{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:53:05Z","timestamp":1791175985306,"version":"4.1.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Preoperative malnutrition may reflect reduced physiological reserve and increased vulnerability to postoperative delirium (POD) in older surgical patients. However, evidence based on standardized diagnostic criteria remains limited. This study aimed to evaluate the association between Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition and POD among older patients undergoing surgery under general anesthesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational cohort study included consecutive patients aged \u226565\u202fyears who underwent elective or emergency surgery under general anesthesia between January 2022 and December 2025. Preoperative malnutrition was retrospectively classified according to the GLIM framework using available phenotypic and etiologic criteria. Patients with and without GLIM-defined malnutrition were matched 1:2 using propensity score matching. POD documented during hospitalization was identified from Confusion Assessment Method assessments, Confusion Assessment Method for the Intensive Care Unit assessments, or explicit physician diagnoses. The association between GLIM-defined malnutrition and POD was examined using conditional logistic regression stratified by matched set. Subgroup and sensitivity analyses were also performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The matched cohort comprised 495 patients, including 165 with GLIM-defined malnutrition and 330 without malnutrition. All propensity score covariates achieved acceptable post-matching balance, with absolute standardized mean differences &amp;lt;0.10. POD occurred in 42 patients with malnutrition (25.5%) and 37 patients without malnutrition (11.2%;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). GLIM-defined malnutrition was associated with higher odds of POD after multivariable adjustment (adjusted odds ratio, 2.36; 95% confidence interval, 1.36\u20134.10;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.002). No significant interactions were identified across age, surgical category, American Society of Anesthesiologists class, or immediate postoperative intensive care unit admission subgroups. Comparable associations were observed in the unmatched cohort, alternative matched analyses, fixed observation windows, restricted-length-of-stay cohorts, and analyses using alternative POD definitions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>GLIM-defined malnutrition was associated with higher odds of POD during hospitalization in older patients undergoing surgery under general anesthesia. GLIM-based nutritional assessment may provide clinically useful information for perioperative delirium risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1878893","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:33:57Z","timestamp":1791174837000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative nutritional status defined by GLIM criteria and postoperative delirium in older patients receiving general anesthesia"],"prefix":"10.3389","volume":"13","author":[{"given":"Yuan","family":"Tian","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Shenzhen University General Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Rui","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Neurology, People\u2019s Hospital of Longhua","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian-Feng","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shenzhen University General Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia-Teng","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shenzhen University General Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun-Fei","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shenzhen University General Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan-Yuan","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shenzhen University General Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"8418","DOI":"10.3390\/jcm14238418","article-title":"From bench to bedside: new Frontiers in understanding and treating postoperative delirium","volume":"14","author":"Meza Monge","year":"2025","journal-title":"J Clin Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e68492","DOI":"10.7759\/cureus.68492","article-title":"Postoperative delirium and neurocognitive disorders: a comprehensive review of pathophysiology, risk factors, and management strategies","volume":"16","author":"Paunikar","year":"2024","journal-title":"Cureus"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1759910","DOI":"10.3389\/fnins.2026.1759910","article-title":"Recent advances in postoperative delirium in elderly patients: pathophysiological mechanisms, risk prediction, and therapeutic strategies","volume":"20","author":"Ding","year":"2026","journal-title":"Front Neurosci"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e2519467","DOI":"10.1001\/jamanetworkopen.2025.19467","article-title":"Postoperative delirium in older adults undergoing noncardiac surgery","volume":"8","author":"Lander","year":"2025","journal-title":"JAMA Netw Open"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.neuroscience.2025.06.068","article-title":"Pathomechanism