Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach
Open accessAbstract
BACKGROUND & AIMS: 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 in support of the etiologic criterion for inflammation. METHODS: A GLIM-constituted working group with 36 participants developed consensus-based guidance through a modified-Delphi review. A multi-round 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 (mg/dL or mg/L) for the clinical laboratory that is being used. CONCLUSION: Confirmation of inflammation should be guided by clinical judgement based upon underlying diagnosis or condition, clinical signs, or CRP.
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Disease conditions that have no clear or perceptible inflammatory components will not fulfill the disease burden/inflammation criterion unless confirmed by laboratory analyses.
“Disease conditions that have no clear or perceptible inflammatory components will not fulfill the disease burden/inflammation criterion unless confirmed by laboratory analyses.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [60]
For chronic conditions, serial measures of CRP higher than the upper reference value for the methodology of the selected clinical laboratory support the presence of the chronic inflammation criterion.
“For chronic conditions, serial measures of CRP higher than the upper reference value for the methodology of the selected clinical laboratory support the presence of the chronic inflammation criterion.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [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.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [60]
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.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [60]
Critical illness or sepsis and exacerbations of COPD or Crohn's disease are examples of acute diseases or conditions that may be associated with acute inflammation of severe/moderate degree.
“Examples of acute diseases or conditions that may be associated with acute inflammation of severe/moderate degree include critical illness or sepsis and exacerbations of COPD or Crohn's disease.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [60]
Repeated measures of CRP higher than the upper cutoff level of the selected clinical laboratory support the presence of chronic inflammation.
“Serial measurements of CRP are recommended, and repeated measures higher than the upper cutoff level of the selected clinical laboratory support the presence of chronic inflammation.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [60]
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”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [60]
The documentation of laboratory markers indicating inflammation may support confirmation of the inflammation criterion.
“The documentation of laboratory markers indicating inflammation may support confirmation of the inflammation criterion.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [60]
The occurrence of acute or chronic disease, infection, or injury that is often/usually associated with inflammatory activity may fulfill the GLIM disease burden/inflammation criterion, and confirmation by laboratory markers is not always necessary.
“The occurrence of acute or chronic disease, infection, or injury that is often/usually associated with inflammatory activity may fulfill the GLIM disease burden/inflammation criterion, and confirmation by laboratory markers is not always necessary.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [60]
The sound interpretation of some indicators of inflammatory disease or condition requires clinical training and expertise.
“The sound interpretation of some of these indicators requires clinical training and expertise.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [60]
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.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [60]
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 [60]
C-reactive protein may be used as a supportive laboratory measure for the inflammation criterion.
“C‐reactive protein may be used as a supportive laboratory measure.”
From GLIM consensus approach to diagnosis of malnutrition: A 5‐year update (2025) · cites this paper as [60]
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- Authors
- 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., 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., Barazzoni, R., & Compher, C.
- Affiliations
- Uppsala University (SE)
- University of Vermont (US)
- Universidade Federal de Minas Gerais (BR)
- Hospital General Universitario Gregorio Marañón (ES)
- OhioHealth (US)
- Pennington Biomedical Research Center (US)
- Corresponding author
- Cederholm, Tommy
- Jensen, Gordon L.
- Correia, M. Isabel T.D.
- Cuerda, Cristina
- Evans, David C.
- Fukushima, Ryoji
- Gramlich, Leah
- Hartono, Joseph
- Heymsfield, Steven B.
- Jayatissa, Renuka
- Keller, Heather
- Malone, Ainsley
- Manzanares, William
- McMahon, M. Molly
- Mendez, Yolanda
- Mogensen, Kris M.
- Mori, Naoharu
- Muscaritoli, Maurizio
- Nogales, Guillermo Contreras
- Nyulasi, Ibolya
- Phillips, Wendy
- Pirlich, Matthias
- Pisprasert, Veeradej
- Rothenberg, Elisabet
- Steiber, Alison
- Winkler, Marion F.
- Barazzoni, Rocco
- Compher, Charlene
- ORCID
- Cederholm, Tommy
- Jensen, Gordon L.
- Ballesteros-Pomar, Maria D.
- Blaauw, Renee
- Correia, M. Isabel T.D.
- Cuerda, Cristina
- Evans, David C.
- Fukushima, Ryoji
- Ochoa Gautier, Juan Bernardo
- Gonzalez, M. Cristina
- Gramlich, Leah
- Heymsfield, Steven B.
- Jager-Wittenaar, Harriët
- Jayatissa, Renuka
- Keller, Heather
- Malone, Ainsley
- Manzanares, William
- McMahon, M. Molly
- Mendez, Yolanda
- Mogensen, Kris M.
- Mori, Naoharu
- Muscaritoli, Maurizio
- Nogales, Guillermo Contreras
- Nyulasi, Ibolya
- Phillips, Wendy
- Pirlich, Matthias
- Pisprasert, Veeradej
- Rothenberg, Elisabet
- de van der Schueren, Marian
- Steiber, Alison
- Winkler, Marion F.
- Barazzoni, Rocco
- Compher, Charlene
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2024-05
- Volume
- 43
- Issue
- 5
- Pages
- 1025-1032
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W4389110106
- Cited by
- 115
- References
- 66
- Citations by year
- 2026: 41 · 2025: 52 · 2024: 22
- FWCI
- 20.40
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical 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, cc-by-nc-nd)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc-nd)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- SUNScholar (Stellenbosch University) (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, disease burden, C-reactive protein, acute phase response, infection, injuries, clinical judgment, consensus recommendations, Delphi consensus
- MeSH terms
- C-Reactive Protein, Delphi Technique, Humans, Inflammation, Biomarkers, Weight Loss, Nutrition Assessment, Body Mass Index, Consensus, Malnutrition
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.
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