u003csup\u003e2\u003c/sup\u003e were considered to be low skeletal muscle mass; 3) Body function test: assessment was performed using a 6-meter step rate measurement, and a step rate of \u0026lt;\u0026thinsp;1m/s was considered a decrease in somatic function. All participants underwent assessments for skeletal muscle mass and grip strength. Those demonstrating diminished skeletal muscle mass and grip strength were formally diagnosed with sarcopenia.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Nutritional Risk Screening and Diagnosis of Malnutrition\u003c/h2\u003e \u003cp\u003ePatients were initially screened using the Nutritional Risk Screening 2002 (NRS-2002). The NRS-2002 comprises three components\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e: disease state, nutritional impairment, and age, resulting in a total score on a scale of 0\u0026ndash;2 for the no nutritional risk group, 3\u0026ndash;4 for the low nutritional risk group, and 5\u0026ndash;7 for the high nutritional risk group. Patients identified as being at nutritional risk, with an NRS-2002 score of \u0026ge;\u0026thinsp;3, underwent reassessment of their nutritional status based on the 2018 Global Leadership Initiative on Malnutrition (GLIM) criteria. The GLIM diagnostic criteria consist of three phenotypic criteria (non-volitional body mass loss, low body mass index, and muscle loss) and two etiologic criteria (reduced food intake or impaired digestion and absorption, inflammation, or disease burden\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e). Moderate malnutrition is diagnosed when the patient meets the criteria of a 5%-10% loss of body mass in 6 months, a BMI\u0026thinsp;\u0026lt;\u0026thinsp;20 kg/m2 for those under 70 years of age or 22 kg/m2 for those over 70 years of age (inclusive), and mild to moderate muscle loss. Severe malnutrition is diagnosed with a loss of \u0026gt;\u0026thinsp;10% of body weight in 6 months or \u0026gt;\u0026thinsp;20% in more than 6 months; BMI\u0026thinsp;\u0026lt;\u0026thinsp;18.5 kg/m2 for those under 70 years of age or \u0026lt;\u0026thinsp;20 kg/m2 for those over 70 years of age, with severe muscle loss\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Detection of biochemical indicators\u003c/h2\u003e \u003cp\u003eThe patient self-administered 5 ml of fasting venous blood in the morning on the day prior, day one, day five, and day seven of the subsequent days. Nutritional status was observed immediately and over an extended period through the quantification of Total Protein (TP), Albumin (ALB), and Retinol-Binding Protein (RBP).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Physical examination\u003c/h2\u003e \u003cp\u003eWe measured height, body mass index (BMI), waist-to-hip ratio (WHR), visceral fat area (VFA), obesity degree (OD), body cell mass (BCM), arm muscle circumference (AMC), and basal metabolic rate (BMR) in all patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.7. Statistical analyses\u003c/h2\u003e \u003cp\u003eWe utilized SPSS 27.0 software for the statistical analysis of this data. Measured data conforming to a normal distribution were expressed as (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s), and non-normally distributed data were expressed as M (P25, P75). Count data were presented as percentages (%), and comparisons were conducted using ANOVA, Z-test, and Cardiovascular test. Spearman\u0026rsquo;s rank correlation analysis was applied to examine the correlation between nutritional status and basic information and physical examination indexes.\u003c/p\u003e \u003cp\u003eNutritional indexes at different time points for the patients underwent repeated measurements ANOVA. Binary logistic regression analysis was employed to analyze the risk factors for the prevalence of sarcopenia in patients with gastrointestinal malignant tumors with different nutritional risks and statuses, with a significance level set at α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Baseline information on study participants\u003c/h2\u003e \u003cp\u003eThis study included a total of 210 preoperative patients with gastrointestinal malignancies, comprising 127 males and 83 females, with ages ranging from 35 to 88 years. The average age was (66.93\u0026thinsp;\u0026plusmn;\u0026thinsp;9.50) years. Significant differences were observed in BMI, ASMI, HGS, VFA, OD, BCM, and AMC between the two groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as presented in Table I.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Variations in nutritional indicators over time between two patient groups\u003c/h2\u003e \u003cp\u003eThe results of the independent samples t-test showed no significant difference in the preoperative levels of TP, ALB, and RBP between the two groups of patients (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, the postoperative sarcopenia group exhibited significantly lower nutritional levels compared to both the preoperative group and the group without sarcopenia (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as detailed in Table\u0026nbsp;2.\u003c/p\u003e \u003cp\u003eA repeated measures analysis of variance, using time as the within-group variable and group as the between-group variable, was conducted. The results revealed statistically significant differences in the time effect and group effect of nutritional indicators TP and ALB between the two groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These findings indicate that, at different time points, the variations in TP and ALB nutritional indicators between patients in different groups are statistically significant. The perioperative trends in TP and ALB changes in the two groups are influenced by the grouping, as depicted in Table\u0026nbsp;3.