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

Authors

• Gordon L. Jensen, University of Vermont Larner College of Medicine, Burlington, VT
• Tommy Cederholm, Karolinska University Hospital, Stockholm, Sweden
• Maria D. Ballesteros-Pomar, Complejo Asistencial Universitario de León, León, Spain
• Renee Blaauw, Stellenbosch University, Cape Town, South Africa
• M Isabel T D Correia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
• Cristina Cuerda, Hospital General Universitario Gregorio Marañón, Madrid, Spain
• David C. Evans, OhioHealth Grant Medical Center, Columbus, OH
• Ryoji Fukushima, Teikyo Heisei University, Tokyo, Japan
• Juan Bernardo Ochoa Gautier, Hunterdon Medical Center, Flemington, NJ
• M Cristina Gonzalez, Universidade Federal de Pelotas, Pelotas, Brazil
• Andre van Gossum, Hospital Universitaire de Bruxelles, Brussels, Belgium
• Leah Gramlich, University of Alberta, Edmonton, Alberta, Canada
• Joseph Hartono, Indonesian Central Army Gatot Soebroto Hospital, Jakarta, Indonesia
• Steven B. Heymsfield, Pennington Biomedical Research Center, Baton Rouge, LA
• Harriët Jager-Wittenaar, Radboud University Medical Center, Nijmegen, The Netherlands
• Renuka Jayatissa, International Institute of Health Sciences, Colombo, Sri Lanka
• Heather Keller, University of Waterloo, Ontario, Canada
• Ainsley Malone, American Society for Parenteral and Enteral Nutrition, Columbus, OH
• William Manzanares, Universidad de la República, Montevideo, Uruguay
• M Molly McMahon, Mayo Clinic, Rochester, MN
• Yolanda Mendez, Colegio Mexicano de Nutrición Clínica y Terapia Nutricional, Mexico City, Mexico
• Kris M. Mogensen, Brigham and Women's Hospital, Boston, MA
• Naoharu Mori, Aichi Medical University, Nagakute, Japan
• Maurizio Muscaritoli, Sapienza University of Rome, Rome, Italy
• Guillermo Contreras Nogales, Hospital Guillermo Almenara EsSalud, Lima, Perú
• Ibolya Nyulasi, Monash University Department of Medicine, Melbourne, Australia
• Wendy Phillips, Morrison Healthcare, Cleveland, OH
• Matthias Pirlich, Imperial Oak Outpatient Clinic, Berlin, Germany
• Veeradej Pisprasert, Khon Kaen University Department of Medicine, Khon Kaen, Thailand
• et al

Document Type

Article

Publication Date

1-15-2024

Publication Title

Journal of Parenteral and Enteral Nutrition

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.

First Page

145

Last Page

154

DOI

10.1002/jpen.2590

Comments

This paper was jointly developed by Clinical Nutrition, Journal of Parental and Enteral Nutrition and jointly published by Elsevier Limited and Wiley Periodicals LLC. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article. https://doi.org/10.1016/j.clnu.2023.11.026

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

Recommended Citation

Jensen, Gordon L.; Cederholm, Tommy; Ballesteros-Pomar, Maria D.; Blaauw, Renee; Correia, M Isabel T D; Cuerda, Cristina; Evans, David C.; Fukushima, Ryoji; Ochoa Gautier, Juan Bernardo; Gonzalez, M Cristina; van Gossum, Andre; Gramlich, Leah; Hartono, Joseph; Heymsfield, Steven B.; Jager-Wittenaar, Harriët; Jayatissa, Renuka; Keller, Heather; Malone, Ainsley; Manzanares, William; McMahon, M Molly; Mendez, Yolanda; Mogensen, Kris M.; Mori, Naoharu; Muscaritoli, Maurizio; Nogales, Guillermo Contreras; Nyulasi, Ibolya; Phillips, Wendy; Pirlich, Matthias; Pisprasert, Veeradej; and al, et, "Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach" (2024). LSU-LCMC Cancer Center Faculty Publications. 154.
https://digitalscholar.lsuhsc.edu/llcc_facpubs/154
10.1002/jpen.2590