GLIM Criteria for the Diagnosis of Malnutrition

This Global Leadership Initiative on Malnutrition (GLIM) initiative targets the priority to adopt global consensus criteria so that malnutrition prevalence, interventions, and outcomes may be compared throughout the world.



GLIM Criteria for the Diagnosis of Malnutrition

Phenotypic and etiologic criteria for the diagnosis of malnutrition.

Phenotypic Criteria

  • Weight loss (%): >5% within past 6 months, or >10% beyond 6 months
  • Low body mass index (kg/m2): <20 if < 70 years, or <22 if >70 years. Asia: <18.5 if < 70 years, or <20 if >70 years
  • Reduced muscle massa: Reduced by validated body composition measuring techniques

Etiologic Criteria

  • Reduced food intake or assimilationb,c: ≤50% of ER > 1 week, or any reduction for >2 weeks, or any chronic GI condition that adversely impacts food assimilation or absorption
  • Inflammationd,e,f: Acute disease/injury or chronic disease-related

Diagnosis of malnutrition: Requires at least 1 phenotypic criterion and 1 etiologic criterion.

Abbreviations: GI, gastro-intestinal, ER, energy requirements.

a For example fat free mass index (FFMI, kg/m²)) by dual-energy absorptiometry (DXA) or corresponding standards using other body composition methods like bioelectrical impedance analysis (BIA), CT or MRI. When not available or by regional preference, physical examination or standard anthropometric measures like mid-arm muscle or calf circumferences may be used. Thresholds for reduced muscle mass need to be adapted to race (Asia). Functional assessments like hand-grip strength may be considered as a supportive measure.
b Consider gastrointestinal symptoms as supportive indicators that can impair food intake or absorption e.g. dysphagia, nausea, vomiting, diarrhea, constipation or abdominal pain. Use clinical judgment to discern severity based upon the degree to which intake or absorption are impaired. Symptom intensity, frequency, and duration should be noted.
c Reduced assimilation of food/nutrients is associated with malabsorptive disorders like short bowel syndrome, pancreatic insufficiency and after bariatric surgery. It is also associated with disorders like esophageal strictures, gastroparesis, and intestinal pseudo-obstruction. Malabsorption is a clinical diagnosis manifest as chronic diarrhea or steatorrhea. Malabsorption in those with ostomies is evidenced by elevated volumes of output. Use clinical judgment or additional evaluation to discern severity based upon frequency, duration, and quantitation of fecal fat and/or volume of losses.
d Acute disease/injury-related. Severe inflammation is likely to be associated with major infection, burns, trauma or closed head injury. Other acute disease/injury-related conditions are likely to be associated with mild to moderate inflammation.
e Chronic disease-related. Severe inflammation is not generally associated with chronic disease conditions. Chronic or recurrent mild to moderate inflammation is likely to
be associated with malignant disease, chronic obstructive pulmonary disease, congestive heart failure, chronic renal disease or any disease with chronic or recurrent
Inflammation. Note that transient inflammation of a mild degree does not meet the threshold for this etiologic criterion.
f C-reactive protein may be used as a supportive laboratory measure.



Thresholds for severity grading of malnutrition

Phenotypic Criteria
Weight loss (%) Low body mass index (kg/m2) Reduced muscle mass*
Stage 1/Moderate Malnutrition
(Requires 1 phenotypic criterion that meets this grade)
5-10% within the past 6 mo,
or 10-20% beyond 6 mo
<20 if < 70 yr,
<22 if ≥ 70 yr
Mild to moderate deficit
(per validated assessment methods)
Stage 2/Severe Malnutrition
(Requires 1 phenotypic criterion that meets this grade)
>10% within the past 6 mo,
or >20% beyond 6 mo
<18.5 if < 70 yr,
<20 if ≥ 70 yr
Severe deficit
(per validated assessment methods)

* For example appendicular lean mass index (ALMI, kg/m2) by dual-energy absorptiometry or corresponding standards using other body composition methods like
bioelectrical impedance analysis (BIA), CT or MRI. When not available or by regional preference, physical examination or standard anthropometric measures like mid-arm muscle or calf circumferences may be used. Functional assessments like hand-grip strength may be used as a supportive measure.




References:

  1. Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, Baptista G, Barazzoni R, Blaauw R, Coats A, Crivelli A, Evans DC, Gramlich L, Fuchs-Tarlovsky V, Keller H, Llido L, Malone A, Mogensen KM, Morley JE, Muscaritoli M, Nyulasi I, Pirlich M, Pisprasert V, de van der Schueren MAE, Siltharm S, Singer P, Tappenden K, Velasco N, Waitzberg D, Yamwong P, Yu J, Van Gossum A, Compher C; GLIM Core Leadership Committee; GLIM Working Group. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clin Nutr. 2019 Feb;38(1):1-9. [Medline]
  2. Cederholm T, Jensen GL, Correia MITD, Gonzalez MC, Fukushima R, Higashiguchi T, Baptista G, Barazzoni R, Blaauw R, Coats AJS, Crivelli AN, Evans DC, Gramlich L, Fuchs-Tarlovsky V, Keller H, Llido L, Malone A, Mogensen KM, Morley JE, Muscaritoli M, Nyulasi I, Pirlich M, Pisprasert V, de van der Schueren MAE, Siltharm S, Singer P, Tappenden K, Velasco N, Waitzberg D, Yamwong P, Yu J, Van Gossum A, Compher C; GLIM Core Leadership Committee, GLIM Working Group. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle. 2019 Feb;10(1):207-217. [Medline]

 

Created: Jun 6, 2019.

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