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Analysis of the link between nutritional state, sarcopenia, and body composition data\u003c/h2\u003e \u003cp\u003eThere was a positive correlation between the nutritional status of the patients and the presence or absence of sarcopenia as assessed by NRS-2002 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, a negative correlation was observed with BMI, ASMI, HGS, VFA, and AC, as depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Analysis of risk factors for preoperative sarcopenia in patients with gastrointestinal malignancies\u003c/h2\u003e \u003cp\u003eIn this study, binary logistic regression analysis was conducted with the occurrence of sarcopenia in patients with gastrointestinal malignancies (no\u0026thinsp;=\u0026thinsp;1, yes\u0026thinsp;=\u0026thinsp;1) as the dependent variable, and the variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in the univariate analysis as the independent variables. The results indicated a H-L test p-value of 0.637 and an Omnibus test of model coefficients x2 of 179.067, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, demonstrating a good fit for the equation.\u003c/p\u003e \u003cp\u003eNutritional grading (Normal nutrition\u0026thinsp;=\u0026thinsp;1, malnutrition\u0026thinsp;=\u0026thinsp;2, severe malnutrition\u0026thinsp;=\u0026thinsp;3; with normal nutrition as a reference), gender (male\u0026thinsp;=\u0026thinsp;1, female\u0026thinsp;=\u0026thinsp;2; with male as a reference), height, and ASMI were identified as risk factors for preoperative sarcopenia, as outlined in Table\u0026nbsp;3.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.5. The prevalence of sarcopenia in different nutritional conditions\u003c/h2\u003e \u003cp\u003eThere was a statistically significant difference observed in the prevalence of sarcopenia among different nutritional groups (χ2\u0026thinsp;=\u0026thinsp;112.107, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The prevalence of sarcopenia in the normal nutritional group was found to be 0.8% (1 out of 124), in the moderate malnutrition group was 36% (18 out of 50), and in the severe malnutrition group was 83% (30 out of 36), as depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eNRS-2002 combined with GLIM criteria Higher prevalence of malnutrition and sarcopenia in patients with gastrointestinal malignancies. The results of this study revealed that the incidence of preoperative malnutrition in patients with gastrointestinal malignancies, as assessed by NRS-2002 combined with GLIM criteria, was 40.95%, of which the incidence of moderate malnutrition was 23.80% and the incidence of severe malnutrition was 17.14%. In the cohort of 210 patients with gastrointestinal malignancies, the incidence of sarcopenia was 23.33%. Within this group, the occurrence of sarcopenia was 0.8% in the normal nutrition group and 36% and 83% in the moderate and severe malnutrition groups, respectively. These rates were higher than those observed in the general cancer population\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. A meta-analysis indicates that malnutrition and decreased skeletal muscle mass are risk factors for sarcopenia, directly influencing the prognosis of patients with malignancies\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Currently, the NRS-2002 scale, recommended by the European Society for Parenteral and Enteral Nutrition, is widely used as a nutritional screening tool in clinical settings. \u003csup\u003e[\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Since the introduction of the GLIM standard by global nutrition leaders in 2019, it has become a valid tool for nutritional assessment and survival prediction in patients with gastrointestinal malignancies\u003csup\u003e[\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. In this study, we assessed the malnutrition of patients through a two-step process in order to improve the positive screening rate of the malnutrition of patients with malignancies and to provide an effective reference for the early screening of sarcopenia in patients with gastrointestinal malignancies.\u003c/p\u003e \u003cp\u003ePatients with gastrointestinal malignancies who are malnourished under the NRS-2002 combined with the GLIM criteria should be subjected to comprehensive nutritional management\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Studies have shown that the nutritional support rate of patients with malignant tumors is only 17.69%\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e, so it is urgent to strengthen the nutritional intervention for malignant tumors. The study results indicated no statistically significant difference in preoperative levels of TP, ALB, and RBP between the two patient groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, the nutritional level in the postoperative sarcopenia group was significantly lower compared to both the preoperative and sarcopenia-free groups. It is noteworthy that clinical nutrition pharmacists played an important role in the nutritional care of patients in this study. For patients at nutritional risk or malnourished, the clinical pharmacists provided nutritional advice to clinicians and prescribed parenteral nutritional aids according to the patient's specific situation.