ESPEN guidelines on definitions and terminology of clinical nutrition
Open accessAbstract
Background A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research.Objective This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures.Methods The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round.Results Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery.Conclusion An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions.
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Patients with chronic diseases and hypoalbuminemia lose fat-free mass despite adequate food intake.
“Further, patients with chronic diseases and hypoalbuminemia lose fat‐free mass, considered to be an essential indicator of the undernourished state, despite adequate food intake.2, 3”
From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [3]
Section 3.2.1.1 describes chronic disease-related malnutrition (cachexia) as involving loss of muscle mass, and section 3.1.1 lists reduced albumin as a possible biochemical indicator of inflammation. The guidelines do not say that patients with both chronic disease and hypoalbuminemia lose fat-free mass despite adequate food intake. They also caution in section 3.3.6.3 that serum proteins should not themselves be used as indicators of nutritional status. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe lack of consensus on nutrition concepts and terminology has hindered development of a common nutrition language to support sharing prevalence data, testing targeted interventions, and monitoring outcomes globally.
“The lack of consensus has hindered the development of a common nutrition language to support sharing of meaningful prevalence data, the testing of targeted interventions, and the monitoring of outcomes across the globe.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [2]
The Introduction says that inconsistent terminology limits a shared professional language and that consensus would improve the comparability of nutrition practices and advance research. It does not specifically link the lack of consensus to sharing prevalence data, testing targeted interventions, or monitoring outcomes across the globe. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn severely underweight patients, the target of 30 kcal/kg actual body weight should be cautiously and slowly achieved because this population is at high risk of refeeding syndrome.
“This target of 30 kcal/kg actual body weight in severely underweight patients should be cautiously and slowly achieved, as this is a population at high risk of refeeding syndrome.”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [74]
Section 3.2.6 (Refeeding syndrome; page unavailable) identifies severe chronic undernutrition as a high-risk condition and says refeeding syndrome can occur when feeding begins too aggressively. It does not specify a target of 30 kcal/kg actual body weight or say how slowly that target should be reached. (LLM, conf=0.88)
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Suggestions for terminology in clinical nutrition
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Self-citationEFSA Panel on Dietetic Products, N. A. A. (. (2015) · EFSA Journal · doi:10.2903/j.efsa.2015.4300 · Cited by 11 · see citing works
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Research works printed but not linked: 1
- Jeejeebhoy KN. Malnutrition, fatigue, frailty, vulnerability, sarcopenia and cachexia. Curr Op Clin Nutr Metabol Care 2012;15:213e9.
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Sarcopenia: revised European consensus on definition and diagnosis
Cruz-Jentoft, A. J., Bahat, G., Bauer, J., Boirie, Y., Bruyère, O., Cederholm, T., Cooper, C., Landi, F., Rolland, Y., Sayer, A. A., et al. (2019) · Age and Ageing · doi:10.1093/ageing/afy169 · Cited by 13,818 · see citing works
Self-citationCederholm, T., Jensen, G. L., Correia, M. I. T. D., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., Baptista, G., Barazzoni, R., Blaauw, R., Coats, A., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.002 · Cited by 3,022 · see citing works
Self-citationESPEN guideline on clinical nutrition in the intensive care unit.
