Journal Article Review Ahead of print 1 citation
PubMed: 42209356 DOI: 10.1016/j.clnu.2026.106643
Guidance for the assessment of the dietary intake and gastrointestinal or nutrition impact symptoms etiologic criterion of GLIM: A modified-Delphi study.
Clin Nutr
Authors: Heather Keller, Renée Blaauw, Christine Marie Mills, Gert Bischoff, Charlene Compher, Marian de van der Schueren, Krista Haines, Nicole Kiss, Charles Lew, Ainsley Malone, Claudia Maza Moscoso, Nancy Stoner, Rocco Barazzoni, Jack J Bell, Madeleine Coetzee, M Isabel T D Correia, Ryoji Fukushima, Elena George, M Cristina Gonzalez, Leah Gramlich, Jacqueline A E Langius, Yen Peng Lim, Roseann Nasser, Matthias Pirlich, Terese Scollard, Nicolette Wierdsma, Marion Winkler, Gordon L Jensen, TommyCederholm
Affiliations
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada; Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
- ZEP-Center for Clinical Nutrition and Prevention, Hospital Barmherzige Brueder Munich (Germany), Munich, Germany.
- Department of Biobehavioral Health Science, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA; Hospital of the University of Pennsylvania, Clinical Nutrition Support Service, Philadelphia, PA, USA.
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, the Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
- Division of Trauma, Critical Care, and Acute Care Surgery, Duke University, Durham, NC, USA; Population Health Sciences, Duke University, Durham, NC, USA.
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia; Allied Health Research, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia.
- Department of Dietetics and Nutrition, Ng Teng Fong General Hospital, Singapore; Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore.
- Retired.
- Centro MĂ©dico Militar, Guatemala City, Guatemala.
- Penn Medicien at Home/Clinical Nutrition, University of Pennsylvania Health System, Philadelphia, PA, USA.
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
- The Prince Charles Hospital, Chermside, Queensland, Australia.
- Wits Donald Gordon Medical Center, Johannesburg, South Africa.
- Department of Surgery, Medical School, ETERNA - Rede Mater Dei de SaĂºde, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
- Department of Health and Dietetics, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo, Japan; Department of Surgery Teikyo, University School of Medicine, Tokyo, Japan.
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.
- Postgraduate Program in Nutrition and Food, Federal University of Pelotas, Pelotas, Brazil.
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
- Department and Research Group Rehabilitation and Technology, The Hague University of Applied Sciences, The Hague, the Netherlands.
- NHG Health, Singapore; Faculty of Health and Social Science, Singapore Institute of Technology, Singapore.
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Saskatchewan Health Authority, Regina Saskatchewan, Canada.
- Imperial Oak Outpatient Clinic, Berlin, Germany.
- MySurgeryPlate LLC, Beaverton, OR, USA.
- Department or Nutrition & Dietetics Amsterdam UMC, Amsterdam, the Netherlands.
- Department of Surgery, Surgical Nutrition Service, Brown University Health, Brown University Medical School, Rhode Island Hospital, Providence, RI, USA.
- Dean's Office and Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA.
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden.
Abstract
The GLIM malnutrition diagnostic framework includes the etiologic criterion for reduced dietary intake or assimilation (i.e., digestion or absorption). This criterion required further specification to support consistent use in clinical practice. Three rounds of a modified Delphi was undertaken to develop consensus on guidance to support identification of this criterion. A working group (n = 11) developed surveys iteratively. Invited global experts with diverse disciplines and practice contexts (n = 30) fully completed surveys; consensus was determined at 75% agreement. Three surveys and rounds of voting resulted in 15 guidance statements. Notable points include: (a) using usual intake as the comparator for reduced dietary intake rather than energy requirement, (b) use of gastrointestinal symptoms and nutrition impact symptoms to determine challenges with absorption or assimilation, rather than solely gastrointestinal conditions, and (c) using clinical judgment to determine severity of these symptoms. The final criterion is "less than or equal to 50% dietary intake in the last week or any reduction in intake greater than 2 weeks OR severe gastrointestinal or nutrition impact symptoms (e.g., dysphagia, nausea, vomiting, diarrhea) as a result of an acute or chronic condition or therapy." Future work should confirm the feasibility of this criterion in clinical practice and its criterion validity within the GLIM framework.
MeSH
Signs And Symptoms, Work, Surveys And Questionnaires, Absorption, Enteral Nutrition