Recognizing malnutrition in adults with critical illness: Guidance statements from the Global Leadership Initiative on Malnutrition

C W Compher¹, R Fukushima², M I T D Correia³, M C Gonzalez⁴, L McKeever⁵, K Nakamura⁶, Z Y Lee^{7

8}, J J Patel⁹, P Singer¹⁰, C Stoppe^{8

11}, J C Ayala¹², R Barazzoni¹³, M M Berger¹⁴, T Cederholm¹⁵, K Chittawatanarat¹⁶, A Cotoia¹⁷, J C Lopez-Delgado¹⁸, C P Earthman¹⁹, G Elke²⁰, W Hartl²¹, M S Hasan²², N Higashibeppu²³, G L Jensen²⁴, K J Lambell²⁵, C C H Lew^{26

27}, J I Mechanick²⁸, M Mourtzakis²⁹, G C C Nogales³⁰, T Oshima³¹, S J Peterson³², T W Rice³³, R Rosenfeld³⁴, P Sheean³⁵, F M Silva³⁶, P C Tah³⁷, M Uyar³⁸

Affiliations

¹ Biobehavioral Health Sciences Department and Nutrition Programs, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
² Department of Surgery, Teikyo University School of Medicine, Teikyo Heisei University, Tokyo, Japan.
³ Department of Surgery, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
⁴ Programa de Pós-graduação em Nutrição e Alimentos, Federal University of Pelotas, Pelotas, Brazil.
⁵ Department of Clinical Nutrition, Rush University Medical Center, Chicago, Illinois, USA.
⁶ Department of Critical Care Medicine, Yokohama City University Hospital, Kanagawa, Japan.
⁷ Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
⁸ Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany.
⁹ Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁰ Intensive Care Department, Herzlia Medical Center, Herzlia and Institute for Nutrition Research, Intensive Care Unit, Beilinson Hospital, Rabin Medical Center, Reichman University, Petah Tikva, Israel.
¹¹ Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital, Würzburg, Würzburg, Germany.
¹² Department of Surgery, Clinica del Country, FUCS, Bogotá, Colombia.
¹³ Department of Medical, Technological and Translational Sciences, Ospedale di Cattinara, University of Trieste, Trieste, Italy.
¹⁴ Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland.
¹⁵ Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala, and Theme Inflammation & Aging, Karolinska University Hospital, Uppsala University, Stockholm, Sweden.
¹⁶ Division of Trauma and Surgical Critical Care, Department of Surgery, Clinical Surgical Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
¹⁷ Department of Medical and Surgical Science, University Hospital of Foggia, Foggia, Italy.
¹⁸ Medical ICU, Clinical Institute of Internal Medicine & Dermatology (ICMiD), Hospital Clínic de Barcelona, Barcelona, Spain.
¹⁹ Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA.
²⁰ Department of Anesthesiology and Intensive Care Medicine, Campus Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany.
²¹ Department of General, Visceral and Transplantation Surgery, LMU University Hospital, LMU Munich, Munich, Germany.
²² Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
²³ Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Japan.
²⁴ Dean's Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.
²⁵ Nutrition and Dietetics Department, Alfred Health, Melbourne, Victoria, Australia.
²⁶ Department of Dietetics and Nutrition, Ng Teng Fong General Hospital, Singapore, Republic of Singapore.
²⁷ Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore, Republic of Singapore.
²⁸ Icahn School of Medicine at Mount Sinai, Mount Sinai Fuster Heart Hospital, New York, New York, USA.
²⁹ Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada.
³⁰ Guillermo Almenara Hospital de Salud, San Martín University, and San Ignacio de Loyola University, La Victoria, Lima, Peru.
³¹ Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba City, Japan.
³² Department of Clinical Nutrition, College of Health Sciences, Rush University Medical Center, Chicago, Illinois, USA.
³³ Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³⁴ Casa de Saude São Jose, Rede Santa Catarina, Rio de Janeiro, Brazil.
³⁵ Department of Applied Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA.
³⁶ Nutrition Department and Graduate Programs in Nutrition Science and Health Science, Federal University of Health Science of Porto Alegre, Porto Alegre, Brazil.
³⁷ Department of Dietetics, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia.
³⁸ Department of Anesthesiology and Intensive Care, Ege University Faculty of Medicine, Ege University Hospital, Bornova, Turkey.