\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. The results show that standardized nutritional assessment and intervention can effectively improve the nutritional status of patients. The ESPEN Practice Guidelines for Surgical Nutrition Therapy 2021 recommend prescribing nutritional supplements to patients undergoing major abdominal surgery if they have a negative preoperative risk screen or malnutrition diagnosis. For patients with nutritional risk or malnutrition, Oral Nutritional Supplements (ONS) are provided first, and patients are informed about how to take enteral nutritional supplements, Enteral Nutrition (EN), or parenteral nutrition if ONS is not an option. Experiences at home and abroad have shown that the establishment and operation of nutritional support groups or multidisciplinary teams help rationalize the management of nutritional interventions and effectively reduce the incidence of complications and medical costs in nutritional support\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e .\u003c/p\u003e \u003cp\u003eMalnutrition is one of the important factors leading to sarcopenia\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Duerksen et al.\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003efound that with every 1-point increase in nutritional status score, a patient's risk of developing sarcopenia increased by 1.478 times. The European Working Group on Sarcopenia in Older People states that patients with low muscle mass or low muscle quality are diagnosed with sarcopenia. Severe sarcopenia is diagnosed when a decrease in muscle mass, along with reduced muscle quality, results in a significant decrease in muscle strength and concomitant low physical functioning\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. A study by Tachiki et al\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e showed that grip strength measurements were significantly and positively correlated with body mass index and ASMI, which is often recommended for the assessment of sarcopenia. Therefore, early screening for nutritional risk is essential for patients with gastrointestinal tumors, and during the screening process, attention should be paid to the NRS-2002 score, BMI, ASMI, grip strength, and other indicators related to sarcopenia in order to promptly identify those who are at risk for sarcopenia. In this study, we observed significant differences in BMI, ASMI, HGS, VFA, and AC among different malnutrition classes. These findings suggest that as the patient's malnutrition class increases, their nutritional status worsens, leading to reduced muscle mass, strength, and metabolism. Consequently, there is an increased likelihood of developing sarcopenia\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe current investigation, utilizing binary logistic regression and controlling for gender, revealed that nutritional risk and malnutrition were distinct risk factors for sarcopenia, height, and BMI. The risk of sarcopenia in patients with low nutritional risk was 2.889 times higher than in patients with normal nutrition (95% CI: 1.272\u0026ndash;6.562, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). For patients with high nutritional risk, the risk of sarcopenia increased to 24.267 times higher than those with normal nutrition (95% CI: 7.076\u0026ndash;83.220, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, the risk of developing sarcopenia in patients with severe malnutrition was 11.323 times higher than in patients with normal nutrition (95% CI: 2.456\u0026ndash;52.183, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These findings suggest that as nutritional risk and the level of malnutrition increase, the risk of developing sarcopenia in patients with gastrointestinal tumors also increases. This phenomenon may be attributed to the following reasons: (1) Gastrointestinal tumor patients often undergo preoperative fasting to meet intestinal cleansing requirements for surgical treatment, potentially leading to insufficient energy and protein intake. (2) Reduced exercise capacity and lower protein intake in patients with GI tumors could result in a reduced effect of direct stimulation of skeletal muscle protein synthesis. Patients with gastrointestinal malignant tumors who are at nutritional risk commonly experience persistent body mass loss and a sudden decrease in energy intake\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Therefore, in clinical practice, healthcare professionals should carry out nutritional risk screening as early as possible and focus on gastrointestinal malignancies patients with nutritional risk. Healthcare professionals should supplement patients with malnutrition with essential amino acids in a timely manner to promote protein synthesis and metabolism in the body, safeguard or promote the balance of protein metabolism, and reduce or prevent the reduction of muscle protein mass.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe combination of NRS-2002 and GLIM criteria is correlated with preoperative sarcopenia in gastrointestinal malignant tumors. Using these two criteria together can effectively increase the positive screening rate of sarcopenia. It enables clinical staff to conduct early nutritional screening and assessment, identifying the high-risk group of sarcopenia patients through BIA measurements of their BMI, ASMI, and other indices. This approach will facilitate targeted and effective preoperative nutrition and exercise management. However, this study has some limitations, including not investigating the patients' dietary status and education level, factors that may impact the study results The study employed a bioelectrical impedance analyzer (BIA) for testing, and dual-energy X-ray absorptiometry, known for its higher precision, was not utilized. Furthermore, this study was a single-center cross-sectional study with a small sample size and an incomplete collection of indicators. Further multicenter cohort studies are needed in the future.