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.037 · Cited by 2,904 · see citing works
Self-citationHypoalbuminemia: Pathogenesis and Clinical Significance
Soeters, P. B., Wolfe, R. R., & Shenkin, A. (2019) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.1451 · Cited by 1,448 · see citing works
ESPEN expert group recommendations for action against cancer-related malnutrition
Arends, J., Baracos, V., Bertz, H., Bozzetti, F., Calder, P. C., Deutz, N. E. P., Erickson, N., Laviano, A., Lisanti, M. P., Lobo, D. N., et al. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2017.06.017 · Cited by 1,305 · see citing works
Self-citationDent, E., Morley, J. E., Cruz-Jentoft, A. J., Arai, H., Kritchevsky, S. B., Guralnik, J., Bauer, J. M., Pahor, M., Clark, B. C., Cesari, M., et al. (2018) · The Journal of nutrition, health and aging · doi:10.1007/s12603-018-1139-9 · Cited by 1,130 · see citing works
Self-citationESPEN guidelines on nutritional support for polymorbid internal medicine patients
Gomes, F., Schuetz, P., Bounoure, L., Austin, P., Ballesteros-Pomar, M., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., Poulia, K.-A., et al. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2017.06.025 · Cited by 363 · see citing works
Self-citationMalnutrition Screening and Assessment
Serón-Arbeloa, C., Labarta-Monzón, L., Puzo-Foncillas, J., Mallor-Bonet, T., Lafita-López, A., Bueno-Vidales, N., & Montoro-Huguet, M. (2022) · doi:10.20944/preprints202205.0071.v1 · Cited by 312
van der Werf, A., Langius, J. A. E., de van der Schueren, M. A. E., Nurmohamed, S. A., van der Pant, K. A. M. I., Blauwhoff-Buskermolen, S., & Wierdsma, N. J. (2018) · European Journal of Clinical Nutrition · doi:10.1038/s41430-017-0034-5 · Cited by 295 · see citing works
Self-citationMerker, M., Felder, M., Gueissaz, L., Bolliger, R., Tribolet, P., Kägi-Braun, N., Gomes, F., Hoess, C., Pavlicek, V., Bilz, S., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.0663 · Cited by 262 · see citing works
ESPEN guideline on hospital nutrition
Thibault, R., Abbasoglu, O., Ioannou, E., Meija, L., Ottens-Oussoren, K., Pichard, C., Rothenberg, E., Rubin, D., Siljamäki-Ojansuu, U., Vaillant, M.-F., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.09.039 · Cited by 259 · see citing works
Self-citationSarcopenic obesity: time to meet the challenge
Barazzoni, R., Bischoff, S. C., Boirie, Y., Busetto, L., Cederholm, T., Dicker, D., Toplak, H., Van Gossum, A., Yumuk, V., & Vettor, R. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2018.04.018 · Cited by 260 · see citing works
Self-citationVerlaan, S., Ligthart-Melis, G. C., Wijers, S. L. J., Cederholm, T., Maier, A. B., & de van der Schueren, M. A. E. (2017) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2016.12.074 · Cited by 246 · see citing works
Self-citationSarcopenic obesity: time to meet the challenge
Barazzoni, R., Bischoff, S., Boirie, Y., Busetto, L., Cederholm, T., Dicker, D., Toplak, H., Van Gossum, A., Yumuk, V., & Vettor, R. (2018) · Obesity Facts · doi:10.1159/000490361 · Cited by 244 · see citing works
Self-citationMuscle loss: The new malnutrition challenge in clinical practice
Landi, F., Camprubi-Robles, M., Bear, D. E., Cederholm, T., Malafarina, V., Welch, A. A., & Cruz-Jentoft, A. J. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.11.021 · Cited by 235 · see citing works
Self-citationMalnutrition as a strong predictor of the onset of sarcopenia
Beaudart, C., Sanchez-Rodriguez, D., Locquet, M., Reginster, J.-Y., Lengelé, L., & Bruyère, O. (2019) · Nutrients · doi:10.3390/nu11122883 · Cited by 226 · see citing works
Duarte‐Rojo, A., Ruiz‐Margáin, A., Montaño‐Loza, A. J., Macías‐Rodríguez, R. U., Ferrando, A., & Kim, W. R. (2018) · Liver Transplantation · doi:10.1002/lt.24958 · Cited by 221 · see citing works
Inflammation and nutrition: friend or foe?
Stumpf, F., Keller, B., Gressies, C., & Schuetz, P. (2023) · Nutrients · doi:10.3390/nu15051159 · Cited by 213 · see citing works
Strategies for minimizing muscle loss during use of incretin‐mimetic drugs for treatment of obesity
Mechanick, J. I., Butsch, W. S., Christensen, S. M., Hamdy, O., Li, Z., Prado, C. M., & Heymsfield, S. B. (2025) · Obesity Reviews · doi:10.1111/obr.13841 · Cited by 149 · see citing works
Keller, H., de van der Schueren, M. A. E., for the GLIM Consortium, Jensen, G. L., Barazzoni, R., Compher, C., Correia, M. I. T. D., Gonzalez, M. C., Jager‐Wittenaar, H., Pirlich, M., et al. (2020) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.1806 · Cited by 131 · see citing works
Self-citationCederholm, T., & Bosaeus, I. (2024) · New England Journal of Medicine · doi:10.1056/nejmra2212159 · Cited by 131 · see citing works
Self-citationFauziah, N., Aviani, J. K., Agrianfanny, Y. N., & Fatimah, S. N. (2022) · Tropical Medicine and Infectious Disease · doi:10.3390/tropicalmed7110371 · Cited by 122 · see citing works
Cederholm, T., Jensen, G. L., Ballesteros-Pomar, M. D., Blaauw, R., Correia, M. I. T. D., Cuerda, C., Evans, D. C., Fukushima, R., Ochoa Gautier, J. B., Gonzalez, M. C., et al. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2023.11.026 · Cited by 115 · see citing works
Self-citationWagenaar, C. A., Dekker, L. H., & Navis, G. J. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.01.005 · Cited by 105 · see citing works
ESPEN guideline on nutritional support for polymorbid medical inpatients
Wunderle, C., Gomes, F., Schuetz, P., Stumpf, F., Austin, P., Ballesteros-Pomar, M. D., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.06.023 · Cited by 105 · see citing works
“The diagnostic criteria and the factors proposed for screening of refeeding syndrome have been proposed elsewhere [74].”
