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, 10 (1), 207-217

GLIM Criteria for the Diagnosis of Malnutrition - A Consensus Report From the Global Clinical Nutrition Community

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GLIM Criteria for the Diagnosis of Malnutrition - A Consensus Report From the Global Clinical Nutrition Community

T Cederholm et al. J Cachexia Sarcopenia Muscle.

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.

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

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