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

doi:10.1002/jcsm.12383

. 2019 Feb;10(1):207-217.

doi: 10.1002/jcsm.12383.

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

T Cederholm^{1

2}, G L Jensen³, M I T D Correia⁴, M C Gonzalez⁵, R Fukushima⁶, T Higashiguchi⁷, G Baptista⁸, R Barazzoni⁹, R Blaauw¹⁰, A J S Coats^{11

12}, A N Crivelli¹³, D C Evans¹⁴, L Gramlich¹⁵, V Fuchs-Tarlovsky¹⁶, H Keller¹⁷, L Llido¹⁸, A Malone^{19

20}, K M Mogensen²¹, J E Morley²², M Muscaritoli²³, I Nyulasi²⁴, M Pirlich²⁵, V Pisprasert²⁶, M A E de van der Schueren^{27

28}, S Siltharm²⁹, P Singer^{30

31}, K Tappenden³², N Velasco³³, D Waitzberg³⁴, P Yamwong³⁵, J Yu³⁶, A Van Gossum³⁷, C Compher³⁸; GLIM Core Leadership Committee, GLIM Working Group

Affiliations

¹ Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
² Theme Aging, Karolinska University Hospital, Stockholm, Sweden.
³ Dean's Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
⁴ Department of Surgery, Universidade Federal de Minas Gerais, Belo Horizante, Brazil.
⁵ Post-graduate Program in Health and Behavior, Catholic University of Pelotas, RS, Brazil.
⁶ Department of Medicine, Department of Surgery, Tokyo University School of Medicine, Tokyo, Japan.
⁷ Department of Surgery and Palliative Medicine, Fujita Health University School of Medicine, Dengakugakubo, Kutsukake, Toyoake-City, Aichi, Japan.
⁸ Medicine Faculty Central University of Venezuela, Universitary Hospital of Caracas, Chief Nutritional Support Unit Hospital Universitary/Academic of Caracas, University Central of Venezuela, Venezuela.
⁹ Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
¹⁰ Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
¹¹ Monash University, Australia.
¹² University of Warwick, Warwick, UK.
¹³ Unit of Nutrition Support and Malabsorptive Diseases, Hospital HIGA San Martín, Buenos Aires, Argentina.
¹⁴ Department of Surgery, The Ohio State University, Columbus, OH, USA.
¹⁵ University of Alberta, Edmonton, Alberta, Canada.
¹⁶ Clinical Nutrition Department, Hospital General de México, Mexico City, Mexico.
¹⁷ Schlegel-UW Research Institute for Aging and Department of Kinesiology, University of Waterloo, Ontario, Canada.
¹⁸ Clinical Nutrition Service, St. Luke's Medical Center-Quezon City, Metro-Manila, Quezon City, Philippines.
¹⁹ The American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA.
²⁰ Mt. Carmel West Hospital, Columbus, OH, USA.
²¹ Department of Nutrition, Brigham and Women's Hospital, Boston, MA, USA.
²² Division of Geriatrics, Saint Louis University Hospital, St. Louis, MO, USA.
²³ Department of Clinical Medicine, Sapienza University of Rome, Italy.
²⁴ Department of Nutrition, Alfred Health and Professor of Dietetic Practice, Department of Rehabilitation, Nutrition and Sport, Latrobe University; Department of Medicine, Central Clinical School, Monash University, Australia.
²⁵ Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology and Clinical Nutrition, Berlin, Germany.
²⁶ Department of Medicine, Khon Kaen University College of Medicine, Khon Kaen, Thailand.
²⁷ Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
²⁸ Faculty of Health and Social Studies, Department of Nutrition and Dietetics, HAN University of Applied Sciences, Nijmegen, the Netherlands.
²⁹ Ministry of Science and Technology, Bangkok, Thailand.
³⁰ Department of General Intensive Care, Rabin Medical Center, Petah Tikva, Israel.
³¹ Sackler School of Medicine, Tel Aviv University, Israel.
³² Department of Kinesiology and Nutrition, University of Illinois-Chicago, Chicago, IL, USA.
³³ Department of Nutrition, Diabetes and Metabolismo, School of Medicine, Pontificia Universidad Catolica de Chile, Chile.
³⁴ Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil.
³⁵ Department of Medicine, Siriaj Hospital, Bangkok, Thailand.
³⁶ GI Surgery and Nutrition Metabolic Division, Department of General Surgery, Peking Union Medical College Hospital, Beijing, China.
³⁷ Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium.
³⁸ Biobehavioral Health Sciences Department and Nutrition Programs, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.