Self-citationManagement of eating disorders for people with higher weight: clinical practice guideline
Ralph, A. F., Brennan, L., Byrne, S., Caldwell, B., Farmer, J., Hart, L. M., Heruc, G. A., Maguire, S., Piya, M. K., Quin, J., et al. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00622-w · Cited by 107 · see citing works
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., et al. (2024) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.2590 · Cited by 84 · see citing works
Self-citationCruz-Jentoft, A. J., Gonzalez, M. C., & Prado, C. M. (2023) · European Geriatric Medicine · doi:10.1007/s41999-023-00760-7 · Cited by 83 · see citing works
GLIM consensus approach to diagnosis of malnutrition: A 5‐year update
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Self-citationOrsso, C. E., Montes‐Ibarra, M., Findlay, M., van der Meij, B. S., de van der Schueren, M. A. E., Landi, F., Laviano, A., & Prado, C. M. (2022) · Journal of Cachexia, Sarcopenia and Muscle · doi:10.1002/jcsm.12954 · Cited by 73 · see citing works
Self-citationvon Berens, Å., Obling, S. R., Nydahl, M., Koochek, A., Lissner, L., Skoog, I., Frändin, K., Skoglund, E., Rothenberg, E., & Cederholm, T. (2020) · BMC Geriatrics · doi:10.1186/s12877-020-01578-9 · Cited by 62 · see citing works
Self-citationDiagnosis and management of malnutrition in patients with heart failure
Esteban-Fernández, A., Villar-Taibo, R., Alejo, M., Arroyo, D., Bonilla Palomas, J. L., Cachero, M., Joaquin, C., Méndez Bailón, M., Pérez-Rivera, J. Á., Romero-Vigara, J. C., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12093320 · Cited by 61 · see citing works
Sarcopenia and polypharmacy among older adults: A scoping review of the literature
Pana, A., Sourtzi, P., Kalokairinou, A., & Velonaki, V. S. (2022) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2021.104520 · Cited by 57 · see citing works
Díaz, G., T.D. Correia, M. I., Gonzalez, M. C., & Reyes, M. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2022.12.007 · Cited by 55 · see citing works
Peric, Z., Botti, S., Stringer, J., Krawczyk, J., van der Werf, S., van Biezen, A., Aljurf, M., Murray, J., Liptrott, S., Greenfield, D. M., et al. (2018) · Bone Marrow Transplantation · doi:10.1038/s41409-018-0137-1 · Cited by 54 · see citing works
Li, J., Wang, L., Zhang, H., Zou, T., Kang, Y., He, W., Xu, Y., & Yin, W. (2023) · Journal of Intensive Care · doi:10.1186/s40560-023-00674-3 · Cited by 49 · see citing works
Hansen, D., Decroix, L., Devos, Y., Nocca, D., Cornelissen, V., Dillemans, B., & Lannoo, M. (2020) · Obesity Surgery · doi:10.1007/s11695-020-04390-x · Cited by 46 · see citing works
Geng, Q., Zhai, H., Wang, L., Wei, H., & Hou, S. (2023) · Medicine · doi:10.1097/md.0000000000034254 · Cited by 33 · see citing works
Sánchez-Rodríguez, D., De Meester, D., Minon, L., Claessens, M., Gümüs, N., Lieten, S., Benoit, F., Surquin, M., & Marco, E. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20075320 · Cited by 32 · see citing works
Nonalcoholic fatty liver disease and sarcopenia: Where do we stand?
