GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community
Open accessAbstract
RATIONALE: This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. METHODS: In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. GLIM appointed a core leadership committee and a supporting working group with representatives bringing additional global diversity and expertise. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications. RESULTS: A two-step approach for the malnutrition diagnosis was selected, i.e., first screening to identify "at risk" status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among the GLIM core and supporting working group members. The top five ranked criteria included three phenotypic criteria (weight loss, low body mass index, and reduced muscle mass) and two etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least one phenotypic criterion and one etiologic criterion should be present. Phenotypic metrics for grading severity as Stage 1 (moderate) and Stage 2 (severe) malnutrition are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories. CONCLUSION: A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure further collaboration and endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The diagnostic construct should be re-considered every 3-5 years.
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A list of conditions was provided in the original guidance that could be used to determine assimilation challenges, but severity and duration were not considered at that time.
“A list of conditions was provided in the original guidance 3 , 4 , 5 that could be used to determine assimilation challenges. However, severity and duration were not considered at that time.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [5]
The Results section, “Reduced food intake or assimilation,” lists conditions associated with reduced assimilation. But the guidance also says to assess severity and note symptom frequency and duration, directly contradicting the claim that severity and duration were not considered. No page number is available in our copy. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredMalnutrition assessment requires the association of a phenotype and an etiology (GLIM criteria).
“Meanwhile, following the screening process, the malnutrition assessment requires the association of a phenotype (weight loss %, BMI, decrease in appetite, and/or low muscle mass) and an etiology e.g.critical illness [17] (GLIM (Global Leadership Initiative on Malnutrition) criteria).”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [17]
The Results section (‘Approach to using combined phenotypic and etiologic criteria’) says GLIM diagnosis requires at least one phenotypic and one etiologic criterion. It lists weight loss, reduced BMI, and reduced muscle mass as phenotypic, but places reduced food intake or assimilation under etiologic criteria; the citing sentence incorrectly lists decreased appetite as phenotypic. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBioelectrical impedance analysis, dual-energy x-ray absorptiometry, computed tomography, magnetic resonance imaging, and ultrasound are methods that can be used to evaluate muscle mass when experience and relevant reference values are available.
“Bioelectrical impedance analysis, dual‐energy x‐ray absorptiometry, computed tomography, magnetic resonance imaging, and ultrasound are methods that can be used when experience and relevant reference values are available.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [5]
In Results > Reduced muscle mass (page not provided), the paper recommends all five listed methods for measuring muscle mass and discusses reference standards and cut-off values. It does not state that their use depends on the availability of experience, so that condition is not supported by our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe 2019 GLIM consensus papers provided a framework for a globally accepted diagnostic process that should be valid for adults in most settings, irrespective of methodological availability and resources.
“These insights culminated in the 2019 GLIM consensus papers that provided a framework for a globally accepted diagnostic process that should be valid for adults in most settings, irrespective of methodological availability and resources.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [5]
The GLIM consensus process arrived at a two-step procedure starting with nutrition screening followed by diagnostic assessment for confirmation of malnutrition.
“The consensus process arrived at a two‐step GLIM procedure that starts with nutrition screening followed by diagnostic assessment for confirmation of malnutrition.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [5]
GLIM introduced an approach for malnutrition diagnosis in 2019 comprising screening followed by assessment of three phenotypic criteria (weight loss, low BMI, low muscle mass) and two etiologic criteria (reduced food intake/assimilation and inflammation/disease burden).
“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).”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [5]
Gastrointestinal symptoms can impair food intake or absorption and should be considered supportive indicators.
“Consider gastrointestinal symptoms as supportive indicators that can impair food intake or absorption (dysphagia, nausea, vomiting, diarrhea, constipation, or abdominal pain).”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [5]
Thresholds for reduced muscle mass need to be adapted to race (Asia).
“Thresholds for reduced muscle mass need to be adapted to race (Asia).”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [5]
Reduced assimilation of food/nutrients is associated with malabsorptive disorders such as short bowel syndrome, pancreatic insufficiency, and after bariatric surgery.
“Reduced assimilation of food/nutrients is associated with malabsorptive disorders such as short bowel syndrome, pancreatic insufficiency, and after bariatric surgery.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [5]
Other acute disease/injury-related conditions are likely to be associated with mild to moderate inflammation.
“Other acute disease/injury‐related conditions are likely to be associated with mild to moderate inflammation.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [5]
Reduced assimilation of food/nutrients is also associated with disorders such as esophageal strictures, gastroparesis, and intestinal pseudo-obstruction.
“It is also associated with disorders such esophageal strictures, gastroparesis, and intestinal pseudo‐obstruction.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [5]
Acute disease/injury-related severe inflammation is likely to be associated with major infection, burns, trauma, or closed head injury.
“Acute disease/injury‐related severe inflammation is likely to be associated with major infection, burns, trauma, or closed head injury.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [5]
Chronic disease-related inflammation is generally mild to moderate and often recurrent and is likely to be associated with malignant disease, chronic obstructive pulmonary disease, congestive heart failure, chronic renal disease, or any disease with chronic or recurrent inflammation.
