Nonlinear association between the triglyceride-cholesterol-body weight index and GLIM-defined hospital-acquired malnutrition among Chinese hospitalized adults: a multicenter prospective cohort study.

BACKGROUND

Hospital-acquired malnutrition (HAM) is prevalent and harmful. Global Leadership Initiative on Malnutrition (GLIM) criteria lack lipid metabolism information, impeding admission risk identification. TCBI integrates lipids and energy reserve, but its predictive utility for HAM remains unclear.

METHODS

This multicenter prospective study (June-September 2014, 34 tertiary hospitals in mainland China) consecutively enrolled 3,382 non-critically ill adults without malnutrition at admission and with hospital stays of 7-30 days. TCBI was calculated as triglyceride (mg/dL) × total cholesterol (mg/dL) × body weight (kg) / 1000 and natural log-transformed (TCBI-LN) due to skewness. The primary outcome was HAM diagnosed at discharge by adapted GLIM framework. Multivariable logistic regression, restricted cubic splines, and subgroup analyses with interaction testing were used to assess the independent association and dose‑response relationship between TCBI-LN and HAM.

RESULTS

Among 3,382 patients without admission malnutrition, 21.6% developed HAM at discharge. After full adjustment, each one-unit increase in log-transformed TCBI was independently associated with a 14.7% lower HAM risk (OR = 0.853), and restricted cubic spline analysis revealed a significant nonlinear dose-response relationship with two inflection points (TCBI-LN 7.27 and 8.50), suggesting three exploratory RCS-derived strata (HAM incidence: 26.1%, 17.0%, and 18.3%, respectively). The high-TCBI high-risk group had a small sample size and wide confidence intervals; findings are hypothesis‑generating only and require validation in larger cohorts enriched for high TCBI. Subgroup analyses further showed that the protective effect was more pronounced in surgical patients and those without hypertension, with significant effect modifications by hospital department and hypertension history.

CONCLUSION

Admission TCBI is independently associated with the risk of HAM, exhibiting a significant nonlinear dose-response relationship. These findings suggest that TCBI may serve as a complementary metabolic-anthropometric marker for risk stratification for identifying patients at elevated risk for HAM at admission, warranting further prospective validation and interventional studies to confirm its clinical utility.