PMID: 30920778
PMCID: PMC6438340
DOI: 10.1002/jcsm.12383

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

T Cederholm et al. J Cachexia Sarcopenia Muscle. 2019 Feb.

. 2019 Feb;10(1):207-217.

doi: 10.1002/jcsm.12383.

Authors

Affiliations

¹ Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
² Theme Aging, Karolinska University Hospital, Stockholm, Sweden.
³ Dean's Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
⁴ Department of Surgery, Universidade Federal de Minas Gerais, Belo Horizante, Brazil.
⁵ Post-graduate Program in Health and Behavior, Catholic University of Pelotas, RS, Brazil.
⁶ Department of Medicine, Department of Surgery, Tokyo University School of Medicine, Tokyo, Japan.
⁷ Department of Surgery and Palliative Medicine, Fujita Health University School of Medicine, Dengakugakubo, Kutsukake, Toyoake-City, Aichi, Japan.
⁸ Medicine Faculty Central University of Venezuela, Universitary Hospital of Caracas, Chief Nutritional Support Unit Hospital Universitary/Academic of Caracas, University Central of Venezuela, Venezuela.
⁹ Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
¹⁰ Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
¹¹ Monash University, Australia.
¹² University of Warwick, Warwick, UK.
¹³ Unit of Nutrition Support and Malabsorptive Diseases, Hospital HIGA San Martín, Buenos Aires, Argentina.
¹⁴ Department of Surgery, The Ohio State University, Columbus, OH, USA.
¹⁵ University of Alberta, Edmonton, Alberta, Canada.
¹⁶ Clinical Nutrition Department, Hospital General de México, Mexico City, Mexico.
¹⁷ Schlegel-UW Research Institute for Aging and Department of Kinesiology, University of Waterloo, Ontario, Canada.
¹⁸ Clinical Nutrition Service, St. Luke's Medical Center-Quezon City, Metro-Manila, Quezon City, Philippines.
¹⁹ The American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA.
²⁰ Mt. Carmel West Hospital, Columbus, OH, USA.
²¹ Department of Nutrition, Brigham and Women's Hospital, Boston, MA, USA.
²² Division of Geriatrics, Saint Louis University Hospital, St. Louis, MO, USA.
²³ Department of Clinical Medicine, Sapienza University of Rome, Italy.
²⁴ Department of Nutrition, Alfred Health and Professor of Dietetic Practice, Department of Rehabilitation, Nutrition and Sport, Latrobe University; Department of Medicine, Central Clinical School, Monash University, Australia.
²⁵ Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology and Clinical Nutrition, Berlin, Germany.
²⁶ Department of Medicine, Khon Kaen University College of Medicine, Khon Kaen, Thailand.
²⁷ Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
²⁸ Faculty of Health and Social Studies, Department of Nutrition and Dietetics, HAN University of Applied Sciences, Nijmegen, the Netherlands.
²⁹ Ministry of Science and Technology, Bangkok, Thailand.
³⁰ Department of General Intensive Care, Rabin Medical Center, Petah Tikva, Israel.
³¹ Sackler School of Medicine, Tel Aviv University, Israel.
³² Department of Kinesiology and Nutrition, University of Illinois-Chicago, Chicago, IL, USA.
³³ Department of Nutrition, Diabetes and Metabolismo, School of Medicine, Pontificia Universidad Catolica de Chile, Chile.
³⁴ Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil.
³⁵ Department of Medicine, Siriaj Hospital, Bangkok, Thailand.
³⁶ GI Surgery and Nutrition Metabolic Division, Department of General Surgery, Peking Union Medical College Hospital, Beijing, China.
³⁷ Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium.
³⁸ Biobehavioral Health Sciences Department and Nutrition Programs, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.

PMID: 30920778
PMCID: PMC6438340
DOI: 10.1002/jcsm.12383

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 (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.

PubMed Disclaimer

Conflict of interest statement

Gordon L Jensen: Conflicts of interest/ financial disclosures ‐none.

Tommy Cederholm: Conflicts of interest/ financial disclosures ‐none.

M. Isabel T.D. Correia: Conflicts of interest/ financial disclosures‐ none.

M. Christina Gonzalez: Conflicts of interest/ financial disclosures‐ none.

Ryoji Fukushima: Research grant from Taiho Pharmaceutical Factory, Inc.; Honoraria from Otsuka Pharmaceutical Factory, Inc., Terumo Corporation, and Abbotte Japan Co., Ltd.

