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. 2019 Feb;38(1):1-9.
doi: 10.1016/j.clnu.2018.08.002. Epub 2018 Sep 3.

GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community

T Cederholm  1 , G L Jensen  2 , M I T D Correia  3 , M C Gonzalez  4 , R Fukushima  5 , T Higashiguchi  6 , G Baptista  7 , R Barazzoni  8 , R Blaauw  9 , A Coats  10 , A Crivelli  11 , D C Evans  12 , L Gramlich  13 , V Fuchs-Tarlovsky  14 , H Keller  15 , L Llido  16 , A Malone  17 , K M Mogensen  18 , J E Morley  19 , M Muscaritoli  20 , I Nyulasi  21 , M Pirlich  22 , V Pisprasert  23 , M A E de van der Schueren  24 , S Siltharm  25 , P Singer  26 , K Tappenden  27 , N Velasco  28 , D Waitzberg  29 , P Yamwong  30 , J Yu  31 , A Van Gossum  32 , C Compher  33 ; GLIM Core Leadership Committee; GLIM Working Group
Collaborators, Affiliations
Free article

GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community

T Cederholm et al. Clin Nutr. 2019 Feb.
Free article

Abstract

Rationale: This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings.

Methods: In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. GLIM appointed a core leadership committee and a supporting working group with representatives bringing additional global diversity and expertise. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications.

Results: A two-step approach for the malnutrition diagnosis was selected, i.e., first screening to identify "at risk" status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among the GLIM core and supporting working group members. The top five ranked criteria included three phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and two etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least one phenotypic criterion and one etiologic criterion should be present. Phenotypic metrics for grading severity as Stage 1 (moderate) and Stage 2 (severe) malnutrition are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories.

Conclusion: A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure further collaboration and endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The diagnostic construct should be re-considered every 3-5 years.

Keywords: Assessment; Diagnosis; Malnutrition; Screening.

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