Mikolasevic, I., Pavic, T., Filipec Kanizaj, T., Bender, D. V., Domislovic, V., & Krznaric, Z. (2020) · Canadian Journal of Gastroenterology and Hepatology · doi:10.1155/2020/8859719 · Cited by 30 · see citing works
Enteral nutrition in hospitalized adults
Gramlich, L., & Guenter, P. (2025) · New England Journal of Medicine · doi:10.1056/nejmra2406954 · Cited by 30 · see citing works
Sousa-Santos, A. R., Afonso, C., Borges, N., Santos, A., Padrão, P., Moreira, P., & F Amaral, T. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-033661 · Cited by 27 · see citing works
Is RED-S in athletes just another face of malnutrition?
Peklaj, E., Reščič, N., Koroušic´ Seljak, B., & Rotovnik Kozjek, N. (2022) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2022.01.031 · Cited by 18 · see citing works
Kohlenberg-Müller, K., Ramminger, S., Kolm, A., Barkmeijer, A., Gast, C., Adam, M., Le Bruyn, B., Heine-Bröring, R., Rachman-Elbaum, S., Werkman, A., et al. (2019) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2019.03.017 · Cited by 10 · see citing works
Self-citationKhoonin, W., Shantavasinkul, P. C., Santivarangkna, C., Praengam, K., & Trachootham, D. (2023) · Frontiers in Nutrition · doi:10.3389/fnut.2023.1164469 · Cited by 7 · see citing works
- Authors
- Cederholm, T., Barazzoni, R., Austin, P., Ballmer, P., Biolo, G., Bischoff, S. C., Compher, C., Correia, I., Higashiguchi, T., Holst, M., Jensen, G. L., Malone, A., Muscaritoli, M., Nyulasi, I., Pirlich, M., Rothenberg, E., Schindler, K., Schneider, S. M., de van der Schueren, M. A. E., Sieber, C., Valentini, L., Yu, J. C., Van Gossum, A., & Singer, P.
- Affiliations
- Uppsala University (SE)
- University of Trieste (IT)
- University Hospital Southampton NHS Foundation Trust (GB)
- Kantonsspital Winterthur (CH)
- University of Hohenheim (DE)
- University of Pennsylvania (US)
- Universidade Federal de Minas Gerais (BR)
- Fujita Health University (JP)
- Aalborg University Hospital (DK)
- University of Vermont (US)
- Mount Carmel Health (US)
- Sapienza University of Rome (IT)
- The Alfred Hospital (AU)
- Kristianstad University (SE)
- Medical University of Vienna (AT)
- Hôpital l'Archet (FR)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Neubrandenburg University of Applied Sciences (DE)
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- Tel Aviv University (IL)
- Corresponding author
- Cederholm, T.
- Barazzoni, R.
- Austin, P.
- Ballmer, P.
- Biolo, G.
- Bischoff, S.C.
- Compher, C.
- Correia, I.
- Higashiguchi, T.
- Holst, M.
- Jensen, G.L.
- Malone, A.
- Muscaritoli, M.
- Nyulasi, I.
- Pirlich, M.
- Rothenberg, E.
- Schindler, K.
- Schneider, S.M.
- Sieber, C.
- Valentini, L.
- Yu, J.C.
- Singer, P.
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2017-02
- Volume
- 36
- Issue
- 1
- Pages
- 49-64
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W2521019952
- Cited by
- 2,560
- References
- 84
- Citations by year
- 2026: 274 · 2025: 329 · 2024: 348 · 2023: 370 · 2022: 314 · 2021: 325 · 2020: 236 · 2019: 185 · 2018: 112 · 2017: 58 · 2016: 4 · 2013: 1
- FWCI
- 124.98
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, cc-by-nc-nd)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- European Society for Clinical Nutrition and Metabolism
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Keywords
- malnutrition, disease-related malnutrition, cachexia, inflammation, overnutrition, sarcopenia, frailty, nutritional screening, nutritional assessment, hospital food service, oral nutritional supplementation, enteral nutrition, parenteral nutrition, medical nutrition therapy
- MeSH terms
- Frailty, Cachexia, Diet, Enteral Nutrition, Humans, Terminology as Topic, Nutritional Status, Obesity, Parenteral Nutrition, Societies, Scientific, Nutrition Assessment, Nutrition Policy, Consensus, Malnutrition, Overweight, Sarcopenia
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