GLIM consensus approach to diagnosis of malnutrition: A 5-year update

Gordon L Jensen¹, Tommy Cederholm^{2

3}, M Isabel T D Correia⁴, M Cristina Gonzalez⁵, Ryoji Fukushima⁶, Veeradej Pisprasert⁷, Renee Blaauw⁸, Diana Cardenas Braz⁹, Fernando Carrasco¹⁰, Alfonso J Cruz Jentoft¹¹, Cristina Cuerda¹², David C Evans¹³, Vanessa Fuchs-Tarlovsky¹⁴, Leah Gramlich¹⁵, Han Ping Shi¹⁶, Jeanette M Hasse¹⁷, Michael Hiesmayr¹⁸, Naoki Hiki¹⁹, Harriët Jager-Wittenaar^{20

21}, Shukri Jahit²², Anayanet Jáquez²³, Heather Keller²⁴, Stanislaw Klek²⁵, Ainsley Malone²⁶, Kris M Mogensen²⁷, Naoharu Mori²⁸, Manpreet Mundi²⁹, Maurizio Muscaritoli³⁰, Doris Ng³¹, Ibolya Nyulasi^{32

33}, Matthias Pirlich³⁴, Stephane Schneider³⁵, Marian de van der Schueren^{36

37}, Soranit Siltharm³⁸, Pierre Singer^{39

40}, Alison Steiber⁴¹, Kelly A Tappenden⁴², Jianchun Yu⁴³, André van Gossum⁴⁴, Jaw-Yuan Wang^{45

46}, Marion F Winkler⁴⁷, Charlene Compher⁴⁸, Rocco Barazzoni⁴⁹

Affiliations

¹ Dean's Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
² Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
³ Theme Inflammation & Aging, Karolinska University Hospital, Stockholm, Sweden.
⁴ Department of Surgery, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
⁵ Postgraduate Program in Nutrition and Food, Federal University of Pelotas, RS, Brazil.
⁶ Department of Health and Dietetics, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo, Japan.
⁷ Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
⁸ Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁹ Nutrition Unit, Gustave Roussy, Villejuif, France.
¹⁰ Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile.
¹¹ Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
¹² Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
¹³ Department of Surgery, OhioHealth Grant Medical Center and Ohio University, Columbus, OH, USA.
¹⁴ Clinical Nutrition Department, Hospital General de México, Mexico City, Mexico.
¹⁵ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
¹⁶ Department of GI Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
¹⁷ Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA.
¹⁸ Center for Medical Data Science, Unit for Medical Statistics, Medical University Vienna, Vienna, Austria.
¹⁹ Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
²⁰ Department of Gastroenterology and Hepatology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands.
²¹ Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
²² National Cancer Institute, Putrajaya, Malaysia.
²³ Pontificia Universidad Catolica Madre y Maestra, Santiago, Republica Dominica.
²⁴ Schlegel-UW Research Institute for Aging and Department of Kinesiology & Health Sciences, University of Waterloo, Ontario, Canada.
²⁵ Surgical Oncology Clinic, The Maria Sklodowska-Curie National Cancer Institute, Krakow, Poland.
²⁶ The American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA.
²⁷ Department of Nutrition, Brigham and Women's Hospital, Boston, MA, USA.
²⁸ Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan.
²⁹ Division of Endocrine, Diabetes, Metabolism, Nutrition, Mayo Clinic, Rochester, MN, USA.
³⁰ Department of Translational and Precision Medicine, Sapienza University of Rome, Italy.
³¹ Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore.
³² Department of Food, Nutrition and Dietetics, Latrobe University; Melbourne, Victoria, Australia.
³³ The School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
³⁴ Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology and Clinical Nutrition, Berlin, Germany.
³⁵ Gastroenterology and Nutrition Department, Nice University Hospital, Côte d'Azur University, Nice, France.
³⁶ Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, the Netherlands.
³⁷ Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
³⁸ Ministry of Science and Technology, Bangkok, Thailand.
³⁹ Institute for Nutrition Research, Rabin Medical Center, Petah Tikva, Israel.
⁴⁰ Intensive Care Unit, Herzlia Medical Center, Reichman University, Herzliya, Israel.
⁴¹ Mission, Impact and Strategy Team, Academy of Nutrition and Dietetics, Chicago, IL, USA.
⁴² Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA.
⁴³ Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, P.R. China.
⁴⁴ Department of Gastroenterology and Clinical Nutrition, Hospital Universitaire de Bruxelles (HUB), Free University of Brussels, Brussels, Belgium.
⁴⁵ Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital and Graduate Institute of Clinical Medicine, Kaohsiung, Taiwan.
⁴⁶ College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴⁷ Alpert Medical School of Brown University; Rhode Island Hospital, Surgical Nutrition Service, Providence, RI, USA.
⁴⁸ Biobehavioral Health Science Department and Nutrition Programs, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
⁴⁹ Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.