“Chronic disease‐related inflammation is generally mild to moderate and often recurrent and is likely to be associated with malignant disease, chronic obstructive pulmonary disease, congestive heart failure, chronic renal disease, or any disease with chronic or recurrent inflammation.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [5]
Transient inflammation of a mild degree does not meet the threshold for the etiologic criterion of inflammation.
“Note that transient inflammation of a mild degree does not meet the threshold for this etiologic criterion.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [5]
At least one phenotypic criterion and one etiologic criterion are required for the diagnosis of malnutrition.
“At least one phenotypic criterion and one etiologic criterion are required for the diagnosis of malnutrition.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [5]
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- Authors
- Cederholm, T., Jensen, G. L., Correia, M. I. T. D., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., Baptista, G., Barazzoni, R., Blaauw, R., Coats, A. J. S., Crivelli, A. N., Evans, D. C., Gramlich, L., Fuchs‐Tarlovsky, V., Keller, H., Llido, L., Malone, A., Mogensen, K. M., Morley, J. E., Muscaritoli, M., Nyulasi, I., Pirlich, M., Pisprasert, V., de van der Schueren, M. A. E., Siltharm, S., Singer, P., Tappenden, K., Velasco, N., Waitzberg, D., Yamwong, P., Yu, J., Van Gossum, A., Compher, C., & GLIM Core Leadership Committee, G. W. G.
- Affiliations
- Uppsala University (SE)
- University of Vermont (US)
- Universidade Federal de Minas Gerais (BR)
- Post‐graduate Program in Health and Behavior Catholic University of Pelotas RS Brazil
- The University of Tokyo (JP)
- Fujita Health University (JP)
- Hospital Clínico Universitario de Caracas (VE)
- University of Trieste (IT)
- Stellenbosch University (ZA)
- University of Warwick (GB)
- Unit of Nutrition Support and Malabsorptive Diseases Hospital HIGA San Martín Buenos Aires Argentina
- The Ohio State University (US)
- University of Alberta (CA)
- Hospital General de México (MX)
- University of Waterloo (CA)
- St. Luke's Medical Center (PH)
- Mount Carmel Health (US)
- Brigham and Women's Hospital (US)
- Saint Louis University Hospital (US)
- Sapienza University of Rome (IT)
- Alfred Health (AU)
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology and Clinical Nutrition Berlin Germany
- Khon Kaen University (TH)
- Department of Nutrition and Dietetics Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam the Netherlands
- Ministry of Science and Technology Thailand (TH)
- Tel Aviv University (IL)
- University of Illinois Chicago (US)
- Pontificia Universidad Católica de Chile (CL)
- Universidade de São Paulo (BR)
- Siriraj Hospital (TH)
- Peking Union Medical College Hospital (CN)
- Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support Hopital Erasme, Free University of Brussels Brussels Belgium
- University of Pennsylvania (US)
- Corresponding author
- Cederholm, T.
- ORCID
- Cederholm, T.
- Jensen, G.L.
- Correia, M.I.T.D.
- Fukushima, R.
- Baptista, G.
- Barazzoni, R.
- Blaauw, R.
- Coats, A.J.S.
- Crivelli, A.N.
- Evans, D.C.
- Gramlich, L.
- Fuchs‐Tarlovsky, V.
- Keller, H.
- Malone, A.
- Mogensen, K.M.
- Morley, J.E.
- Muscaritoli, M.
- Nyulasi, I.
- Pirlich, M.
- Pisprasert, V.
- Singer, P.
- Tappenden, K.
- Velasco, N.
- Waitzberg, D.
- Yu, J.
- Compher, C.
- Venue
- Journal of Cachexia, Sarcopenia and Muscle
- Publisher
- Wiley
- Published
- 2019-02
- Volume
- 10
- Issue
- 1
- Pages
- 207-217
- ISSN
- 2190-5991 (ISSN-L)
- 2190-6009
- PMC
- PMC6438340
- OpenAlex
- W2930675045
- Cited by
- 1,724
- References
- 4
- Citations by year
- 2026: 174 · 2025: 209 · 2024: 233 · 2023: 216 · 2022: 191 · 2021: 315 · 2020: 270 · 2019: 103 · 2018: 9 · 2013: 1
- FWCI
- 150.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Cachexia Sarcopenia and Muscle (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- OpenBU (Boston University) (submittedVersion, cc-by)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
- ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, cc-by)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion, other-oa)
- Warwick Research Archive Portal (University of Warwick) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Japan Society for the Promotion of Science (17K10608)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Keywords
- malnutrition diagnosis, GLIM criteria, malnutrition screening, weight loss, body mass index, muscle mass, hypophagia, inflammation, cachexia, sarcopenia
- MeSH terms
- Adult, Eating, Humans, Phenotype, Global Health, Weight Loss, Body Mass Index, Consensus, Malnutrition, Sarcopenia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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