Takashi Higashiguchi: Conflicts of interest/ financial disclosures‐ none.

Gertrudis Adrianza de Baptista: Conflicts of interest/ financial disclosures ‐ none.

Rocco Barazzoni: Conflicts of interest/ financial disclosures ‐none.

Renée Blaauw: Conflicts of interest/ financial disclosures ‐none.

Andrew JS Coats: Conflicts of interest/ financial disclosures ‐none.

Adriana Crivelli: Conflicts of interest/ financial disclosures ‐none.

David C Evans: Paid for consulting by Coram / CVS Infusion (Parenteral Nutr. Advisory Board) and Lyric; Abbott Nutrition and Lyric both paid Evan's institution for research grants; Paid by Abbott Nutrition for speaking honoraria.

Leah Gramlich: Conflicts of interest/ financial disclosures ‐none.

Vanessa Fuchs‐Tarlovsky: Hospital General de México, Mexico City (honoraria and travel expenses),Tata Memorial Hospital India (travel expenses), UPAEP (Puebla Autonomus University – travel expenses); professional societies including FELANPE, PENSA, the Academy of Nutrition and Dietetics, and the Colegio Mexicano de Nutriologos (travel expenses); and an industry sponsor Fresenius Kabi (travel expenses).

Heather Keller: Paid by Nestle Health Sciences for Manuscript focused on dysphagia; Paid for development of educational presentations including service on speakers’ bureaus by Abbott Nutrition and Nestle Health Sciences; Travel/accommodations expenses covered or reimbursed by Abbott Nutrition.

Luisito Llido: Conflicts of interest/ financial disclosures ‐ none.

Ainsley Malone: Conflicts of interest/ financial disclosures ‐none.

Kris M Mogensen: Board membership with ThriveRx; Consultancy from Pfizer, Employment with Brigham and Women's Hospital, Honoraria from Abbott Nutrition Health Institute and Baxter, Royalties from Wolf Rinke Associates.

John E Morley: Conflicts of interest/ financial disclosures ‐none.

Maurizio Muscaritoli: Conflicts of interest/ financial disclosures‐ none.

Ibolya Nyulasi: Conflicts of interest/ financial disclosures ‐none.

Matthias Pirlich: Consultancy from seca GmbH, Hamburg, Germany.

Veeradej Pisprasert: Conflicts of interest/ financial disclosures‐ none.

Marian de van der Schueren: Conflicts of interest/ financial disclosures ‐ none.

Soranit Siltharm: Conflicts of interest/ financial disclosures ‐none.

Pierre Singer: Grants from Baxter, B Braun, Abbott, and Fresenius Kabi; Honoraria from Baxter, B Braun, Fresenius Kabi, GE, and Cosmed.

Kelly A. Tappenden: Conflicts of interest/ financial disclosures ‐none.

Nicolas Velasco: Conflicts of interest/ financial disclosures ‐none.

Preyanuj Yamwong: Conflicts of interest/ financial disclosures‐ none.

Jianchun Yu: Conflicts of interest/ financial disclosures e none.

Dan L. Waitzberg: Paid by Fresenius‐Kabi as a member of Member of the Felanpe Award; Paid by Danone for Overview of enteral nutrition in healing manuscript preparation; Travel expenses paid for by Fresenius‐Kabi and Nestle for Aspen and Espen conferences in 2018.

Andre Van Gossum: Conflicts of interest/ financial disclosures ‐none.

Charlene Compher: Conflicts of interest/ financial disclosures ‐none.

