Dean's Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.
Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, and Theme Aging, Karolinska University Hospital, Stockholm, Sweden.
JPEN J Parenter Enteral Nutr. 2019 Jan;43(1):32-40. doi: 10.1002/jpen.1440. Epub 2018 Sep 2.
This initiative aims to build a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings.
The Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications.
A 2-step approach for the malnutrition diagnosis was selected, that is, 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 GLIM participants that selected 3 phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and 2 etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least 1 phenotypic criterion and 1 etiologic criterion should be present. Phenotypic metrics for grading severity 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.
A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The construct should be re-considered every 3-5 years.
本倡议旨在就临床环境中成人营养不良的核心诊断标准达成全球共识。
全球营养不良领导倡议 (GLIM) 由多个主要的全球临床营养学会召集。通过一系列面对面会议、电话会议和电子邮件沟通，达成了经验共识。
选择了两步法进行营养不良诊断，即首先使用任何经过验证的筛查工具进行筛查以确定风险状态，然后进行评估以诊断和分级营养不良的严重程度。考虑的营养不良标准是从现有的筛查和评估方法中检索到的。潜在标准在 GLIM 参与者中进行了投票，选出了 3 个表型标准（非自愿性体重减轻、低体重指数和肌肉量减少）和 2 个病因标准（食物摄入或吸收减少以及炎症或疾病负担）。要诊断营养不良，至少应存在 1 个表型标准和 1 个病因标准。提出了严重程度的表型指标分级。建议使用病因标准来指导干预和预期结果。建议的方法支持将营养不良分为四个与病因相关的诊断类别。
提出了一种用于在全球范围内诊断临床环境中成人营养不良的共识方案。下一步是争取领先的营养专业学会的认可，确定与恶病质和肌肉减少症等综合征的重叠，并促进传播、验证研究和反馈。该结构应每 3-5 年重新考虑一次。
