PROGNOSTIC IMPACT OF GLIM-DEFINED MALNUTRITION IN PATIENTS WITH RESECTABLE GASTRIC CANCER

Introduction Gastric cancer remains among the leading causes of cancer-related mortality worldwide. Malnutrition is highly prevalent in oncology patients and is associated with poorer clinical and prognostic outcomes. The Global Leadership Initiative on Malnutrition (GLIM) proposes standardized criteria for the diagnosis of malnutrition, integrating phenotypic and etiologic parameters and allowing a comprehensive assessment of nutritional status. However, the prognostic impact of GLIM-defined malnutrition in patients with resectable gastric cancer remains insufficiently explored. Objective To evaluate the prevalence of malnutrition according to GLIM criteria and its association with body composition and overall survival in patients with resectable gastric cancer. Methods This retrospective study included patients with gastric cancer who underwent surgical treatment at the Hospital de Clínicas of the University of Campinas (UNICAMP) between 2010 and 2018 and was approved by the Institutional Research Ethics Committee (CAAE: 90784618.1.0000.5404). Demographic and clinical data were collected, along with computed tomography images for body composition assessment. Malnutrition was diagnosed according to GLIM criteria, considering both phenotypic and etiologic components, with systemic inflammation assessed by the neutrophil-to-lymphocyte ratio (NLR). The primary outcome was overall survival. Results A total of 272 patients were included, with a median age of 62 years (IQR: 55–69) and a predominance of males (68%). Malnutrition according to GLIM criteria was identified in 69% of patients at the time of cancer diagnosis. Among phenotypic criteria, 72% presented weight loss, 28% low body mass index, and 26% low muscularity. Regarding etiologic criteria, 65% had reduced food intake and 43% showed systemic inflammation assessed by NLR. Malnourished patients had lower skeletal muscle area (129 vs. 142 cm²; p < 0.001) and skeletal muscle index (48.1 vs. 53.2 cm²/m²; p < 0.001), as well as a higher prevalence of low muscularity (31% vs. 15%; p = 0.006). Myosteatosis was observed in 66% of the sample, with no significant difference between groups. Visceral obesity was more prevalent among non-malnourished patients (46% vs. 26%; p < 0.001), whereas malnourished patients showed lower visceral and subcutaneous fat areas and indices (p < 0.05). In overall survival analysis, malnourished patients had a worse prognosis (HR = 2.61; 95% CI: 1.69–4.04; p < 0.001). A progressive reduction in survival was observed according to malnutrition severity, with increased mortality risk in patients with moderate malnutrition (HR = 2.12; 95% CI: 1.19–3.79; p = 0.01) and severe malnutrition (HR = 2.81; 95% CI: 1.80–4.39; p < 0.001). In multivariate analysis, malnutrition remained independently associated with a higher risk of mortality (HR = 1.77; 95% CI: 1.07–2.95; p = 0.027). Conclusion Malnutrition defined by GLIM criteria is highly prevalent in patients with resectable gastric cancer, is associated with significant alterations in body composition, and represents an independent prognostic factor for reduced overall survival. Stratification of malnutrition severity using GLIM criteria allows the identification of subgroups with progressively higher mortality risk, reinforcing its clinical applicability as a standardized and relevant tool for nutritional assessment and prognostic stratification in oncologic care.