PMID: 40162679
PMCID: PMC12053144
DOI: 10.1002/jpen.2748

Recognizing malnutrition in adults with critical illness: Guidance statements from the Global Leadership Initiative on Malnutrition

C W Compher et al. JPEN J Parenter Enteral Nutr. 2025 May.

. 2025 May;49(4):405-413.

doi: 10.1002/jpen.2748. Epub 2025 Mar 31.

Authors

Affiliations

¹ Biobehavioral Health Sciences Department and Nutrition Programs, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
² Department of Surgery, Teikyo University School of Medicine, Teikyo Heisei University, Tokyo, Japan.
³ Department of Surgery, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
⁴ Programa de Pós-graduação em Nutrição e Alimentos, Federal University of Pelotas, Pelotas, Brazil.
⁵ Department of Clinical Nutrition, Rush University Medical Center, Chicago, Illinois, USA.
⁶ Department of Critical Care Medicine, Yokohama City University Hospital, Kanagawa, Japan.
⁷ Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
⁸ Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany.
⁹ Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁰ Intensive Care Department, Herzlia Medical Center, Herzlia and Institute for Nutrition Research, Intensive Care Unit, Beilinson Hospital, Rabin Medical Center, Reichman University, Petah Tikva, Israel.
¹¹ Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital, Würzburg, Würzburg, Germany.
¹² Department of Surgery, Clinica del Country, FUCS, Bogotá, Colombia.
¹³ Department of Medical, Technological and Translational Sciences, Ospedale di Cattinara, University of Trieste, Trieste, Italy.
¹⁴ Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland.
¹⁵ Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala, and Theme Inflammation & Aging, Karolinska University Hospital, Uppsala University, Stockholm, Sweden.
¹⁶ Division of Trauma and Surgical Critical Care, Department of Surgery, Clinical Surgical Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
¹⁷ Department of Medical and Surgical Science, University Hospital of Foggia, Foggia, Italy.
¹⁸ Medical ICU, Clinical Institute of Internal Medicine & Dermatology (ICMiD), Hospital Clínic de Barcelona, Barcelona, Spain.
¹⁹ Department of Health Behavior and Nutrition Sciences, University of Delaware, Newark, Delaware, USA.
²⁰ Department of Anesthesiology and Intensive Care Medicine, Campus Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany.
²¹ Department of General, Visceral and Transplantation Surgery, LMU University Hospital, LMU Munich, Munich, Germany.
²² Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
²³ Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Japan.
²⁴ Dean's Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.
²⁵ Nutrition and Dietetics Department, Alfred Health, Melbourne, Victoria, Australia.
²⁶ Department of Dietetics and Nutrition, Ng Teng Fong General Hospital, Singapore, Republic of Singapore.
²⁷ Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore, Republic of Singapore.
²⁸ Icahn School of Medicine at Mount Sinai, Mount Sinai Fuster Heart Hospital, New York, New York, USA.
²⁹ Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada.
³⁰ Guillermo Almenara Hospital de Salud, San Martín University, and San Ignacio de Loyola University, La Victoria, Lima, Peru.
³¹ Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba City, Japan.
³² Department of Clinical Nutrition, College of Health Sciences, Rush University Medical Center, Chicago, Illinois, USA.
³³ Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, Tennessee, USA.
³⁴ Casa de Saude São Jose, Rede Santa Catarina, Rio de Janeiro, Brazil.
³⁵ Department of Applied Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA.
³⁶ Nutrition Department and Graduate Programs in Nutrition Science and Health Science, Federal University of Health Science of Porto Alegre, Porto Alegre, Brazil.
³⁷ Department of Dietetics, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia.
³⁸ Department of Anesthesiology and Intensive Care, Ege University Faculty of Medicine, Ege University Hospital, Bornova, Turkey.