of postoperative delirium: systemic inflammatory response and neuroinflammation following anesthesia\/surgery","volume":"581","author":"Li","year":"2025","journal-title":"Neuroscience"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"19","DOI":"10.12703\/r\/12-19","article-title":"Recent advances in predicting, preventing, and managing postoperative delirium","volume":"12","author":"Qureshi","year":"2023","journal-title":"Fac Rev"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"11314","DOI":"10.3390\/ijms262311314","article-title":"Post-operative delirium in elderly patients: a narrative review","volume":"26","author":"Smirnov","year":"2025","journal-title":"Int J Mol Sci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1700911","DOI":"10.3389\/fneur.2025.1700911","article-title":"Anesthesia-related factors in the pathogenesis of postoperative cognitive dysfunction: a mechanistic perspective","volume":"16","author":"Qin","year":"2025","journal-title":"Front Neurol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e32991","DOI":"10.1097\/md.0000000000032991","article-title":"Postoperative delirium, neuroinflammation, and influencing factors of postoperative delirium: a review","volume":"102","author":"Xiao","year":"2023","journal-title":"Medicine (Baltimore)"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"45","DOI":"10.4235\/agmr.24.0129","article-title":"Perioperative risk factors for postoperative delirium in non-dementia older patients after non-cardiac surgery and anesthesia: a prospective study","volume":"29","author":"Wattanaboot","year":"2025","journal-title":"Ann Geriatr Med Res"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2764","DOI":"10.3390\/nu13082764","article-title":"Malnutrition in older adults\u2014recent advances and remaining challenges","volume":"13","author":"Norman","year":"2021","journal-title":"Nutrients"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"910","DOI":"10.3390\/nu14040910","article-title":"Malnutrition in hospitalized old patients: screening and diagnosis, clinical outcomes, and management","volume":"14","author":"Bellanti","year":"2022","journal-title":"Nutrients"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1186\/s12877-024-05566-1","article-title":"Risk of sarcopenia, frailty and malnutrition as predictors of postoperative delirium in surgery","volume":"24","author":"Moellmann","year":"2024","journal-title":"BMC Geriatr"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.clnu.2025.03.018","article-title":"The GLIM consensus approach to diagnosis of malnutrition: a 5-year update","volume":"49","author":"Cederholm","year":"2025","journal-title":"Clin Nutr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1673973","DOI":"10.3389\/fnut.2025.1673973","article-title":"The predictive value comparison of the different nutritional assessment tools for postoperative delirium in elderly patients after non-cardiac surgery","volume":"12","author":"Dang","year":"2025","journal-title":"Front Nutr"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1186\/s12871-024-02874-2","article-title":"Association between the geriatric nutritional risk index and postoperative delirium in gastric surgery patients: an analysis of the MIMIC-IV database","volume":"24","author":"Chen","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1007\/s00586-024-08142-8","article-title":"Preoperative geriatric nutritional risk index is useful factor for predicting postoperative delirium among elderly patients with degenerative lumbar diseases","volume":"33","author":"Chen","year":"2024","journal-title":"Eur Spine J"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1386797","DOI":"10.3389\/fmed.2024.1386797","article-title":"Effects of general and spinal anesthesia on postoperative rehabilitation in older adults after lower limb surgery: a retrospective cohort study","volume":"11","author":"Li","year":"2024","journal-title":"Front Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1002\/jcsm.12383","article-title":"GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community","volume":"10","author":"Cederholm","year":"2019","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1002\/jpen.2756","article-title":"GLIM consensus approach to diagnosis of malnutrition: a 5-year update","volume":"49","author":"Jensen","year":"2025","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1596193","DOI":"10.3389\/fnut.2025.1596193","article-title":"Consistency of Mini-nutritional assessment short form and nutritional risk screening 2002 in nutritional evaluation of diabetic foot patients","volume":"12","author":"Ran","year":"2025","journal-title":"Front Nutr"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/s13741-025-00582-0","article-title":"Geriatric nutritional risk index and prognostic nutritional index improves predictive value of postoperative mortality: a large-scale retrospective cohort study","volume":"14","author":"Liu","year":"2025","journal-title":"Perioper Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s13741-023-00345-9","article-title":"The impact of preoperative malnutrition on postoperative delirium: a systematic review and