Purpose <p>To assess the predictive and concurrent validity of Global Leadership Initiative on Malnutrition (GLIM) criteria using prognostic nutritional index (PNI), advanced lung cancer inflammation index (ALI), and geriatric nutritional risk index (GNRI) as alternative screening tools (vs. NRS-2002-based GLIM) for malnutrition in cancer patients.</p> Methods <p>A total of 11,693 patients with cancer were included in the retrospective cohort study. The Cox/logistic regression analyzed associations of GLIM-defined malnutrition with survival, short-term outcomes, and healthcare burden. Agreement analyses of each nutritional risk-screening tool were performed using kappa statistics and Harrell’s concordance-index.</p> Results <p>Under the GLIM framework, all nutrition-related indicators used as nutritional risk screening tools were effective for identifying patients with poor prognosis. Logistic regression showed that the nutrition-related indicator-based GLIM criteria were useful for predicting short-term outcomes, length of stay, and hospital expenses in patients with cancer. Of different GLIM measures, the ALI-based GLIM had the best prognostic discriminative ability, followed by the PNI-based and GNRI-based GLIM, with NRS-2002 ranking the lowest. The prevalence of malnutrition determined using the GLIM criteria based on the NRS-2002, ALI, GNRI, and PNI screening was 29.4%, 25.9%, 26.9%, and 23.3%, respectively. The agreement of the ALI-based, GNRI-based, and PNI-based GLIM with the NRS-2002-based GLIM was 0.550, 0.600, and 0.496, respectively.</p> Conclusions <p>Nutritional indicators can serve as an effective initial step in the GLIM criteria for nutritional risk assessment in patients with cancer, with ALI being the optimal nutritional risk screening tool. Using nutritional indicator-based GLIM criteria is effective for predicting short-term outcomes, medical burden, and long-term prognosis in patients with cancer.</p>