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

Fuchs-Tarlovsky, Vanessa; Jensen, Gordon L.; Compher, Charlene; Cederholm, Tommy; Gossum, A. Van; Correia, María Isabel Toulson Davisson; González, Marı́a Cristina; Fukushima, Ryoji; Higashiguchi, Takashi; Baptista, Gertrudis Adrianza de; Barazzoni, Rocco; Blaauw, R.; Coats, Andrew J.S.; Crivelli, Adriana; Evans, David C.; Gramlich, Leah; Fuchs, V.; Keller, Heather; Llido, Luisito O.; Malone, Ainsley; Mogensen, Kris M.; Morley, John E.; Muscaritoli, Maurizio; Nyulasi, Ibolya; Pirlich, Matthias; Pisprasert, Veeradej; Schueren, Marian A.E. de van der; Siltharm, S.; Singer, Pierre; Tappenden, Kelly A.; Velasco, N; Waitzberg, Dan Linetzky; Yamwong, Preyanuj; Yu, Jianchun

doi:10.1016/j.clnu.2018.08.002

Cited by 1,925 publications

(2,221 citation statements)

References 26 publications

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“…Other criteria sets for diagnosing malnutrition, such as that proposed by ASPEN and the Academy of Nutrition and Dietetics 49 and the newer guideline from the Global Leadership Initiative on Malnutrition (GLIM), 50 may be predictive of RS. But these have not been studied for their predictive value.…”

Section: Screening and Assessmentmentioning

confidence: 99%

ASPEN Consensus Recommendations for Refeeding Syndrome

Silva¹,

et al. 2020

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Introduction In the spring of 2017, the American Society for Parenteral and Enteral Nutrition (ASPEN) Parenteral Nutrition Safety Committee and the Clinical Practice Committee convened an interprofessional task force to develop consensus recommendations for identifying patients with or at risk for refeeding syndrome (RS) and for avoiding and managing the condition. This report provides narrative review and consensus recommendations in hospitalized adult and pediatric populations. Methods Because of the variation in definitions and methods reported in the literature, a consensus process was developed. Subgroups of authors investigated specific issues through literature review. Summaries were presented to the entire group for discussion via email and teleconferences. Each section was then compiled into a master document, several revisions of which were reviewed by the committee. Findings/Recommendations This group proposes a new clinical definition, and criteria for stratifying risk with treatment and screening strategies. The authors propose that RS diagnostic criteria be stratified as follows: a decrease in any 1, 2, or 3 of serum phosphorus, potassium, and/or magnesium levels by 10%–20% (mild), 20%–30% (moderate), or >30% and/or organ dysfunction resulting from a decrease in any of these and/or due to thiamin deficiency (severe), occurring within 5 days of reintroduction of calories. Conclusions These consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. This consensus definition is additionally intended to be used as a basis for further research into the incidence, consequences, pathophysiology, avoidance, and treatment of RS.

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Section: Screening and Assessmentmentioning

confidence: 99%

ASPEN Consensus Recommendations for Refeeding Syndrome

Silva¹,

et al. 2020

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“…Body weight loss remains a valid criterion; in a recent study including almost 5000 patients, a significant weight loss began relatively early during the course of CKD and was associated with a substantially higher risk for death after dialysis therapy initiation . Overall, both classifications have identified a non‐voluntary weight loss as a phenotypical criterion based on a robust literature: greater than 5% within the past 6 months or >10% beyond 6 months as recently proposed by the Global Leadership Initiative on Malnutrition . The presence of a critical weight loss (>5% in 6 months) should probably be considered as a major criterion to define cachexia/PEW.…”

Section: What Is the Difference Between Cachexia And Protein‐energy Wmentioning

confidence: 99%

Kidney cachexia or protein‐energy wasting in chronic kidney disease: facts and numbers

