GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community
GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community
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DOI：
10.1016/j.clnu.2019.02.033
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发表时间：
2019-02-01
影响因子：
8.9
通讯作者：
Compher, C.
中科院分区：
文献类型：
--
作者：
Cederholm, T.;Jensen, G. L.;Compher, C.
理由：该倡议的重点是围绕临床环境中成人营养不良的核心诊断标准建立全球共识。方法：2016 年 1 月，全球几个主要临床营养学会召开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，其中的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交流，达成了经验共识。 结果：选择了营养不良诊断的两步法，即首先使用任何经过验证的筛查工具进行筛查以识别“危险”状态，然后评估诊断并分级营养不良的严重程度。供考虑的营养不良标准是从现有的筛查和评估方法中检索出来的。潜在标准由 GLIM 核心和支持工作组成员进行投票。排名前五的标准包括三个表型标准（非自愿体重减轻、低体重指数和肌肉质量减少）和两个病因学标准（食物摄入或同化减少以及炎症或疾病负担）。为了诊断营养不良，至少应该存在一种表型标准和一种病因学标准。提出了将营养不良严重程度分级为第一阶段（中度）和第二阶段（严重）营养不良的表型指标。建议使用病因标准来指导干预和预期结果。推荐的方法支持将营养不良分为四个与病因相关的诊断类别。结论：提出了全球范围内临床环境中诊断成人营养不良的共识方案。下一步是确保领先营养专业协会的进一步合作和认可，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。诊断结构应每 3-5 年重新考虑一次。 (C) 2018 Elsevier Ltd、欧洲临床营养和代谢学会以及美国肠外和肠内营养学会。保留所有权利。基本原理该倡议的重点是围绕临床环境中成人营养不良的核心诊断标准建立全球共识。方法 2016 年 1 月，全球几个主要临床营养学会召开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，其中的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。结果 选择了营养不良诊断的两步方法，即首先使用任何经过验证的筛查工具进行筛查以识别“危险”状态，然后评估诊断并对营养不良的严重程度进行分级。供考虑的营养不良标准是从现有的筛查和评估方法中检索出来的。潜在标准由 GLIM 核心和支持工作组成员进行投票。排名前五的标准包括三个表型标准（体重减轻、低体重指数和肌肉质量减少）和两个病因学标准（食物摄入或同化减少、炎症或疾病负担）。为了诊断营养不良，至少应该存在一种表型标准和一种病因学标准。提出了将营养不良严重程度分级为第一阶段（中度）和第二阶段（严重）营养不良的表型指标。建议使用病因标准来指导干预和预期结果。推荐的方法支持将营养不良分为四个与病因相关的诊断类别。结论 提出了全球范围内临床环境中诊断成人营养不良的共识方案。下一步是确保领先营养专业协会的进一步合作和认可，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。诊断结构应每 3-5 年重新考虑一次。
Rationale: This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings.Methods: 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.Results: 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.Conclusion: 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. (C) 2018 Elsevier Ltd, European Society for Clinical Nutrition and Metabolism and American Society for Parenteral and Enteral Nutrition. All rights reserved.Rationale This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. Methods 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. Results 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 (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. Conclusion 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.