Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden; Theme Aging, Karolinska University Hospital, Stockholm, Sweden.
Dean's Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
Clin Nutr. 2019 Feb;38(1):1-9. doi: 10.1016/j.clnu.2018.08.002. Epub 2018 Sep 3.
This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings.
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.
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.
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.
本倡议旨在就临床环境中成人营养不良的核心诊断标准建立全球共识。
2016 年 1 月，由多个主要全球临床营养学会召集成立了全球营养不良领导倡议（GLIM）。GLIM 任命了一个核心领导委员会和一个支持工作组，成员代表带来了更多的全球多样性和专业知识。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 核心和支持工作组成员中进行了投票。排名前五的标准包括三个表型标准（非自愿体重减轻、低体重指数和肌肉减少）和两个病因标准（减少食物摄入或吸收以及炎症或疾病负担）。要诊断营养不良，至少应存在一个表型标准和一个病因标准。提出了用于分级严重程度的表型指标，分为 1 期（中度）和 2 期（重度）营养不良。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临床环境中诊断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进一步合作和认可，确定与恶病质和肌少症等综合征的重叠，并促进传播、验证研究和反馈。诊断结构应每 3-5 年重新考虑一次。
