Clinical Nutrition · Sep 26, 2025

GLIM Criteria-defined malnutrition and short-term mortality in acute care hospitals: A nationwide claims-based historical cohort study

By Shimizu A, Tomata Y, Hasegawa Y et al.

BACKGROUND & AIMS: Malnutrition is associated with adverse clinical outcomes in hospitalized patients. The Global Leadership Initiative on Malnutrition (GLIM) criteria have been proposed as an internationally standardized nutritional assessment; however, their adoption and prognostic value in real-world hospital settings remain underexplored. In June 2024, Japan's Diagnosis Procedure Combination (DPC) reimbursement system began encouraging routine GLIM-based assessments, creating a quasi-natural experiment to evaluate its implementation and prognostic utility at scale. This study evaluated the association between GLIM-defined malnutrition and mortality in routine clinical practice under Japan's DPC system. METHODS: This retrospective cohort study utilized Japan's nationwide DPC database provided by JMDC, Inc., which includes patient data from approximately 1,700 hospitals. Adult patients (age ≥ 18 y) hospitalized between June 2024 and August 2024 were included. The primary outcomes were the 30-d and 60-d mortality rates. Cox proportional hazards models were used to estimate the multivariate-adjusted hazard ratios (HR) and 95 % confidence intervals (CI) for mortality. RESULTS: Of the 174,439 eligible patients, 3.9 % were classified as malnourished, 47.9 % as nonmalnourished, and 48.2 % had GLIM criteria assessments that were not performed or had missing data. GLIM-defined malnutrition was significantly associated with a higher risk of 30-d mortality (HR = 1.46; 95 % CI: 1.33-1.60) and 60-d mortality (HR = 1.46; 95 % CI: 1.34-1.59). Additionally, patients with incomplete GLIM assessment data had a higher mortality risk than those without malnutrition. Among the patients with completed GLIM criteria assessments (n = 90,321), the most frequently missing GLIM sub-items were "reduced food intake/absorption" (2.7 %) and "low muscle mass" (2.6 %). CONCLUSIONS: In this nationwide cohort of 174,439 hospitalized adult patients, both GLIM-defined malnutrition and incomplete or missing GLIM assessment data were associated with substantially higher 30-d and 60-d mortality rates, highlighting the potential utility of the criteria for mortality risk stratification in routine clinical practice and identifying underassessment as a pragmatic risk indicator.

doi.org/10.1016/j.clnu.2025.09.012Open accessPubMed 41045840Biomarkers