Elsevier

Clinical Nutrition

Volume 38, Issue 1, February 2019, Pages 1-9
Clinical Nutrition

ESPEN Endorsed Recommendation
GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community

https://doi.org/10.1016/j.clnu.2018.08.002Get rights and content

Summary

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

Malnutrition
Screening
Assessment
Diagnosis

Cited by (0)

This article is simultaneously published by The European Society for Clinical Nutrition and Metabolism in the journal Clinical Nutrition and by the American Society for Parenteral and Enteral Nutrition in the Journal of Parenteral and Enteral Nutrition and will be subsequently published by The Society on Sarcopenia, Cachexia and Wasting Disorders in the Journal of Cachexia, Sarcopenia and Muscle. Minor differences in style may appear in each publication, but the article is substantially the same in each journal.

1

Contributed equally.

2

Contributed equally.

3

Members of the GLIM Core Leadership Committee and GLIM Working Group are listed at the end of the article.

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