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e: The authors declare that they have no conflict of interest with materials presented here.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003eNo conflicting financial interests exist between authors.\u003c/p\u003e\n\u003cp\u003eFunding Project:\u0026nbsp;Yangzhou Innovation Capacity Building Program Key Laboratory of Basic and Clinical Transformation of Digestive Diseases/Metabolism (YZ2020159)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003eAll of the writers contributed to the manuscript\u0026apos;s conception and design, Xu Yeming and Shi Na jointly designed the idea and framework of the article and complete writing of the article. Zhao Yuqiu and Gao Shuyang were responsible for collecting and analyzing the data of all patients in this study. Hua Mingbo and Wang Tianxiu disposed by using the statistical software is responsible for the data part of the article. The final version of the article was evaluated by Wang Daorong and Sun Qiannan, and all authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBARKER L A, GOUT B S, CROWE T C. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system [J]. Int J Environ Res Public Health, 2011, 8(2): 514\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXIE H, WEI L, LIU M, et al. Preoperative computed tomography-assessed sarcopenia as a predictor of complications and long-term prognosis in patients with colorectal cancer: a systematic review and meta-analysis [J]. Langenbecks Arch Surg, 2021, 406(6): 1775\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCRUZ-JENTOFT A J, SAYER A A. Sarcopenia [J]. Lancet, 2019, 393(10191): 2636\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSIEBER C C. Malnutrition and sarcopenia [J]. Aging Clin Exp Res, 2019, 31(6): 793\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKALUŹNIAK-SZYMANOWSKA A, KRZYMIŃSKA-SIEMASZKO R, DESKUR-ŚMIELECKA E, et al. Malnutrition, Sarcopenia, and Malnutrition-Sarcopenia Syndrome in Older Adults with COPD [J]. Nutrients, 2021, 14(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDU Y P, LI L L, HE Q, et al. [Nutritional risk screening and nutrition assessment for gastrointestinal cancer patients] [J]. Zhonghua Wei Chang Wai Ke Za Zhi, 2012, 15(5): 460\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGASC\u0026oacute;N-RUIZ M, CASAS-DEZA D, TORRES-RAM\u0026oacute;N I, et al. Comparation of different malnutrition screening tools according to GLIM criteria in cancer outpatients [J]. Eur J Clin Nutr, 2022, 76(5): 698\u0026ndash;702.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWIE G A, CHO Y A, KIM S Y, et al. Prevalence and risk factors of malnutrition among cancer patients according to tumor location and stage in the National Cancer Center in Korea [J]. Nutrition, 2010, 26(3): 263\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKONDRUP J, RASMUSSEN H H, HAMBERG O, et al. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials [J]. Clin Nutr, 2003, 22(3): 321\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCEDERHOLM T, JENSEN G L, CORREIA M, et al. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community [J]. Clin Nutr, 2019, 38(1): 1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBARAZZONI R, JENSEN G L, CORREIA M, et al. Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition (GLIM) diagnosis of malnutrition [J]. Clin Nutr, 2022, 41(6): 1425\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOFLAZOGLU U, ALACACIOGLU A, VAROL U, et al. Prevalence and related factors of sarcopenia in newly diagnosed cancer patients [J]. Support Care Cancer, 2020, 28(2): 837\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLIGTHART-MELIS G C, LUIKING Y C, KAKOUROU A, et al. Frailty, Sarcopenia, and Malnutrition Frequently (Co-)occur in Hospitalized Older Adults: A Systematic Review and Meta-analysis [J]. J Am Med Dir Assoc, 2020, 21(9): 1216\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHERSBERGER L, BARGETZI L, BARGETZI A, et al. Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial [J]. Clin Nutr, 2020, 39(9): 2720\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCAO J, XU H, LI W, et al. Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer [J]. Curr Probl Cancer, 2021, 45(1): 100638.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZHANG Z, PEREIRA S L, LUO M, et al. Evaluation of Blood Biomarkers Associated with Risk of Malnutrition in Older Adults: A Systematic Review and Meta-Analysis [J]. Nutrients, 2017, 9(8).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZHANG Z, WAN Z, ZHU Y, et al. Prevalence of malnutrition comparing NRS2002, MUST, and PG-SGA with the GLIM criteria in adults with cancer: A multi-center study [J]. Nutrition, 2021, 83: 111072.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDE GROOT L M, LEE G, ACKERIE A, et al. Malnutrition Screening and Assessment in the Cancer Care Ambulatory Setting: Mortality Predictability and Validity of the Patient-Generated Subjective Global Assessment Short form (PG-SGA SF) and the GLIM Criteria [J]. Nutrients, 2020, 12(8).