Gordon L Jensen1, Tommy Cederholm2, M Isabel T D Correia3, M Christina Gonzalez4, Ryoji Fukushima5, Takashi Higashiguchi6, Gertrudis Adrianza de Baptista7, Rocco Barazzoni8, Renée Blaauw9, Andrew J S Coats10, Adriana Crivelli11, David C Evans12, Leah Gramlich13, Vanessa Fuchs-Tarlovsky14, Heather Keller15, Luisito Llido16, Ainsley Malone17, Kris M Mogensen18, John E Morley19, Maurizio Muscaritoli20, Ibolya Nyulasi21, Matthias Pirlich22, Veeradej Pisprasert23, Marian de van der Schueren24, Soranit Siltharm25, Pierre Singer26, Kelly A Tappenden27, Nicolas Velasco28, Dan L Waitzberg29, Preyanuj Yamwong30, Jianchun Yu31, Charlene Compher32, Andre Van Gossum33. 1. Dean's Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA. 2. Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, and Theme Aging, Karolinska University Hospital, Stockholm, Sweden. 3. Department of Surgery, Universidade Federal de Minas Gerais, Belo Horizante. 4. Postgraduate Program in Health and Behavior, Catholic University of Pelotas, RS, Brazil. 5. Department of Medicine, Department of Surgery, Tokyo University School of Medicine, Tokyo. 6. Department of Surgery and Palliative Medicine, Fujita Health University School of Medicine, Dengakugakubo, Kutsukake, Toyoake-City, Aichi, Japan. 7. Medicine Faculty Central University of Venezuela, University Hospital of Caracas, Chief Nutritional Support Unit Hospital Universitary/Academic of Caracas, University Central of Venezuela. 8. Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy. 9. Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. 10. Monash University Australia and University of Warwick, Warwick, UK; Member Board of Directors Society on Sarcopenia, Cachexia and Wasting Disorders. 11. Nutritional Support Unit, San Martín Hospital, La Plata, Argentina. 12. Department of Surgery, The Ohio State University, Columbus, Ohio, USA. 13. University of Alberta, Edmonton, Alberta, Canada. 14. Clinical Nutrition Department, Hospital General de México, Mexico City, Mexico. 15. Schlegel-UW Research Institute for Aging and Department of Kinesiology, University of Waterloo, Ontario, Canada. 16. Clinical Nutrition Service, St. Luke's Medical Center-Quezon City, Metro-Manila, Phillippines, Quezon City, Philippines. 17. The American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, and Mt. Carmel West Hospital, Columbus, Ohio, USA. 18. Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA. 19. Division of Geriatrics, Saint Louis University Hospital, St. Louis, Missouri, U.S.A. Member Board of Directors Society on Sarcopenia, Cachexia and Wasting Disorders. 20. Department of Clinical Medicine, Sapienza University of Rome, Italy. 21. 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. 22. Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology and Clinical Nutrition, Berlin, Germany. 23. Department of Medicine, Khon Kaen University College of Medicine, Khon Kaen, Thailand. 24. Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Nutrition and Dietetics, Amsterdam, the Netherlands; HAN University of Applied Sciences, Faculty of Health and Social studies, Department of Nutrition and Dietetics, Nijmegen, the Netherlands. 25. Ministry of Science and Technology, Bangkok, Thailand. 26. Department of General Intensive Care, Rabin Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, Israel. 27. Department of Kinesiology and Nutrition, University of Illinois-Chicago, Chicago, Illinois, USA. 28. Department of Nutrition, Diabetes and Metabolismo. School of Medicine, Pontificia Universidad Catolica de Chile. 29. Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, Brazil. 30. Department of Medicine, Siriaj Hospital, Bangkok, Thailand. 31. GI Surgery and Nutrition Metabolic Division, Department of General Surgery, Peking Union Medical College Hospital, Beijing, China. 32. Biobehavioral Health Sciences Department and Nutrition Programs, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA. 33. Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium.
Abstract
BACKGROUND: This initiative aims to build a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. METHODS: The Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications. RESULTS: A 2-step approach for the malnutrition diagnosis was selected, that is, 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 GLIM participants that selected 3 phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and 2 etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least 1 phenotypic criterion and 1 etiologic criterion should be present. Phenotypic metrics for grading severity 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. CONCLUSIONS: A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The construct should be re-considered every 3-5 years.
BACKGROUND: This initiative aims to build a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. METHODS: The Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications. RESULTS: A 2-step approach for the malnutrition diagnosis was selected, that is, 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 GLIM participants that selected 3 phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and 2 etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least 1 phenotypic criterion and 1 etiologic criterion should be present. Phenotypic metrics for grading severity 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. CONCLUSIONS: A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The construct should be re-considered every 3-5 years.
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