GLIM‑Defined Malnutrition in Critically Ill Patients: A Comparison of Nutrition Risk Screening 2002 and Modified Nutrition Risk in Critically Ill as First‑Step Screening Tools

He Gao,1 Yang Yang,2 Lingyi Mi,1 Li Xu,1 Wenjing Tang,3 Ye Ji4 1Department of Clinical Nutrition, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 311100, People’s Republic of China; 2Yunnan Provincial Key Laboratory of Public Health and Biosafety & School of Public Health, Kunming Medical University, Kunming, 650500, People’s Republic of China; 3Department of Critical Care Medicine, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 311100, People’s Republic of China; 4Department of Nutrition, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, People’s Republic of ChinaCorrespondence: Ye Ji, Department of Nutrition, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Lixia District, Jinan, Shandong, 250014, People’s Republic of China, Tel +86-0531-89268090, Email [email protected]: Given the high prevalence and prognostic significance of malnutrition in critically ill patients, selecting an appropriate first-step screening tool within the Global Leadership Initiative on Malnutrition (GLIM) framework is critical. This study aimed to compare the consistency of Nutrition Risk Screening-2002 (NRS-2002) and the modified Nutrition Risk in the Critically Ill (mNUTRIC) as GLIM-based screening strategies and to assess their associations with clinical outcomes in this population.Patients and Methods: A single-center prospective observational study was conducted involving 173 critically ill patients hospitalized ≥ 4 days in an intensive care unit (ICU). Nutritional risk was screened within 24 hours of admission using NRS-2002 or mNUTRIC. Patients screening positive underwent malnutrition diagnosis using GLIM (phenotypic: weight loss or low body mass index; etiologic: reduced intake or inflammation/disease burden). The consistency between the two screening strategies was assessed, and their associations with clinical outcomes were analyzed. The effect of nutritional treatment in patients with malnutrition has been explored in a subgroup analysis.Results: Malnutrition prevalence was 18.5% (32/173) using NRS-2002+GLIM and 13.9% (24/173) using mNUTRIC+GLIM. The two screening strategies showed substantial agreement (κ = 0.79, p < 0.001). Malnutrition diagnosed by mNUTRIC+GLIM demonstrated stronger associations with adverse outcomes. These included significantly greater proportions of ICU days under sedation (b = 0.20, 95% confidence interval (CI): 0.08– 0.33) and vasopressor (b = 0.21, 95% CI: 0.06– 0.37), as well as a higher risk of adverse discharge status (odds ratio = 6.24, 95% CI: 2.20– 18.38). In the exploratory subgroup analysis with a limited sample size, patients identified as malnutrition by mNUTRIC+GLIM showed lower in‑hospital mortality following nutrition treatment. (0% vs. 66.7%; p < 0.05).Conclusion: Substantial consistency was observed between NRS-2002+GLIM and mNUTRIC+GLIM, and both were significantly associated with unfavorable clinical outcomes. Notably, mNUTRIC+GLIM showed stronger prognostic value, indicating its potential as a more appropriate screening strategy in critically ill patients.Keywords: malnutrition, nutrition assessment, intensive care units, nutrition risk