Koppe

Fouque

Kalantar-Zadeh

2019

J cachexia sarcopenia muscle

159

105

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Background Weight loss and homeostatic disturbances of both energy and protein balances are characteristics of several illnesses including cancer, heart failure, and chronic kidney disease (CKD). Different definitions have been used to describe this deleterious process. The term protein‐energy wasting (PEW) has been proposed for CKD patients by the International Society of Renal Nutrition and Metabolism . Methods We searched the publication in Medline from February 2008 to September 2018 using PEW or cachexia in their title. Results Since its inception, the term PEW has been exceptionally successful, highlighted by 327 original publications referenced in PubMed over 10 years. Using this classification, several studies have confirmed that PEW is among the strongest predictors of mortality in CKD patients [hazard ratio of 3.03; confidence interval of 1.69–5.26 in 1068 haemodialysis patients and 1.40 (1.04–1.89) in 1487 non‐dialysed patients across PEW stages 0 to 4]. Based on this classification, prevalence of PEW is 28% to 54% among 16 434 adults undergoing maintenance dialysis. PEW prevalence increases when renal function declines, that is, from <2% in CKD stages 1–2 to 11–54% in CKD stages 3–5. A more general definition of cachexia for all chronic diseases proposed by the Society on Sarcopenia, Cachexia and Wasting Disorders was also published concurrently. In the CKD area, we found 180 publications using ‘cachexia’ underlining that some confusion or overlap may exist. The definitions of PEW and cachexia are somewhat similar, and the main difference is that a loss of body weight >5% is a mandatory criterion for cachexia but supportive for PEW. Conclusions The recent understanding of cachexia physiopathology during CKD progression suggests that PEW and cachexia are closely related and that PEW corresponds the initial state of a continuous process that leads to cachexia, implicating the same metabolic pathways as in other chronic diseases. Despite the success of the definition of PEW, using a more uniform term such as ‘kidney disease cachexia’ could be more helpful to design future research through collaborative groups of researchers with focus on cachexia.

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“…This lack of a ‘common malnutrition language’ in clinical care and research has been recognised as a problem across many chronic diseases. Attempting to achieve standardisation, global leaders in malnutrition recently came together to formulate the Global Leadership Initiative on Malnutrition (GLIM) guidelines for diagnosing malnutrition. They agreed upon new consensus criteria for malnutrition, including one phenotypic criterion (ie non‐volitional weight loss, reduced muscle mass or low BMI) and one etiologic criterion (ie inflammation/disease burden and reduced food intake).…”

Section: Discussionmentioning

confidence: 99%

“…They can be broadly classified into one of four categories: (a) bedside single measure nutritional assessment tools (NATs) (ie) mid‐arm muscle circumference (MAMC), hand grip strength (HGS), etc (b) bedside global NATs (ie) subjective global assessment (SGA), Royal Free Hospital‐Global Assessment (RFH‐GA), (c) non‐cross‐sectional imaging‐based body composition assessment tools (ie) bioelectrical impedance analysis (BIA) and (d) cross‐sectional imaging‐based sarcopenia assessment (ie) L3 skeletal index via computed tomography (CT) or magnetic resonance imaging (MRI). The information provided by NATs is supplemented by additional dietitian input, thus leading to an evaluation including food intake, barriers to intake and the stress associated with disease or illness in order to formulate a personalised nutritional plan …”

Section: Introductionmentioning

confidence: 99%

Systematic review with meta‐analysis: Nutritional screening and assessment tools in cirrhosis

Ney

Vandermeer

et al. 2019

Liver International

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Background & Aims Disease‐related malnutrition is common in cirrhosis. Multiple studies have evaluated nutritional screening tools (NSTs, rapid bedside tests targeting who needs assessment) and nutritional assessment tools (NATs, used in diagnosing malnutrition) as predictors of clinical outcome in this population. We performed a systematic review and meta‐analysis of this literature with the aim of summarising the varying definitions of malnutrition across studies, the available evidence for NSTs and the ability of NSTs and NATs to predict clinical outcomes in cirrhosis. Methods The primary outcome measures were pre‐ and post‐transplant mortality with a range of secondary outcomes. Inclusion: cirrhosis over age 16. Exclusion: >25% with hepatocellular carcinoma, primarily laboratory test‐based NATs or lack of screening, assessment or outcome criteria. Results Eight thousand eight hundred fifty patients were included across 47 studies. Only 3 studies assessed NSTs. Thirty‐two definitions for malnutrition were utilised across studies. NATs predicted pre‐transplant mortality in 69% of cases that were assessed with a risk ratio (RR) of 2.38 (95% CI 1.96‐2.89). NATs were prognostic for post‐transplant mortality only 28% of the times they were assessed, with a RR of 3.04 (95% CI 1.51‐6.12). Conclusions The cirrhosis literature includes limited data on nutrition screening and multiple definitions for what constitutes malnutrition using NATs. Despite this discordance, it is clear that malnutrition is a valuable predictor of pre‐transplant mortality almost regardless of how it is defined. We require clinical and research consensus around the definition of malnutrition and the accepted processes and cut‐points for nutrition screening and assessment in cirrhosis.

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

Cited by 1,925 publications

References 26 publications

ASPEN Consensus Recommendations for Refeeding Syndrome

ASPEN Consensus Recommendations for Refeeding Syndrome

Kidney cachexia or protein‐energy wasting in chronic kidney disease: facts and numbers

Systematic review with meta‐analysis: Nutritional screening and assessment tools in cirrhosis

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