Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach

Gordon L Jensen¹, Tommy Cederholm^{2

3}, Maria D Ballesteros-Pomar⁴, Renee Blaauw⁵, M Isabel T D Correia⁶, Cristina Cuerda⁷, David C Evans⁸, Ryoji Fukushima⁹, Juan Bernardo Ochoa Gautier¹⁰, M Cristina Gonzalez¹¹, Andre van Gossum¹², Leah Gramlich¹³, Joseph Hartono¹⁴, Steven B Heymsfield¹⁵, Harriët Jager-Wittenaar^{16

17}, Renuka Jayatissa¹⁸, Heather Keller¹⁹, Ainsley Malone²⁰, William Manzanares²¹, M Molly McMahon²², Yolanda Mendez²³, Kris M Mogensen²⁴, Naoharu Mori²⁵, Maurizio Muscaritoli²⁶, Guillermo Contreras Nogales²⁷, Ibolya Nyulasi²⁸, Wendy Phillips²⁹, Matthias Pirlich³⁰, Veeradej Pisprasert³¹, Elisabet Rothenberg³², Marian de van der Schueren³³, Han Ping Shi³⁴, Alison Steiber³⁵, Marion F Winkler³⁶, Charlene Compher³⁷, Rocco Barazzoni³⁸

Affiliations

¹ Deans Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.
² Clinical Nutrition & Metabolism, Uppsala University, Uppsala, Sweden.
³ Theme Inflammation & Ageing, Karolinska University Hospital, Stockholm, Sweden.
⁴ Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain.
⁵ Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁶ Food Science Post Graduation Program; Surgery Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
⁷ Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
⁸ Trauma, Critical Care, General & Gastrointestinal Surgery, OhioHealth Grant Medical Center, Columbus, Ohio, USA.
⁹ Department of Health and Dietetics, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo, Japan.
¹⁰ Hunterdon Medical Center, Flemington, New Jersey, USA.
¹¹ Universidade Federal de Pelotas, Pelotas, Brazil.
¹² Department of Gastroenterology and Clinical Nutrition, Hospital Universitaire de Bruxelles, Brussels, Belgium.
¹³ Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
¹⁴ Indonesian Central Army Gatot Soebroto Hospital, Jakarta, Indonesia.
¹⁵ Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA.
¹⁶ Department of Gastroenterology and Hepatology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands.
¹⁷ Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
¹⁸ Department of Nutrition and Food Science, International Institute of Health Sciences, Colobo, Sri Lanka.
¹⁹ Department of Kinesiology and Health Sciences, Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada.
²⁰ American Society for Parenteral and Enteral Nutrition, Columbus, Ohio, USA.
²¹ Critical Care Medicine, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay.
²² Division of Endocrinology, Metabolism, Diabetes and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.
²³ Internal Medicine, Clinical Nutrition, Colegio Mexicano de Nutrición Clínica y Terapia Nutricional, Mexico City, Mexico.
²⁴ Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA.
²⁵ Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan.
²⁶ Internal Medicine, Sapienza University of Rome, Rome, Italy.
²⁷ Hospital Guillermo Almenara EsSalud, Lima, Perú.
²⁸ Department of Medicine, Central Clinical School, Monash University; Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Victoria, Australia.
²⁹ Morrison Healthcare, Cleveland, Ohio, USA.
³⁰ Departments of Endocrinology, Gastroenterology, and Clinical Nutrition, Imperial Oak Outpatient Clinic, Berlin, Germany.
³¹ Division of Clinical Nutrition, Department of Medicine, Khon Kaen University, Khon Kaen, Thailand.
³² Kristianstad University, Kristianstad, Sweden.
³³ School of Allied Health, HAN University of Applied Sciences; Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands.
³⁴ Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
³⁵ Academy of Nutrition and Dietetics, Cleveland, Ohio, USA.
³⁶ Surgical Nutrition Service, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
³⁷ Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing and Clinical Nutrition Support Service, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³⁸ Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.

PMID: 38221842
DOI: 10.1002/jpen.2590

Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach

Gordon L Jensen et al. JPEN J Parenter Enteral Nutr. 2024 Feb.

. 2024 Feb;48(2):145-154.

doi: 10.1002/jpen.2590. Epub 2024 Jan 15.