PMID: 40223699
PMCID: PMC12053077
DOI: 10.1002/jpen.2756

Review

GLIM consensus approach to diagnosis of malnutrition: A 5-year update

Gordon L Jensen et al. JPEN J Parenter Enteral Nutr. 2025 May.

. 2025 May;49(4):414-427.

doi: 10.1002/jpen.2756. Epub 2025 Apr 14.

Authors

Affiliations

¹ Dean's Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
² Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
³ Theme Inflammation & Aging, Karolinska University Hospital, Stockholm, Sweden.
⁴ Department of Surgery, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
⁵ Postgraduate Program in Nutrition and Food, Federal University of Pelotas, RS, Brazil.
⁶ Department of Health and Dietetics, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo, Japan.
⁷ Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
⁸ Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁹ Nutrition Unit, Gustave Roussy, Villejuif, France.
¹⁰ Department of Nutrition, Faculty of Medicine, University of Chile, Santiago, Chile.
¹¹ Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
¹² Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
¹³ Department of Surgery, OhioHealth Grant Medical Center and Ohio University, Columbus, OH, USA.
¹⁴ Clinical Nutrition Department, Hospital General de México, Mexico City, Mexico.
¹⁵ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
¹⁶ Department of GI Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
¹⁷ Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA.
¹⁸ Center for Medical Data Science, Unit for Medical Statistics, Medical University Vienna, Vienna, Austria.
¹⁹ Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
²⁰ Department of Gastroenterology and Hepatology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands.
²¹ Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
²² National Cancer Institute, Putrajaya, Malaysia.
²³ Pontificia Universidad Catolica Madre y Maestra, Santiago, Republica Dominica.
²⁴ Schlegel-UW Research Institute for Aging and Department of Kinesiology & Health Sciences, University of Waterloo, Ontario, Canada.
²⁵ Surgical Oncology Clinic, The Maria Sklodowska-Curie National Cancer Institute, Krakow, Poland.
²⁶ The American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA.
²⁷ Department of Nutrition, Brigham and Women's Hospital, Boston, MA, USA.
²⁸ Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Aichi, Japan.
²⁹ Division of Endocrine, Diabetes, Metabolism, Nutrition, Mayo Clinic, Rochester, MN, USA.
³⁰ Department of Translational and Precision Medicine, Sapienza University of Rome, Italy.
³¹ Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore.
³² Department of Food, Nutrition and Dietetics, Latrobe University; Melbourne, Victoria, Australia.
³³ The School of Translational Medicine, Monash University, Melbourne, Victoria, Australia.
³⁴ Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology and Clinical Nutrition, Berlin, Germany.
³⁵ Gastroenterology and Nutrition Department, Nice University Hospital, Côte d'Azur University, Nice, France.
³⁶ Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, the Netherlands.
³⁷ Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
³⁸ Ministry of Science and Technology, Bangkok, Thailand.
³⁹ Institute for Nutrition Research, Rabin Medical Center, Petah Tikva, Israel.
⁴⁰ Intensive Care Unit, Herzlia Medical Center, Reichman University, Herzliya, Israel.
⁴¹ Mission, Impact and Strategy Team, Academy of Nutrition and Dietetics, Chicago, IL, USA.
⁴² Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA.
⁴³ Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, P.R. China.
⁴⁴ Department of Gastroenterology and Clinical Nutrition, Hospital Universitaire de Bruxelles (HUB), Free University of Brussels, Brussels, Belgium.
⁴⁵ Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital and Graduate Institute of Clinical Medicine, Kaohsiung, Taiwan.
⁴⁶ College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴⁷ Alpert Medical School of Brown University; Rhode Island Hospital, Surgical Nutrition Service, Providence, RI, USA.
⁴⁸ Biobehavioral Health Science Department and Nutrition Programs, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
⁴⁹ Department of Medical, Technological and Translational Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy.

