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. 2024 May;43(5):1025-1032.
doi: 10.1016/j.clnu.2023.11.026. Epub 2023 Nov 29.

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

Tommy Cederholm  1 , Gordon L Jensen  2 , Maria D Ballesteros-Pomar  3 , Renee Blaauw  4 , M Isabel T D Correia  5 , Cristina Cuerda  6 , David C Evans  7 , Ryoji Fukushima  8 , Juan Bernardo Ochoa Gautier  9 , M Cristina Gonzalez  10 , Andre van Gossum  11 , Leah Gramlich  12 , Joseph Hartono  13 , Steven B Heymsfield  14 , Harriët Jager-Wittenaar  15 , Renuka Jayatissa  16 , Heather Keller  17 , Ainsley Malone  18 , William Manzanares  19 , M Molly McMahon  20 , Yolanda Mendez  21 , Kris M Mogensen  22 , Naoharu Mori  23 , Maurizio Muscaritoli  24 , Guillermo Contreras Nogales  25 , Ibolya Nyulasi  26 , Wendy Phillips  27 , Matthias Pirlich  28 , Veeradej Pisprasert  29 , Elisabet Rothenberg  30 , Marian de van der Schueren  31 , Han Ping Shi  32 , Alison Steiber  33 , Marion F Winkler  34 , Rocco Barazzoni  35 , Charlene Compher  36
Affiliations
Free article

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

Tommy Cederholm et al. Clin Nutr. 2024 May.
Free article

Abstract

Background & aims: 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 in support of the etiologic criterion for inflammation.

Methods: A GLIM-constituted working group with 36 participants developed consensus-based guidance through a modified-Delphi review. A multi-round 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 (mg/dL or mg/L) for the clinical laboratory that is being used.

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

Keywords: Assessment; C-reactive protein; Inflammation; Malnutrition.

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Conflict of interest statement

Conflicts of interest M. Isabel T. D. Correia reported support from Abbott, Danone, Fresenius, Nestlé for lectures and educational materials. David Evans disclosed support from Abbott Nutrition for research grants, and consulting and speaking honoraria; Fresenius Kabi for consulting and speaking honoraria; Coram/CVS Optioncare for consulting and speaking honoraria; and Alcresta Therapeutics for consulting and speaking honoraria. M. Cristina Gonzalez disclosed receiving honoraria and/or paid consultancy from Abbott Nutrition, Nutricia, and Nestle Health Science Brazil. Steven Heymsfield reported serving on the medical advisory boards of Tanita Corporation, Medifast, Abbott, and Novo Nordisk. Ainsley Malone disclosed that she is an employee of ASPEN and that she has received an honorarium from the Abbott Nutrition Health Institute. Kris M. Mogensen disclosed serving on the Baxter Advisory Board for parenteral nutrition and indirect calorimetry. Alison Steiber reported that she is an employee of the Academy of Nutrition and Dietetics and that she has received grant funding from the Academy of Nutrition and Dietetics Foundation and the Administration for Community Living. All other authors reported no disclosures.

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