Cited by 3,022Nutrition and Health in AgingClinical Nutrition and GastroenterologyBody Composition Measurement Techniques

GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community

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Cederholm, T., Jensen, G.L., Correia, M.I.T.D., Gonzalez, M.C., Fukushima, R., Higashiguchi, T., Baptista, G., Barazzoni, R. +58 more·2019·Clinical Nutrition

Abstract

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 (non-volitional 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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Crossref · 10.1016/j.clnu.2018.08.002

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  • GLIM convened in 2018 to build a global consensus for diagnostic criteria for malnutrition in adults applicable in diverse global settings.

    “In 2018 (Figure 1), the Global Leadership Initiative on Malnutrition (GLIM) convened to build a global consensus for diagnostic criteria for malnutrition in adults applicable in diverse global settings (15).”

    From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [15]

    The Introduction and Abstract explicitly say GLIM was convened in January 2016, not 2018. The paper supports the stated goal of developing global consensus on adult malnutrition diagnostic criteria, but contradicts the claimed convening year. The Results describe a meeting in January 2018, which is distinct from GLIM's convening. (LLM, conf=0.92)

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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 [4]

    Section 3.6 (page unavailable) lists conditions associated with reduced nutrient assimilation, supporting the first part of the claim. But it explicitly instructs clinicians to discern severity using factors including frequency and duration of losses, contrary to the claim that severity and duration were not considered. (LLM, conf=0.88)

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  • The most accurate and reliable methods for assessing body composition, magnetic resonance imaging, computed tomography, and dual-energy X-ray absorptiometry, have limited availability in outpatient settings and relatively high costs.

    “The most accurate and reliable methods for assessing body composition (magnetic resonance imaging [MRI], computed tomography [CT], and DXA) have limited availability in outpatient settings and relatively high costs.”

    From Strategies for minimizing muscle loss during use of incretin‐mimetic drugs for treatment of obesity (2025) · cites this paper as [62]

    Section 3.5 (page not provided) recommends DXA, CT and MRI as validated measures and says such methods are unavailable in most settings for nutritional assessment. It anticipates less costly technologies, but does not call these three methods the most accurate and reliable, establish their costs, or specifically describe outpatient availability. (LLM, conf=0.86)

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  • GLIM recommends measuring C-reactive protein (CRP) as a biomarker to judge whether systemic inflammation is chronic or severe, although low albumin/prealbumin levels are also included.

    “To judge whether systemic inflammation is chronic or severe, GLIM recommends the measurement of C-reactive protein (CRP) as a biomarker, although low albumin/prealbumin levels are also included.”

    From Evolution of the diagnosis of malnutrition in adults: a primer for clinicians (2024) · cites this paper as [15]

    Section 3.7 (page unavailable) lists CRP, albumin, and pre-albumin as possible supportive proxy measures of inflammation, and the table note reproduced in section 3.6 says CRP may be used as a supportive laboratory measure. The paper describes clinical diagnosis and judgment for recognizing chronic or severe inflammation; it does not recommend CRP measurement as necessary for judging either, nor does it specify low albumin/pre-albumin levels as GLIM criteria. (LLM, conf=0.86)

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  • The 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 [4]

    The consensus procedure and Discussion describe a framework intended for global use, with simple criteria and widely available methods; Section 3.5 offers alternative measures where preferred methods are unavailable. But the Conclusion limits the proposed criteria to adults in clinical settings and calls for validation, so applicability across most settings regardless of resources is stronger than the paper establishes. The indexed copy does not provide page numbers. (LLM, conf=0.82)

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Research works printed but not linked: 1

  1. [17]17. Chen LK, Lee WJ, Peng LN, Liu LK, Arai H, Akishita M, Asian working group for sarcopenia. Recent advances in sarcopenia research in Asia: updat from the Asian working group for sarcopenia. JAMDA 2016;17:767.e1e7.

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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., Crivelli, A., 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., Jensen, G. L., Charlene, C., Cederholm, T., Van Gossum, A., Correia, M. I. T. D., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., Baptista, G., Barazzoni, R., Blaauw, R., Coats, A., Crivelli, A., Evans, D. C., Gramlich, L., Fuchs, 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.
Affiliations
  • University of Vermont (US)
  • Universidade Federal de Minas Gerais (BR)
  • Universidade Católica de Pelotas (BR)
  • The University of Tokyo (JP)
  • Fujita Health University (JP)
  • Hospital General de México (MX)
  • University of Pennsylvania (US)
  • University of Waterloo (CA)
Venue
Clinical Nutrition
Publisher
Elsevier BV
Published
2019-02
Volume
38
Issue
1
Pages
1-9
ISSN
0261-5614 (ISSN-L)
OpenAlex
W4231015464
Cited by
3,022
References
24
Citations by year
2026: 540 · 2025: 499 · 2024: 495 · 2023: 422 · 2022: 370 · 2021: 325 · 2020: 255 · 2019: 103 · 2018: 11
FWCI
119.30
Type
journal article
Language
en
Open access
Locations
  • Clinical Nutrition (publishedVersion)
  • ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, other-oa)
  • 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)
  • Warwick Research Archive Portal (University of Warwick) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
  • EA Pharma Co., Ltd.
  • Terumo
  • Taiho Pharmaceutical
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, low body mass index, inflammation, malnutrition screening, adults, consensus criteria

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