meta-analysis","volume":"12","author":"Dong","year":"2023","journal-title":"Perioper Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1016\/j.clnu.2023.11.026","article-title":"Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: a modified Delphi approach","volume":"43","author":"Cederholm","year":"2024","journal-title":"Clin Nutr"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"225","DOI":"10.3390\/nu13010225","article-title":"Comparison of nutrition risk screening 2002 and subjective global assessment form as short nutrition assessment tools in older hospitalized adults","volume":"13","author":"Kroc","year":"2021","journal-title":"Nutrients"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"3491","DOI":"10.1007\/s10072-021-05339-3","article-title":"Why is delirium more frequent in the elderly?","volume":"42","author":"Bugiani","year":"2021","journal-title":"Neurol Sci"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2381","DOI":"10.1097\/cm9.0000000000003735","article-title":"Aging and perioperative brain health: mechanisms, management, and future","volume":"138","author":"Cong","year":"2025","journal-title":"Chin Med J"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1186\/s12987-024-00599-5","article-title":"Role of the transcription factor NRF2 in maintaining the integrity of the blood-brain barrier","volume":"21","author":"Cazalla","year":"2024","journal-title":"Fluids Barriers CNS"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"386","DOI":"10.3390\/jcm14020386","article-title":"The crucial role of the blood-brain barrier in neurodegenerative diseases: mechanisms of disruption and therapeutic implications","volume":"14","author":"Kim","year":"2025","journal-title":"J Clin Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1435429","DOI":"10.3389\/fnut.2025.1435429","article-title":"Frailty and GLIM-defined malnutrition contribute to poor clinical outcomes in older adult inpatients in the general surgery department","volume":"12","author":"Liu","year":"2025","journal-title":"Front Nutr"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1482150","DOI":"10.3389\/fnut.2025.1482150","article-title":"Comparative analysis of four nutritional scores in predicting delirium in ICU patients","volume":"12","author":"Yu","year":"2025","journal-title":"Front Nutr"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1080\/07853890.2023.2187875","article-title":"Daytime variation in non-cardiac surgery impacts the recovery after general anesthesia","volume":"55","author":"Xu","year":"2023","journal-title":"Ann Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1543421","DOI":"10.3389\/fnins.2025.1543421","article-title":"The impact of postoperative pain interventions on circadian rhythm disruptions: mechanisms and clinical implications","volume":"19","author":"Ma","year":"2025","journal-title":"Front Neurosci"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1275201","DOI":"10.3389\/fnins.2023.1275201","article-title":"Perioperative cognition in association with malnutrition and frailty: a narrative review","volume":"17","author":"Dammavalam","year":"2023","journal-title":"Front Neurosci"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1213\/ane.0000000000004469","article-title":"Prevention of early postoperative decline: a randomized, controlled feasibility trial of perioperative cognitive training","volume":"130","author":"O'Gara","year":"2020","journal-title":"Anesth Analg"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"926","DOI":"10.4103\/ija.ija_377_25","article-title":"Incidence and perioperative risk factors for postoperative delirium in the intensive care unit among adult surgical patients - retrospective cohort study","volume":"69","author":"Kamata","year":"2025","journal-title":"Indian J Anaesth"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"CD012317","DOI":"10.1002\/14651858.CD012317.pub2","article-title":"Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery","volume":"2018","author":"Miller","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"112018","DOI":"10.1016\/j.jclinane.2025.112018","article-title":"Incidence and risk factors of postoperative delirium after surgery in the spanish population: the DELPO study","volume":"107","author":"de la Varga-Mart\u00ednez","year":"2025","journal-title":"J Clin Anesth"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e24967","DOI":"10.1016\/j.heliyon.2024.e24967","article-title":"Risk factors of postoperative delirium following spine surgery: a meta-analysis of 50 cohort studies with 1.1 million participants","volume":"10","author":"Luo","year":"2024","journal-title":"Heliyon"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1097\/eja.0000000000001876","article-title":"Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients","volume":"41","author":"Aldecoa","year":"2024","journal-title":"Eur J Anaesthesiol"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1878893\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:34:03Z","timestamp":1791174843000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1878893\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,5]]},"references-count":40,"alternative-id":["10.3389\/fnut.2026.1878893"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1878893","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,5]]},"article-number":"1878893"}}