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZHANG X, TANG M, ZHANG Q, et al. The GLIM criteria as an effective tool for nutrition assessment and survival prediction in older adult cancer patients [J]. Clin Nutr, 2021, 40(3): 1224\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHEN Z, HONG B, HE J J, et al. Examining the impact of early enteral nutritional support on postoperative recovery in patients undergoing surgical treatment for gastrointestinal neoplasms [J]. World J Gastrointest Surg, 2023, 15(10): 2222\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSIMMANCE N, CORTINOVIS T, GREEN C, et al. Introducing novel advanced practice roles into the health workforce: Dietitians leading in gastrostomy management [J]. Nutr Diet, 2019, 76(1): 14\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCOOK F, RODRIGUEZ J M, MCCAUL L K. Malnutrition, nutrition support and dietary intervention: the role of the dietitian supporting patients with head and neck cancer [J]. Br Dent J, 2022, 233(9): 757\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRIO A, CAWADIAS E. Nutritional advice and treatment by dietitians to patients with amyotrophic lateral sclerosis/motor neurone disease: a survey of current practice in England, Wales, Northern Ireland and Canada [J]. J Hum Nutr Diet, 2007, 20(1): 3\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZHOU X, QIU F, WAN D, et al. Nutrition support for critically ill patients in China: role of the pharmacist [J]. Asia Pac J Clin Nutr, 2019, 28(2): 246\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDUERKSEN D R, LAPORTE M, JEEJEEBHOY K. Evaluation of Nutrition Status Using the Subjective Global Assessment: Malnutrition, Cachexia, and Sarcopenia [J]. Nutr Clin Pract, 2021, 36(5): 942\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCEDERHOLM T, BOSAEUS I, BARAZZONI R, et al. Diagnostic criteria for malnutrition - An ESPEN Consensus Statement [J]. Clin Nutr, 2015, 34(3): 335\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTACHIKI T, KOUDA K, DONGMEI N, et al. Muscle strength is associated with bone health independently of muscle mass in postmenopausal women: the Japanese population-based osteoporosis study [J]. J Bone Miner Metab, 2019, 37(1): 53\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSAYER A A, CRUZ-JENTOFT A. Sarcopenia definition, diagnosis and treatment: consensus is growing [J]. Age Ageing, 2022, 51(10).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDHILLON R J, HASNI S. Pathogenesis and Management of Sarcopenia [J]. Clin Geriatr Med, 2017, 33(1): 17\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGUO Z Q, YU J M, LI W, et al. Survey and analysis of the nutritional status in hospitalized patients with malignant gastric tumors and its influence on the quality of life [J]. Support Care Cancer, 2020, 28(1): 373\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"NRS-2002, GLIM criteria, Sarcopenia, Gastrointestinal malignancies, Malnutrition","lastPublishedDoi":"10.21203/rs.3.rs-4005866/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4005866/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground \u0026amp; Purpose\u003c/h2\u003e \u003cp\u003eSince the Global Leadership Initiative on Malnutrition (GLIM) criteria are based on expert consensus recommendations, more clinical practice is needed to be validated. Currently, there is a lack of Nutritional Risk Screening 2002(NRS-2002) combined with the GLIM used in the diagnosis of muscle loss and malnutrition. The aim is to investigate the correlation between NRS-2002 in combination with The GLIM criteria in patients with gastrointestinal malignancies with muscle loss (sarcopenia).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this study, we selected 210 patients with gastrointestinal malignant tumors from June 2022 to July 2023 from X Hospital. The nutritional status of the patients was assessed using the NRS-2002 and the GLIM diagnostic criteria. Patients were categorized as nutritionally normal, at nutritional risk, moderately malnourished, or severely malnourished based on the NRS-2002 in conjunction with the GLIM criteria.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe prevalence of sarcopenia differed among various nutritional status groups( \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In the moderately malnourished group and the severely malnourished group, the prevalence of sarcopenia was 36% and 83%, respectively. A positive correlation was observed between malnourishment and the presence of sarcopenia, as indicated by NRS-2002 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Results from binary logistic regression analysis revealed that gender, height, ASMI, nutritional risk, and malnutrition were all risk factors for the development of sarcopenia (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe prevalence of preoperative sarcopenia in patients with gastrointestinal malignancies is high, and there is a correlation between the NRS-2002 combined with GLIM criteria and sarcopenia in gastrointestinal malignancies.\u003c/p\u003e","manuscriptTitle":"Correlation between NRS-2002 combined with GLIM criteria and preoperative sarcopenia in patients with gastrointestinal malignancies：A prospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-06 19:23:54","doi":"10.21203/rs.3.rs-4005866/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"21767188-3712-42d6-94b0-aa7f4e0bea40","owner":[],"postedDate":"March 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-08T02:53:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-06 19:23:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4005866","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4005866","identity":"rs-4005866","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}