ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
Comparative Performance of the Patient-Generated Subjective Global Assessment, European Society for Clinical Nutrition and Metabolism Criteria, and Global Leadership Initiative on Malnutrition Criteria in Patients with Colorectal Cancer: A Multicenter Study Utilizing Bayesian Inference
Provisionally accepted
Zecheng Zhang1,2
WeiDong Jin2
Hong-Jiang Ma1
Yunlong Li1
Jun Zhu1
Yihuan Qiao1
Yongtao Du1Yu Jiang1
Jiawei Song1Jialin Wang1
Shuai Liu1Yajie Guo1
Boyu Kang1Qi Wang1Shihao Qin1
Jipeng Li1
Chun Hua Song3*
Hanping Shi4*- 1Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, China
- 2People's Liberation Army General Hospital of Central Theater Command, Wuhan, China
- 3Zhengzhou University College of Public Health, Zhengzhou, China
- 4Beijing Shijitan Hospital Capital Medical University, Beijing, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Malnutrition is a common complication among patients with colorectal cancer and has a significant impact on prognosis. However, the lack of a diagnostic gold standard for malnutrition complicates clinical nutritional intervention. This study aimed to compare the diagnostic value of the Patient-Generated Subjective Global Assessment (PG-SGA), European Society for Clinical Nutrition and Metabolism (ESPEN), and Global Leadership Initiative on Malnutrition (GLIM) criteria in identifying malnutrition in patients with colorectal cancer and to assess their ability to predict survival outcomes. Methods: This study retrospectively reviewed data from 3,182 patients diagnosed with colorectal cancer in the Investigation on Nutrition Status and Clinical Outcome of Patients with Common Cancers in China database collected between July 2013 and March 2022. Using Bayesian principles, we calculated the sensitivity and specificity of the PG-SGA, ESPEN, and GLIM criteria for diagnosing malnutrition among patients with colorectal cancer. We also analyzed the relation between nutritional diagnosis and patient survival. Results: Our findings revealed that the PG-SGA has high sensitivity [0.80, 95% credible interval (CrI): 0.61–0.94] and specificity (0.99, 95% CrI: 0.99–1.00) for diagnosing malnutrition in patients with colorectal cancer. The ESPEN criteria showed high sensitivity (0.84, 95% CrI: 0.80–0.86), whereas the GLIM criteria exhibited high specificity (0.81, 95% CrI: 0.79–0.82). All three nutritional assessment methods were identified as independent risk factors for overall survival. Statistically significant differences in survival periods existed among the GLIM-defined nutritional status subgroups. Conclusions: The PG-SGA demonstrated superior sensitivity and specificity in diagnosing malnutrition among patients with colorectal cancer. By contrast, the GLIM criteria performed better in predicting survival outcomes. Malnutrition is a significant risk factor that influences the survival of patients with colorectal cancer.
Keywords: colorectal cancer, Patient-Generated Subjective Global Assessment, European Society for Clinical Nutrition and Metabolism, global leadership initiative on malnutrition, Malnutrition, diagnosis, Bayesian
Received: 22 Jul 2025; Accepted: 19 Nov 2025.
Copyright: © 2025 Zhang, Jin, Ma, Li, Zhu, Qiao, Du, Jiang, Song, Wang, Liu, Guo, Kang, Wang, Qin, Li, Song and Shi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Chun Hua Song, sch16@zzu.edu.cn
Hanping Shi, shihp@ccmu.edu.cn
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.