## 3 Results
### Evaluation of Methods to Detect Malnutrition and Obesity  
Compared with DXA, low HGS had higher sensitivity in detecting malnutrition (63%) than low BMI, defined by GLIM criteria (42%), BMI \(<\) 18.5 (8%), and NRS2002 (0%) (Table 4). Abdominal obesity had the highest sensitivity in detecting a very high level of FMI, but had lower specificity than the BMI categories \(\geq\)28 and \(\geq\)30 (67%) (Table 5). \begin{table}
\begin{tabular}{c c c c c c c} \hline \hline  & **Malnourished \({}^{a}\)** & **Well-Nourished** & **Sensitivity** & **Specificity** & **PPV** & **NPV** \\ \hline  & (\(n\)) & (\(n\)) & (\%) & (\%) & (\%) & (\%) \\ BMI \(<\)18.5 \({}^{b}\) & & & 8 & 100 & 100 & 82 \\ Yes (\(n\)) & 1 & 0 & & & & \\ No (\(n\)) & 11 & 51 & & & & \\ BMI \(<\)20, or \(<\)22 if & & & 42 & 100 & 100 & 88 \\ \(\geq\)70 y \({}^{c}\) & & & & & & \\ Yes (\(n\)) & 5 & 0 & & & & \\ No (\(n\)) & 7 & 51 & & & & \\ At nutritional risk \({}^{d}\) & & & 0 & 100 & 0 & 81 \\ Yes (\(n\)) & 0 & 0 & & & & \\ No (\(n\)) & 12 & 51 & & & & \\ Low HGS & & & 63 & 73 & 28 & 92 \\ Yes (\(n\)) & 5 & 13 & & & & \\ No (\(n\)) & 3 & 36 & & & & \\ \hline \hline \end{tabular}  
* PPV: positive predictive value. NPV: negative predictive value. \({}^{d}\) Malnourished patients defined as fat-free mass index (FFMI; kg/m\({}^{2}\)) \(<\) 16.7 (M), \(<\)14.6 (F), measured by DXA. \({}^{b}\) kg/m\({}^{2}\). \({}^{c}\) Defined as low BMI by the Global Leadership Initiative on Malnutrition. \({}^{d}\) NRS2002: Nutritional Risk Screening 2002 \(\geq\)3. Low handgrip strength (HGS) \(<\)5 pct in age- and sex-matched healthy adults [33].  
\end{table} 
Table 4: Sensitivity, specificity, positive predictive value, and negative predictive value of malnutrition identified by BMI, Nutritional Risk Screening 2002 (NRS2002), and handgrip strength (HGS); \(N=\) 63. \begin{table}
\begin{tabular}{c c c c c c} \hline \hline
**Variable** & **Underweight** & **Normal Weight** & **Overweight** & **Obese** & **Total** \\ \hline  & **BMI \(<\) 18.5 \({}^{a}\)** & **BMI 18.5–24.9 \({}^{a}\)** & **BMI 25–29.9 \({}^{a}\)** & **BMI \(\geq\) 30 \({}^{a}\)** & \\ \hline  & \(n\) (\%) & \(n\) (\%) & \(n\) (\%) & \(n\) (\%) & \(n\) (\%) \\ Low FMI \({}^{a}\) & - & - & - & - & - \\ Normal FMI \({}^{a}\) & 1 (2) & 11 (17) & - & - & 12 (19) \\ High FMI \({}^{a}\) & - & 11 (17) & 7 (11) & - & 18 (29) \\ Very high FMI \({}^{a}\) & - & 1 (2) & 7 (11) & 25 (40) & 33 (52) \\ \hline Low FFMI \({}^{a}\) & 1 (2) & 11 (17) & - & - & 12 (19) \\ Normal FFMI \({}^{a}\) & - & 10 (16) & 12 (19) & 7 (11) & 29 (46) \\ High FFMI \({}^{a}\) & - & 2 (3) & 2 (3) & 8 (13) & 12 (19) \\ Very high FFMI \({}^{a}\) & - & - & - & 10 (16) & 10 (16) \\ \hline Total \(n\) (\%) & 1 (2) & 23 (36) & 14 (22) & 25 (40) & 63 (100) \\ \hline \hline \end{tabular}  
* \({}^{a}\) kg/m\({}^{2}\). Body composition measured by dual-energy X-ray absorptiometry. Low, normal, high, and very high fat mass index (FMI; kg/m\({}^{2}\)), and fat-free mass index (FFMI; kg/m\({}^{2}\)) defined as levels reported in a healthy European population with body mass index (BMI) of \(<\)18.5 kg/m\({}^{2}\), 18.5–24.9 kg/m\({}^{2}\), 25–29.9 kg/m\({}^{2}\), and \(\geq\)30 kg/m\({}^{2}\), respectively [31]. Low FMI: \(<\)18.0 (M), \(<\)3.9 (F). Normal FMI: 18.5–2.3 (M), 3.9–8.2 (F). High FMI: 5.2–8.3 (M), 82–11.8 (F). Very high FMI: \(\geq\)8.3 (M), \(\geq\)11.8 (F). Low FFM: \(<\)16.7 (M), \(<\)14.6 (F). Normal FFMI: 16.7–19.8 (M), 14.6–16.8 (F). High FFMI: 19.8–21.7 (M), 16.8–18.2 (F). Very high FFMI \(\geq\)21.7 (M), \(\geq\)18.2 (F).  
\end{table} 
Table 3: Distribution of low, normal, high, and very high levels of fat mass index and fat-free mass index within the BMI categories; \(N=\) 63. Only one patient in the entire study population had low BMI, but interestingly, one-fifth of the patients had a low FFMI and one in seven had RC. In contrast to other studies, none of our patients had experienced involuntary weight loss within the last 6 months [44].