Malnutrition by GLIM and its overlap with sarcopenic obesity in older adults with elevated body mass index: A retrospective cross-sectional study

Abstract

Background: This study examined the overlap of sarcopenic obesity and malnutrition using the 2025 Global Leadership Initiative on Malnutrition (GLIM) criteria and their impact on geriatric outcomes. Methods: In this cross-sectional study, 264 geriatric outpatients (body mass index [BMI] ≥ 25 kg/m²) were assessed. Sarcopenia and sarcopenic obesity were diagnosed using the European Working Group on Sarcopenia in Older People 2 and the European Society for Clinical Nutrition and Metabolism (ESPEN) and The European Association for the Study of Obesity (EASO) consensus definitions. Malnutrition was diagnosed using the GLIM criteria, applied regardless of their Mini Nutritional Assessment Short Form (MNA-SF) results to detect overlooked cases. Outcomes included frailty, disability, incontinence, and falls. Results: Sarcopenic obesity prevalence was 15.9%, and GLIM-defined malnutrition was 30.3%. More than half (58.8%) of patients with GLIM-defined malnutrition were not at risk per the MNA-SF. In patients without MNA-defined malnutrition risk, GLIM malnutrition was more frequent in patients with sarcopenic obesity than without (42.9% vs 18.7%, P = 0.002). The co-occurrence of sarcopenic obesity and GLIM-defined malnutrition showed a synergistic effect on frailty (odds ratio [OR] = 5.11) and Instrumental Activities of Daily Living disability (OR = 3.74), independent of age and comorbidity. Conclusion: Standard tools like the MNA-SF markedly underdetect malnutrition in older adults with BMI ≥ 25 kg/m2, including those with sarcopenic obesity. Because GLIM's two-step process depends on initial screening, many patients at risk may not proceed to full GLIM assessment. Our findings demonstrate that GLIM, supported by body composition analysis, more accurately identifies malnutrition and highlights the added harm of coexisting sarcopenic obesity.