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

T Cederholm, G L Jensen, M I T D Correia, M C Gonzalez, R Fukushima, T Higashiguchi, G Baptista, R Barazzoni, R Blaauw, A J S Coats, A N Crivelli, D C Evans, L Gramlich, V Fuchs-Tarlovsky, H Keller, L Llido, A Malone, K M Mogensen, J E Morley, M Muscaritoli, I Nyulasi, M Pirlich, V Pisprasert, M A E de van der Schueren, S Siltharm, P Singer, K Tappenden, N Velasco, D Waitzberg, P Yamwong, J Yu, A Van Gossum, C Compher, GLIM Core Leadership Committee, GLIM Working Group, T Cederholm, G L Jensen, M I T D Correia, M C Gonzalez, R Fukushima, T Higashiguchi, G Baptista, R Barazzoni, R Blaauw, A J S Coats, A N Crivelli, D C Evans, L Gramlich, V Fuchs-Tarlovsky, H Keller, L Llido, A Malone, K M Mogensen, J E Morley, M Muscaritoli, I Nyulasi, M Pirlich, V Pisprasert, M A E de van der Schueren, S Siltharm, P Singer, K Tappenden, N Velasco, D Waitzberg, P Yamwong, J Yu, A Van Gossum, C Compher, GLIM Core Leadership Committee, GLIM Working Group

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.

© 2018 Elsevier Ltd, the European Society for Clinical Nutrition and Metabolism and American Society for Parenteral and Enteral Nutrition. All rights reserved.

Figures

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

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.
    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.
    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.
    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.
    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.
    1. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 2011;12:489–495.
    1. White JV, Guenter P, Jensen G, Malone A, Schofield M, Academy Malnutrition Work Group , et al. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Parenter Enteral Nutr 2012;36:275–283.
    1. Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, et al. Diagnostic criteria for malnutrition – An ESPEN consensus statement. Clin Nutr 2015;34:335–340.
    1. Jensen GL. Global Leadership Conversation: Addressing Malnutrition. J Parenter Enteral Nutr 2016;40:455–457.
    1. Cederholm T, Jensen GL. To create a consensus on malnutrition diagnostic criteria: A report from the Global Leadership Initiative on Malnutrition (GLIM) meeting at the ESPEN Congress 2016. Clin Nutr 2017;36:7–10.
    1. Jensen GL, Cederholm T. Global Leadership Initiative on Malnutrition: Progress Report From ASPEN Clinical Nutrition Week 2017. J Parenter Enteral Nutr 2017; 10.1177/0148607117707761.
    1. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN) . ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22:415–421.
    1. Skipper A, Ferguson M, Thompson K, Castellanos VH, Porcari J. Nutrition screening tools: an analysis of the evidence. J Parenter Enteral Nutr 2012;36:292–298.
    1. van Bokhorst‐de van der Schueren MA, Guaitoli PR, Jansma EP, de Vet HC. Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr 2014;33:39–58.
    1. Cruz‐Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39:412–423.
    1. Studenski SA, Peters KW, Alley DE, Cawthon PM, McLean RR, Harris TB, et al. The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci 2014;69:547–558.
    1. Chen LK, Lee WJ, Peng LN, Liu LK, Arai H, Akishita M, et al. Recent advances in sarcopenia research in Asia: Updat from the Asian working group for sarcopenia. J Am Med Dir Assoc 2016;17:767.e1–767.e7.
    1. Delmonico MJ, Harris TB, Visser M, Park SW, Conroy MB, Velasquez‐Mieyer P, et al. Longitudinal study of muscle strength, quality, and adipose tissue infiltration. Am J Clin Nutr 2009;90:1579–1585.
    1. Jensen GL, Hsiao PY, Wheeler D. Adult nutrition assessment tutorial. J Parenter Enteral Nutr 2012;36:267–274.
    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146–M156.
    1. Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short‐form mini‐nutritional assessment (MNA‐SF). J Gerontol A Biol Sci Med Sci 2001;56:M366–M372.
    1. Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the 'malnutrition universal screening tool' ('MUST') for adults. Br J Nutr 2004;92:799–808.
    1. Fouque D, Kalantar‐Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, et al. A proposed nomenclature and diagnostic criteria for protein–energy wasting in acute and chronic kidney disease. Kidney Int 2008;73:391–398.
    1. Cruz‐Jentoft A. personal communication for EWGSOP2 (to be published).
    1. Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 1998;147:755–763.
    1. Chiles Shaffer N, Ferrucci L, Shardell M, Simonsick EM, Studenski S. Agreement and Predictive Validity Using Less‐Conservative Foundation for the National Institutes of Health Sarcopenia Project Weakness Cut points. J Am Geriatr Soc 2017;65:574–579.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera