Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition diagnosis of malnutrition
Open accessAbstract
The Global Leadership Initiative on Malnutrition (GLIM) provides consensus criteria for the diagnosis of malnutrition that can be widely applied. The GLIM approach is based on the assessment of three phenotypic (weight loss, low body mass index, and low skeletal muscle mass) and two etiologic (low food intake and presence of disease with systemic inflammation) criteria, with diagnosis confirmed by any combination of one phenotypic and one etiologic criterion fulfilled. Assessment of muscle mass is less commonly performed than other phenotypic malnutrition criteria, and its interpretation may be less straightforward, particularly in settings that lack access to skilled clinical nutrition practitioners and/or to body composition methodologies. In order to promote the widespread assessment of skeletal muscle mass as an integral part of the GLIM diagnosis of malnutrition, the GLIM consortium appointed a working group to provide consensus‐based guidance on assessment of skeletal muscle mass. When such methods and skills are available, quantitative assessment of muscle mass should be measured or estimated using dual‐energy x‐ray absorptiometry, computerized tomography, or bioelectrical impedance analysis. For settings where these resources are not available, then the use of anthropometric measures and physical examination are also endorsed. Validated ethnic‐ and sex‐specific cutoff values for each measurement and tool are recommended when available. Measurement of skeletal muscle function is not advised as surrogate measurement of muscle mass. However, once malnutrition is diagnosed, skeletal muscle function should be investigated as a relevant component of sarcopenia and for complete nutrition assessment of persons with malnutrition.
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Assessment of body composition and muscle function can provide useful information to guide the clinical management of obesity.
“Assessment of body composition (lean/muscle mass and fat mass) and muscle function can provide useful information to guide the clinical management of obesity.”
From Strategies for minimizing muscle loss during use of incretin‐mimetic drugs for treatment of obesity (2025) · cites this paper as [111]
The ‘Level of agreement: 92%’ section recommends investigating muscle mass when low muscle function is detected, especially in people with overweight or obesity, and says muscle-function measures can help assess nutrition treatment. The paper addresses malnutrition assessment, however; it does not establish that measuring fat mass or muscle function guides the clinical management of obesity itself. No page number was supplied for these indexed passages. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAmong GLIM criteria, assessment of skeletal muscle mass is least often applied, while BMI is most applied.
“However, among the criteria included in the GLIM diagnosis, assessment of skeletal muscle mass is least often applied, while BMI continues to be the most applied (57).”
From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [57]
The Abstract says muscle-mass assessment is performed less commonly than the other phenotypic GLIM criteria, supporting that part of the claim. It does not say that BMI is the most applied criterion, or compare muscle-mass assessment with the etiologic criteria. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMRI can be considered a gold-standard method for accuracy, but MRI is not routinely available for assessment of muscle mass.
“Magnetic resonance imaging (MRI) can be considered a gold‐standard method for accuracy, 42 but MRI is not routinely available for the assessment of muscle mass. 40 , 41 , 42”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [41]
The 'Level of agreement 79%' section says MRI is unlikely to be available for routine clinical practice, supporting the availability claim. But 'General commentary and conclusions (Figure 2)' says no criterion-standard or superior technique is currently acknowledged, so this paper does not support calling MRI a gold standard for accuracy. Page numbers are not provided in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA GLIM working group later published guidance on how to measure muscle mass and define low muscle mass.
“For this reason, a GLIM working group later published such guidance. 40 , 41”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [41]
The guidance papers clarified that low muscle strength, although often closely associated with loss of muscle mass and included in full nutrition assessment after malnutrition diagnosis, is not a component of the GLIM diagnostic algorithm.
“The guidance papers clarified that low muscle strength, although often closely associated with loss of muscle mass and included in full nutrition assessment after malnutrition diagnosis, is not a component of the GLIM diagnostic algorithm. 40 , 41”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [41]
Calf circumference may be considered in the absence of machine-based techniques to evaluate muscle mass, and clinical judgment of inflammatory disease burden may only require laboratory confirmation (by CRP) in cases of uncertainty.
“Two GLIM working groups have since provided more detailed guidance; ie, calf circumference may be considered in the absence of machine‐based techniques to evaluate muscle mass, 40 , 41 and clinical judgment of inflammatory disease burden may only require laboratory confirmation (by CRP) in cases of uncertainty. 59 , 60”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [41]
When machine-based techniques are not available or by regional preference, physical examination or standard anthropometric measures such as calf circumference or mid-arm muscle circumference may be used to evaluate muscle mass.
