Cited by 90Nutrition and Health in AgingClinical Nutrition and GastroenterologyBody Composition Measurement Techniques

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

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Jensen, Gordon L., Cederholm, Tommy, Ballesteros‐Pomar, Maria D., Blaauw, Renee, Correia, M. Isabel T. D., Cuerda, Cristina, Evans, David C., Fukushima, Ryoji +28 more·2024·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.

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  • Anorexia of aging may explain loss of appetite experienced by some persons of advanced age who do not appear to have known disease conditions that affect appetite and are not receiving known appetite-suppressing treatments; such individuals do appear to have low-grade inflammation and associated hunger-satiety imbalance.

    ““Anorexia of aging” may explain the loss of appetite experienced by some persons of advanced age who do not appear to have known disease conditions that affect appetite and are not receiving known appetite‐suppressing treatments. Such individuals do appear to have low‐grade inflammation and associated hunger‐satiety imbalance. 58 , 59”

    From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [59]

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  • Congestive heart failure, cancer, and chronic kidney disease are examples of diseases that may be associated with chronic inflammation of mild/moderate degree.

    “Examples of diseases that may be associated with chronic inflammation of mild/moderate degree include congestive heart failure, cancer, and chronic kidney disease.”
  • Anorexia nervosa, depression, dysphagia, and nondisease conditions associated with limited resources or environments that compromise food security, access, or intake, including poverty, famine, and war, are examples of conditions with no clear or perceptible inflammatory components.

    “Examples include anorexia nervosa, depression, dysphagia, and nondisease conditions that are associated with limited resources or environments that compromise food security, access, or intake, including poverty, famine, and war.”
  • A GLIM working group undertook a robust modified Delphi process to provide comprehensive guidance.

    “A GLIM working group, therefore, undertook a robust modified Delphi process to provide comprehensive guidance. 59 , 60”
  • For acute conditions, CRP levels ≥10 times higher than the upper reference value for the methodology of the selected clinical laboratory can be used to support the presence of moderate to severe acute inflammation.

    “For acute conditions, CRP levels ≥10 times higher than the upper reference value for the methodology of the selected clinical laboratory can be used to support the presence of moderate to severe acute inflammation.”

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  1. [11]11. Jensen GL. Malnutrition and nutritional assessment. In: Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson J, eds. Harrison's Principles of Internal Medicine, 21e . McGraw Hill; 2022. Accessed October 7, 2023. https://accesspharmacy.mhmedical.com/content. aspx?bookid=3095&sectionid=264532265
  2. [29]29. Detsky A, McLaughlin JR, Baker J, et al. What is subjective global assessment? JPEN J Parenter Enteral Nutr . 1987;11(1):8 -13.
  3. [69]69. Nehring SM, Goyal A, Patel BC. C reactive protein. In: StatPearls . StatPearls Publishing; 2023. Updated July 10, 2023. Accessed October 7, 2023. https://www.ncbi.nlm.nih.gov/books/NBK441843/

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Authors
Jensen, G. L., Cederholm, T., Ballesteros‐Pomar, M. D., Blaauw, R., Correia, M. I. T. D., Cuerda, C., Evans, D. C., Fukushima, R., Gautier, J. B. O., Gonzalez, M. C., van Gossum, A., Gramlich, L., Hartono, J., Heymsfield, S. B., Jager‐Wittenaar, H., Jayatissa, R., Keller, H., Malone, A., Manzanares, W., McMahon, M. M., Mendez, Y., Mogensen, K. M., Mori, N., Muscaritoli, M., Nogales, G. C., Nyulasi, I., Phillips, W., Pirlich, M., Pisprasert, V., Rothenberg, E., de van der Schueren, M., Shi, H. P., Steiber, A., Winkler, M. F., Compher, C., & Barazzoni, R.
Affiliations
  • University of Vermont (US)
  • Uppsala University (SE)
  • Department of Endocrinology and Nutrition Complejo Asistencial Universitario de León León Spain
  • Division of Human Nutrition, Faculty of Medicine and Health Sciences Stellenbosch University Cape Town South Africa
  • Universidade Federal de Minas Gerais (BR)
  • Hospital General Universitario Gregorio Marañón (ES)
  • OhioHealth (US)
  • Teikyo Heisei University (JP)
  • Hunterdon Medical Center Flemington New Jersey USA
  • Universidade Federal de Pelotas Pelotas Brazil
  • Department of Gastroenterology and Clinical Nutrition Hospital Universitaire de Bruxelles Brussels Belgium
  • University of Alberta (CA)
  • Gatot Soebroto Army Hospital (ID)
  • Pennington Biomedical Research Center (US)
  • Hanze University of Applied Sciences (NL)
  • Department of Nutrition and Food Science International Institute of Health Sciences Colobo Sri Lanka
  • University of Waterloo (CA)
  • American Society for Parenteral and Enteral Nutrition (US)
  • Universidad de la República de Uruguay (UY)
  • Mayo Clinic (US)
  • Internal Medicine, Clinical Nutrition Colegio Mexicano de Nutrición Clínica y Terapia Nutricional Mexico City Mexico
  • Brigham and Women's Hospital (US)
  • Aichi Medical University (JP)
  • Sapienza University of Rome (IT)
  • EsSALUD (PE)
  • La Trobe University (AU)
  • Morrison Healthcare Cleveland Ohio USA
  • Departments of Endocrinology, Gastroenterology, and Clinical Nutrition Imperial Oak Outpatient Clinic Berlin Germany
  • Khon Kaen University (TH)
  • Kristianstad University (SE)
  • School of Allied Health, HAN University of Applied Sciences; Division of Human Nutrition and Health Wageningen University Wageningen The Netherlands
  • Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital Capital Medical University Beijing China
  • Academy of Nutrition and Dietetics (US)
  • Brown University (US)
  • Hospital of the University of Pennsylvania (US)
  • University of Trieste (IT)
Corresponding author
Jensen, Gordon L.
Venue
Journal of Parenteral and Enteral Nutrition
Publisher
Wiley
Published
2024-01-15
Volume
48
Issue
2
Pages
145-154
ISSN
  • 0148-6071 (ISSN-L)
  • 1941-2444
OpenAlex
W4390885126
Cited by
84
References
71
Citations by year
2026: 33 · 2025: 35 · 2024: 16
FWCI
23.91
Type
journal article
Language
en
Open access
Locations
  • Journal of Parenteral and Enteral Nutrition (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, cc-by-nc-nd)
  • Socio-Environmental Systems Modeling (submittedVersion, cc-by-nc-nd)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-nd)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
  • VUBIR (Vrije Universiteit Brussel) (submittedVersion)
Funders
  • American Society for Parenteral and Enteral Nutrition
  • European Society for Clinical Nutrition and Metabolism
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
GLIM criteria, malnutrition diagnosis, inflammation assessment, C-reactive protein, disease burden, infection, injuries, consensus recommendations, Delphi consensus, weight loss, body mass index, skeletal muscle mass
MeSH terms
Humans, Inflammation, Leadership, Weight Loss, Nutrition Assessment, Cost of Illness, Consensus, Malnutrition

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