PMID: 40162679
PMCID: PMC12053144
DOI: 10.1002/jpen.2748

Abstract

Background: Patients with critical illness may present with disease-related malnutrition upon intensive care unit (ICU) admission. They are at risk of development and progression of malnutrition over the disease trajectory because of inflammation, dysregulated metabolism, and challenges with feeding.

Methods: The Global Leadership Initiative on Malnutrition (GLIM) convened a panel of 36 clinical nutrition experts to develop consensus-based guidance statements addressing the diagnosis of malnutrition during critical illness using a modified Delphi approach with a requirement of ≥75% agreement.

Results: (1) To identify pre-existing malnutrition, we suggest evaluation within 48 h of ICU admission when feasible (100% agreement) or within 4 days (94% agreement). (2) To identify the development and progression of malnutrition, we suggest re-evaluation of all patients every 7-10 days (97% agreement). (3) To identify progressive loss of muscle mass, we suggest evaluation of muscle mass as soon as feasible (92% agreement) and again after 7-10 days (89% agreement). (4) To identify the development and progression of malnutrition before and after ICU discharge, we suggest re-evaluating nutrition status before ICU discharge and during clinical visits that follow (100% agreement).

Conclusion: Research using consistent etiologic and phenotypic variables offers great potential to assess the efficacy of nutrition interventions for critically ill patients with malnutrition. Assessment of these variables during and beyond the ICU stay will clarify the trajectory of malnutrition and enable exploration of impactful treatment modalities at each juncture. GLIM offers a diagnostic approach that can be used to identify malnutrition in critically ill patients.

Keywords: Global Leadership Initiative on Malnutrition; ICU; malnutrition; muscle mass.

© 2025 The Author(s). Published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition, and Elsevier Limited on behalf of The European Society for Clinical Nutrition and Metabolism and Elsevier Ltd.

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Conflict of interest statement

None declared.

References

1. Vallejo KP, Martínez CM, Matos Adames AA, et al. Current clinical nutrition practices in critically ill patients in Latin America: a multinational observational study. Crit Care. 2017;21(1):227. 10.1186/s13054-017-1805-z - DOI - PMC - PubMed
1. Canales C, Elsayes A, Yeh DD, et al. Nutrition Risk in Critically Ill versus the Nutritional Risk Screening 2002: are they comparable for assessing risk of malnutrition in critically ill patients? JPEN J Parenter Enteral Nutr. 2019;43(1):81‐87. 10.1002/jpen.1181 - DOI - PubMed
1. Lew CCH, Yandell R, Fraser RJL, Chua AP, Chong MFF, Miller M. Association between malnutrition and clinical outcomes in the intensive care unit: a systematic review. JPEN J Parenter Enteral Nutr. 2017;41(5):744‐758. 10.1177/0148607115625638 - DOI - PubMed
1. Lew CCH, Lee ZY, Day AG, et al. The association between malnutrition and high protein treatment on outcomes in critically ill patients. Chest. 2024;165(6):1380‐1391. 10.1016/j.chest.2024.02.008 - DOI - PubMed
1. Chapple LS, Kouw IWK, Summers MJ, et al. Muscle protein synthesis after protein administration in critical illness. Am J Respir Crit Care Med. 2022;206(6):740‐749. 10.1164/rccm.202112-2780OC - DOI - PubMed

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Recognizing malnutrition in adults with critical illness: Guidance statements from the Global Leadership Initiative on Malnutrition

Affiliations

Recognizing malnutrition in adults with critical illness: Guidance statements from the Global Leadership Initiative on Malnutrition

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical