TY - JOUR
T1 - Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition
T2 - A modified Delphi approach
AU - Cederholm, Tommy
AU - Jensen, Gordon L
AU - Ballesteros-Pomar, Maria D
AU - Blaauw, Renee
AU - Correia, M Isabel T D
AU - Cuerda, Cristina
AU - Evans, David C
AU - Fukushima, Ryoji
AU - Gautier, Juan Bernardo Ochoa
AU - Gonzalez, M Cristina
AU - van Gossum, Andre
AU - Gramlich, Leah
AU - Hartono, Joseph
AU - Heymsfield, Steven B
AU - Jager-Wittenaar, Harriët
AU - Jayatissa, Renuka
AU - Keller, Heather
AU - Malone, Ainsley
AU - Manzanares, William
AU - McMahon, M Molly
AU - Mendez, Yolanda
AU - Mogensen, Kris M
AU - Mori, Naoharu
AU - Muscaritoli, Maurizio
AU - Nogales, Guillermo Contreras
AU - Nyulasi, Ibolya
AU - Phillips, Wendy
AU - Pirlich, Matthias
AU - Pisprasert, Veeradej
AU - Rothenberg, Elisabet
AU - de van der Schueren, Marian
AU - Shi, Han Ping
AU - Steiber, Alison
AU - Winkler, Marion F
AU - Barazzoni, Rocco
AU - Compher, Charlene
N1 - © 2023 The Authors. Journal of Parenteral and Enteral Nutrition published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition.
PY - 2023/11/28
Y1 - 2023/11/28
N2 - 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.
AB - 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.
KW - Nutrition
KW - Malnutrition
KW - Infammation
KW - assessment
KW - C‐reactive protein
KW - inflammation
KW - malnutrition
U2 - 10.1016/j.clnu.2023.11.026
DO - 10.1016/j.clnu.2023.11.026
M3 - Article
SN - 0261-5614
VL - 43
JO - Clinical Nutrition
JF - Clinical Nutrition
IS - 5
ER -