Figures

**Figure 1**
GLIM diagnostic scheme for screening, assessment, diagnosis and grading of malnutrition.

See this image and copyright information in PMC

Cited by

Revisional surgery for malnutrition after SADI-S: prevalence, indications, techniques and outcomes.
Sánchez-Pernaute A, Lasses B, Antoñanzas LL, Rubio MÁ, Marcuello C, Ferré NP, Torres A, Pérez-Aguirre E. Sánchez-Pernaute A, et al. Updates Surg. 2024 May 28. doi: 10.1007/s13304-024-01900-9. Online ahead of print. Updates Surg. 2024. PMID: 38805173
Malnutrition elevates delirium and ICU stay among critically ill older adult COVID-19 patients.
Gholi Z, Rezaei M, Vahdat Shariatpanahi Z, Momen R, Fallah Bagher Shaidaei M, Gholami M, Aghaee S, Eskandari Sabzi H, Rajabi MR. Gholi Z, et al. Front Med (Lausanne). 2024 May 10;11:1259320. doi: 10.3389/fmed.2024.1259320. eCollection 2024. Front Med (Lausanne). 2024. PMID: 38799151 Free PMC article.
Differences in the Evaluation of Malnutrition and Body Composition Using Bioelectrical Impedance Analysis, Nutritional Ultrasound, and Dual-Energy X-ray Absorptiometry in Patients with Heart Failure.
Benitez-Velasco A, Alzas-Teomiro C, Zurera Gómez C, Muñoz Jiménez C, López Aguilera J, Crespin M, Vallejo-Casas JA, Gálvez-Moreno MÁ, Molina Puerta MJ, Herrera-Martínez AD. Benitez-Velasco A, et al. Nutrients. 2024 May 20;16(10):1535. doi: 10.3390/nu16101535. Nutrients. 2024. PMID: 38794773 Free PMC article.
Arthritis is associated with high nutritional risk among older Canadian adults from the Canadian Longitudinal Study on Aging.
Bennett R, Demmers TA, Plourde H, Arrey K, Armour B, Ferland G, Kakinami L. Bennett R, et al. Sci Rep. 2024 May 11;14(1):10807. doi: 10.1038/s41598-024-58370-7. Sci Rep. 2024. PMID: 38734730 Free PMC article.
What We Do and What We Should Do Against Malnutrition in Spinal Cord Injury: A Position Paper From Italian Spinal Cord Injury Network Rehabilitation Centers.
Areni A, Capeci W, Cassinis A, De Palma L, Del Popolo G, Fergnani F, Pelizzari L. Areni A, et al. J Clin Med Res. 2024 Apr;16(4):138-154. doi: 10.14740/jocmr5015. Epub 2024 Apr 30. J Clin Med Res. 2024. PMID: 38715555 Free PMC article. Review.

See all "Cited by" articles

References

1. Jensen GL, Mirtallo J, Compher C, Dhaliwal R, Forbes A, Grijalba RF, et al. Adult starvation and disease‐related malnutrition: a proposal for etiology‐based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. J Parenter Enteral Nutr 2010;34:156–159, Clin Nutr 2010;29:151–3. - PubMed
1. Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017;36:49–64. - PubMed
1. Soeters PB, Reijven PL, van Bokhorst‐de van der Schueren MA, Schols JM, Halfens RJ, Meijers JM, et al. A rational approach to nutritional assessment. Clin Nutr 2008;27:706–716. - PubMed
1. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? J Parenter Enteral Nutr 1987;11:8–13. - PubMed
1. Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: a new definition. Clin Nutr 2008;27:793–799. - PubMed

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

[1] Jensen GL, Mirtallo J, Compher C, Dhaliwal R, Forbes A, Grijalba RF, et al. Adult starvation and disease‐related malnutrition: a proposal for etiology‐based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. J Parenter Enteral Nutr 2010;34:156–159, Clin Nutr 2010;29:151–3. - PubMed

[2] Jensen GL, Mirtallo J, Compher C, Dhaliwal R, Forbes A, Grijalba RF, et al. Adult starvation and disease‐related malnutrition: a proposal for etiology‐based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. J Parenter Enteral Nutr 2010;34:156–159, Clin Nutr 2010;29:151–3. - PubMed

[3] Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017;36:49–64. - PubMed

[4] Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017;36:49–64. - PubMed

[5] Soeters PB, Reijven PL, van Bokhorst‐de van der Schueren MA, Schols JM, Halfens RJ, Meijers JM, et al. A rational approach to nutritional assessment. Clin Nutr 2008;27:706–716. - PubMed

[6] Soeters PB, Reijven PL, van Bokhorst‐de van der Schueren MA, Schols JM, Halfens RJ, Meijers JM, et al. A rational approach to nutritional assessment. Clin Nutr 2008;27:706–716. - PubMed

[7] Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? J Parenter Enteral Nutr 1987;11:8–13. - PubMed

[8] Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? J Parenter Enteral Nutr 1987;11:8–13. - PubMed

[9] Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: a new definition. Clin Nutr 2008;27:793–799. - PubMed

[10] Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: a new definition. Clin Nutr 2008;27:793–799. - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

MeSH terms

Related information

LinkOut - more resources

Full Text Sources

Medical