Authors

Affiliations

¹ Deans Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.
² Clinical Nutrition & Metabolism, Uppsala University, Uppsala, Sweden.
³ Theme Inflammation & Ageing, Karolinska University Hospital, Stockholm, Sweden.
⁴ Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, León, Spain.
⁵ Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁶ Food Science Post Graduation Program; Surgery Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
⁷ Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
⁸ Trauma, Critical Care, General & Gastrointestinal Surgery, OhioHealth Grant Medical Center, Columbus, Ohio, USA.
⁹ Department of Health and Dietetics, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo, Japan.
¹⁰ Hunterdon Medical Center, Flemington, New Jersey, USA.
¹¹ Universidade Federal de Pelotas, Pelotas, Brazil.
¹² Department of Gastroenterology and Clinical Nutrition, Hospital Universitaire de Bruxelles, Brussels, Belgium.
¹³ Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
¹⁴ Indonesian Central Army Gatot Soebroto Hospital, Jakarta, Indonesia.
¹⁵ Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA.
¹⁶ Department of Gastroenterology and Hepatology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands.
¹⁷ Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
¹⁸ Department of Nutrition and Food Science, International Institute of Health Sciences, Colobo, Sri Lanka.
¹⁹ Department of Kinesiology and Health Sciences, Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada.
²⁰ American Society for Parenteral and Enteral Nutrition, Columbus, Ohio, USA.
²¹ Critical Care Medicine, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay.
²² Division of Endocrinology, Metabolism, Diabetes and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.
²³ Internal Medicine, Clinical Nutrition, Colegio Mexicano de Nutrición Clínica y Terapia Nutricional, Mexico City, Mexico.
²⁴ Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA.
²⁵ Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan.
²⁶ Internal Medicine, Sapienza University of Rome, Rome, Italy.
²⁷ Hospital Guillermo Almenara EsSalud, Lima, Perú.
²⁸ Department of Medicine, Central Clinical School, Monash University; Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Victoria, Australia.
²⁹ Morrison Healthcare, Cleveland, Ohio, USA.
³⁰ Departments of Endocrinology, Gastroenterology, and Clinical Nutrition, Imperial Oak Outpatient Clinic, Berlin, Germany.
³¹ Division of Clinical Nutrition, Department of Medicine, Khon Kaen University, Khon Kaen, Thailand.
³² Kristianstad University, Kristianstad, Sweden.
³³ School of Allied Health, HAN University of Applied Sciences; Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands.
³⁴ Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
³⁵ Academy of Nutrition and Dietetics, Cleveland, Ohio, USA.
³⁶ Surgical Nutrition Service, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
³⁷ Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing and Clinical Nutrition Support Service, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³⁸ Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.

PMID: 38221842
DOI: 10.1002/jpen.2590

Abstract

Background: The Global Leadership Initiative on Malnutrition (GLIM) approach to malnutrition diagnosis is based on assessment of three phenotypic (weight loss, low body mass index, and reduced skeletal muscle mass) and two etiologic (reduced food intake/assimilation and disease burden/inflammation) criteria, with diagnosis confirmed by fulfillment of any combination of at least one phenotypic and at least one etiologic criterion. The original GLIM description provided limited guidance regarding assessment of inflammation, and this has been a factor impeding further implementation of the GLIM criteria. We now seek to provide practical guidance for assessment of inflammation.

Methods: A GLIM-constituted working group with 36 participants developed consensus-based guidance through a modified Delphi review. A multiround review and revision process served to develop seven guidance statements.

Results: The final round of review was highly favorable, with 99% overall "agree" or "strongly agree" responses. The presence of acute or chronic disease, infection, or injury that is usually associated with inflammatory activity may be used to fulfill the GLIM disease burden/inflammation criterion, without the need for laboratory confirmation. However, we recommend that recognition of underlying medical conditions commonly associated with inflammation be supported by C-reactive protein (CRP) measurements when the contribution of inflammatory components is uncertain. Interpretation of CRP requires that consideration be given to the method, reference values, and units (milligrams per deciliter or milligram per liter) for the clinical laboratory that is being used.

Conclusion: Confirmation of inflammation should be guided by clinical judgment based on underlying diagnosis or condition, clinical signs, or CRP.

Keywords: C-reactive protein; assessment; inflammation; malnutrition.

© 2024 The Author(s). Published by Elsevier Limited on behalf of European Society for Clinical Nutrition and Metabolism and Elsevier Ltd and Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition.

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References

REFERENCES

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Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach

Affiliations

Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach

Authors

Affiliations

Abstract

References

REFERENCES

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials

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