Pre and Post-Operative Nutritional Intervention on the Phenotypic and Etiologic Criteria of GLIM in Gastric Cancer

Abstract

Background: Malnutrition is a frequent and serious complication among patients with gastrointestinal (GI) cancers, adversely affecting clinical outcomes such as post-operative recovery, extended duration of hospitalization (LOS), overall survival, good health and well-being. The Global Leadership Initiative on Malnutrition (GLIM) provides standardized criteria for diagnosing malnutrition, this can be enriched by handgrip strength (HGS) as a functional marker.

Aim: This research sought to assess the outcomes of structured dietary support on the phenotypic, etiological aspects of nutritional status in individuals with stomach cancer.

Methods: This prospective interventional study included 30 adult participants with upper or lower GI cancers who underwent elective surgery at a multispecialty tertiary care hospital. Nutritional assessments were conducted pre- and post-operatively using GLIM criteria, and HGS. Individualized nutritional interventions included oral nutritional counselling, oral nutrition supplements (ONS), and post-operative dietary support with total parenteral nutrition (TPN) and enteral nutrition (EN) as indicated. The impact on nutritional status, time to achieve estimated calorie and protein requirements, and length of hospital stay (LOS) were evaluated. Statistical significance of the impact of nutritional intervention was assessed using chi-square and Wilcoxon signed-rank tests, and outcomes shown as p<0.05.

Results: Pre-operatively, 80% of participants were classified as moderately malnourished and 20% as severely malnourished according to GLIM criteria. Post-operatively, all patients were categorized as moderately malnourished. Handgrip strength was below reference values in 73% pre-operatively and 80% post-operatively. However, the mean HGS demonstrated a statistically significant improvement following intervention (p=0.026). Participants receiving oral nutritional supplements and/or TPN achieved 75% of their estimated energy and protein requirements earlier compared to those maintained on oral diet alone. Severely malnourished patients had a significantly longer LOS (11 ± 0.7 days) compared to moderately malnourished patients (8.9 ± 1.2 days).

Conclusion: Use of GLIM criteria combined with HGS is effective for timely identification and monitoring of malnutrition, structured nutritional interventions based on standardized screening may reduce length of hospital stay, enhance clinical outcomes, there by optimizing overall patient prognosis.