PMID: 40223699
PMCID: PMC12053077
DOI: 10.1002/jpen.2756

Abstract

Background: The Global Leadership Initiative on Malnutrition (GLIM) introduced an approach for malnutrition diagnosis in 2019 that comprised screening followed by assessment of three phenotypic criteria (weight loss, low body mass index [BMI], and low muscle mass) and two etiologic criteria (reduced food intake/assimilation and inflammation/disease burden). This planned update reconsiders the GLIM framework based on published knowledge and experience over the past 5 years.

Methods: A working group (n = 43 members) conducted a literature search spanning 2019-2024 using the keywords "Global Leadership Initiative on Malnutrition or GLIM." Prior GLIM guidance activities for using the criteria on muscle mass and inflammation were reviewed. Successive rounds of revision and review were used to achieve consensus.

Results: More than 400 scientific reports were published in peer-reviewed journals, forming the basis of 10 systematic reviews, some including meta-analyses of GLIM validity that indicate strong construct and predictive validity. Limitations and future priorities are discussed. Working group findings suggest that assessment of low muscle mass should be guided by experience and available technological resources. Clinical judgment may suffice to evaluate the inflammation/disease burden etiologic criterion. No revisions of the weight loss, low BMI, or reduced food intake/assimilation criteria are suggested. After two rounds of review and revision, the working group secured 100% agreement with the conclusions reported in the 5-year update.

Conclusion: Ongoing initiatives target priorities that include malnutrition risk screening procedures, GLIM adaptation to the intensive care setting, assessment in support of the reduced food intake/assimilation criterion, and determination of malnutrition in obesity.

Keywords: assessment; inflammation; malnutrition; muscle; screening.

© 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.

PubMed Disclaimer

Conflict of interest statement

Tommy Cederholm disclosed receiving lecture honoraria from Fresenius‐Kabi, Nutricia/Danone, and Nestlé. M. Isabel T. D. Correia reported support from Abbott, Baxter, Danone, Fresenius, and Nestlé for lectures and educational materials. David C. Evans disclosed support from Abbott Nutrition for consulting and speaking honoraria, Fresenius Kabi 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 Nestlé Health Science Brazil. Jeanette M. Hasse disclosed serving on the speakers bureau for Alcresta Therapeutics. Ainsley Malone disclosed that she is an employee of ASPEN. Kris M. Mogensen disclosed serving as an advisory board member for American Regent. Manpreet Mundi disclosed research grants from Nestlé and Northsea as well as service on the advisory boards of Baxter, NutriShare, and Otsuka. 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. The remaining authors declare no conflicts of interest.

Figures

**Figure 1**
GLIM diagnostic scheme for screening, diagnostic assessment and grading of malnutrition. First, identify subjects with risk factors for malnutrition. Second, apply the two etiologic criteria and the three phenotypic criteria. When at least one of each set of criteria is fulfilled, the diagnosis of malnutrition is confirmed. Third, determine severity, i.e., moderate or severe malnutrition based on the degree of aberration in the phenotypic criteria. This figure is adapted from the original 2019 consensus paper., ,

See this image and copyright information in PMC

References

1. Jensen GL, Mirtallo J, Compher C, et al. Adult starvation and disease‐related malnutrition: a proposal for etiology‐based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. JPEN J Parenter Enteral Nutr. 2010;34(2):156‐159. - PubMed
1. Cederholm T, Barazzoni R, Austin P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36(1):49‐64. - PubMed
1. Jensen GL, Cederholm T, Correia MITD, et al. GLIM criteria for the diagnosis of malnutrition: a consensus report from the global clinical nutrition community. JPEN J Parenter Enteral Nutr. 2019;43(1):32‐40. - PubMed
1. Cederholm T, Jensen GL, Correia MITD, et al. GLIM criteria for the diagnosis of malnutrition: a consensus report from the global clinical nutrition community. Clin Nutr. 2019;38(1):1‐9. - PubMed
1. Cederholm T, Jensen GL, Correia MITD, et al. GLIM criteria for the diagnosis of malnutrition—a consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle. 2019;10:207‐217. - PMC - PubMed

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GLIM consensus approach to diagnosis of malnutrition: A 5-year update

Affiliations

GLIM consensus approach to diagnosis of malnutrition: A 5-year update

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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LinkOut - more resources

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