Interpreting the GLIM malnutrition diagnosis criteria

In an effort to establish global consensus regarding malnutrition diagnosis, experts from leading clinical nutrition organizations united as the Global Leadership Initiative on Malnutrition (GLIM) was established in January 2016 and sought to bring unity and standardization to the world of malnutrition.

The GLIM criteria

GLIM leadership reviewed existing malnutrition screening and diagnostic parameters to first establish what was most relevant and valid. Leaders in clinical nutrition provided their insight and voted on each criterion. The following criteria were selected by global consensus as the official criteria for malnutrition diagnosis:

Phenotypic criteria

• Non-volitional weight loss
• Low body mass index (BMI)
• Reduced muscle mass

Etiologic criteria

• Reduced food intake or assimilation
• Disease burden/inflammation

Click here to review the details and cut-points for each parameter.

Using the GLIM criteria

GLIM leadership suggests that a malnutrition diagnosis be made when an individual meets at least one phenotypic and one etiologic criterion. The phenotypic criteria are well-established effects and manifestations of malnutrition, while the etiologic criteria drive interventions. The phenotypic criteria also determine whether the malnutrition is of a moderate or severe degree. Severe malnutrition is present if at least one severe phenotypic criterion is met.

Click here to familiarize yourself with the moderate and severe levels of malnutrition.

What’s next?

Like any new assessment technique, you can expect to see these criteria popping up in validation studies in the next few years. Even though the criteria were derived from validated assessment standards and expert recommendation, they must be properly vetted to establish their clinical relevance. Ultimately, GLIM hopes this new set of global standards will help to elevate the importance of malnutrition in the clinical realm and may assist with revising ICD codes to better reflect malnutrition as it exists and affects individuals.

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Reference:

Jensen GL, Cederholm T, Correia MITD, Gonzalez C, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition: a consensus report from the global clinical nutrition community. JPEN. 2018. DOI: 10.1002/jpen.1440.