“When not available or by regional preference, physical examination or standard anthropometric measures such as calf circumference or mid‐arm muscle circumference may be used.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [41]
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Self-citation
- Authors
- Compher, C., Cederholm, T., Correia, M. I. T. D., Gonzalez, M. C., Higashiguch, T., Shi, H. P., Bischoff, S. C., Boirie, Y., Carrasco, F., Cruz‐Jentoft, A., Fuchs‐Tarlovsky, V., Fukushima, R., Heymsfield, S. B., Mourtzakis, M., Muscaritoli, M., Norman, K., Nyulasi, I., Pisprasert, V., Prado, C. M., de van der Schuren, M., Yoshida, S., Yu, J., Jensen, G., & Barazzoni, R.
- Affiliations
- University of Pennsylvania (US)
- Uppsala University (SE)
- Department of Surgery, Medical School Universidade Federal de Minas Gerais Belo Horizonte Brazil
- Post‐Graduate Program in Health and Behavior Catholic University of Pelotas Pelotas Rio Grande do Sul Brazil
- Yonaha Okanoue Hospital Kuwana Japan
- Key Laboratory of Cancer FSMP for State Market Regulation, Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University Beijing China
- University of Hohenheim (DE)
- Unité de Nutrition Humaine, Clinical Nutrition Department, INRAE, CHU Clermont‐Ferrand, CRNH Auvergne Université Clermont Auvergne Clermont‐Ferrand France
- Department of Nutrition, Faculty of Medicine, Nutrition and Bariatric Surgery Center University of Chile, and Clínica Las Condes Santiago Chile
- Servicio de Geriatría Hospital Universitario Ramón y Cajal (IRYCIS) Madrid Spain
- Hospital General de México (MX)
- Teikyo Heisei University (JP)
- Pennington Biomedical Research Center (US)
- University of Waterloo (CA)
- Sapienza University of Rome (IT)
- Humboldt-Universität zu Berlin (DE)
- La Trobe University (AU)
- Khon Kaen University (TH)
- University of Alberta (CA)
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health HAN University of Applied Sciences Nijmegen The Netherlands
- Department of Rehabilitation Chuzan Hospital Okinawa‐city Okinawa Prefecture Japan
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- University of Vermont (US)
- University of Trieste (IT)
- Corresponding author
- Compher, Charlene
- ORCID
- Compher, Charlene
- Cederholm, Tommy
- Correia, Maria Isabel T. D.
- Gonzalez, Maria Cristina
- Bischoff, Stephan C.
- Boirie, Yves
- Fuchs‐Tarlovsky, Vanessa
- Fukushima, Ryoji
- Heymsfield, Steven B.
- Mourtzakis, Marina
- Muscaritoli, Maurizio
- Norman, Kristina
- Nyulasi, Ibolya
- Pisprasert, Veeradej
- Prado, Carla M.
- Yoshida, Sadao
- Yu, Jianchun
- Jensen, Gordon
- Barazzoni, Rocco
- Venue
- Journal of Parenteral and Enteral Nutrition
- Publisher
- Wiley
- Published
- 2022-04-19
- Volume
- 46
- Issue
- 6
- Pages
- 1232-1242
- ISSN
- 0148-6071 (ISSN-L)
- 1941-2444
- OpenAlex
- W4224221762
- Semantic Scholar
- cd33ee0a4f04194842d6770ded63d9aecec59ac2
- Cited by
- 125
- References
- 85
- Citations by year
- 2026: 35 · 2025: 24 · 2024: 32 · 2023: 25 · 2022: 8
- FWCI
- 14.08
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Journal of Parenteral and Enteral Nutrition (publishedVersion)
- PubMed (publishedVersion)
- ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, other-oa)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Keywords
- malnutrition diagnosis, skeletal muscle mass, GLIM criteria, anthropometry, body composition measurement, dual-energy X-ray absorptiometry, bioelectrical impedance analysis, computed tomography, cut-off values, sarcopenia, muscle function testing, nutritional assessment
- MeSH terms
- Female, Humans, Leadership, Male, Muscles, Nutritional Status, Weight Loss, Nutrition Assessment, Malnutrition, Sarcopenia
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