GLIM Criteria for the Diagnosis of Malnutrition: A Consensus Report From the Global Clinical Nutrition Community

Jensen, Gordon L.; Cederholm, Tommy; Correia, María Isabel Toulson Davisson; Gonzalez, Maria Cristina; Fukushima, Ryoji; Higashiguchi, Takashi; Baptista, Gertrudis Adrianza de; Barazzoni, Rocco; Blaauw, R.; Coats, Andrew J.S.; Crivelli, Adriana; Evans, David C.; Gramlich, Leah; Fuchs-Tarlovsky, Vanessa; Keller, Heather; Llido, Luisito O.; Malone, Ainsley; Mogensen, Kris M.; Morley, John E.; Muscaritoli, Maurizio; Nyulasi, Ibolya; Pirlich, Matthias; Pisprasert, Veeradej; Schueren, Marian A.E. de van der; Siltharm, S.; Singer, Pierre; Tappenden, Kelly A.; Velasco, N; Waitzberg, Dan Linetzky; Yamwong, Preyanuj; Yu, Jianchun; Compher, Charlene; Gossum, A. Van

doi:10.1002/jpen.1440

Cited by 764 publications

(452 citation statements)

References 29 publications

(57 reference statements)

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“…4,[6][7][8] Importantly, sarcopenia can develop in the absence of body weight change or fat loss and can therefore go undetected in patients who are overweight or obese, and its presence has been associated with particularly poor outcomes in obese patients. 3,5,[8][9][10] There are several accepted methodologies to quantify the amount of skeletal muscle 4,11,12 ; in the oncology setting, secondary analysis of computed tomography (CT) images, obtained for diagnostic purposes, has emerged as the preferred method. 4,12,13 CT-defined sarcopenia refers to a skeletal muscle index below a specific threshold associated with an increased risk of death.…”

Section: Introductionmentioning

confidence: 99%

“…3,5,[8][9][10] There are several accepted methodologies to quantify the amount of skeletal muscle 4,11,12 ; in the oncology setting, secondary analysis of computed tomography (CT) images, obtained for diagnostic purposes, has emerged as the preferred method. 4,12,13 CT-defined sarcopenia refers to a skeletal muscle index below a specific threshold associated with an increased risk of death. [14][15][16] Herein, when the term sarcopenia is used, it will refer to CT-defined sarcopenia.…”

Section: Introductionmentioning

confidence: 99%

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Cancer‐Associated Malnutrition and CT‐Defined Sarcopenia and Myosteatosis Are Endemic in Overweight and Obese Patients

Martin

Gioulbasanis²,

Sénesse

et al. 2019

J Parenter Enteral Nutr

102

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Background Overweight/obese patients’ large fat mass can mask the loss of skeletal muscle, which is associated with mortality in the oncology setting. We investigated the prevalence of computed tomography (CT)‐defined sarcopenia and myosteatosis across different levels of nutrition risk assessed by the Patient‐Generated Subjective Global Assessment Short Form (PG‐SGA SF). We also evaluated whether the PG‐SGA SF, sarcopenia, and myosteatosis were prognostic of overall survival. Methods This was a prospective, observational study. Consecutive patients with body mass index ≥25.0 kg/m2 with newly diagnosed head and neck cancer (any stage) or lung and gastrointestinal tract cancer (locally recurrent or metastatic) were screened at presentation to oncology clinics. Nutrition risk was assigned based on PG‐SGA SF triage recommendations. Based on CT, patients were classified with sarcopenia and/or myosteatosis using published cutoffs. Survival analyses were conducted. Results Patients (n=1157) were 63.6 ± 11.4 years, 64% male, and 61% had stage IV disease. Sarcopenia and myosteatosis were prevalent across PG‐SGA SF nutrition risk categories (scores 0–1 [no risk; 36% sarcopenic; 44% myosteatotic], scores 2–3 [37%; 37%], scores 4–8 [40%; 41%], and scores ≥9 [high risk; 50%; 49%]). In multivariable survival analysis, PG‐SGA SF scores ≥9 (hazard ratio [HR] 2.08, 95% confidence interval [CI] 1.66‐2.60, P<0.001), sarcopenia (HR 1.25, 95% CI 1.06‐1.46, P=0.006), and myosteatosis (HR 1.25, 95% CI 1.07‐1.46, P<0.001) independently predicted reduced survival. Conclusion CT‐defined sarcopenia and myosteatosis are prevalent across different levels of nutrition risk in overweight/obese patients with cancer. Assessment of skeletal muscle using CT adds prognostic value to the PG‐SGA SF.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cancer‐Associated Malnutrition and CT‐Defined Sarcopenia and Myosteatosis Are Endemic in Overweight and Obese Patients

Martin

Gioulbasanis²,

Sénesse

et al. 2019

J Parenter Enteral Nutr

102

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“…The American Society for Parenteral and Enteral Nutrition (ASPEN) defines malnutrition by the presence of 2 of the following 6 characteristics: insufficient caloric intake, recent weight loss, loss of muscle mass, loss of subcutaneous fat, localized or general fluid accumulation, and diminished functional status as measured by hand grip strength . Newer criteria released by the Global Leadership Initiative on Malnutrition (GLIM) incorporates phenotypes (body mass index, muscle wasting, weight loss) and explains those phenotypes with an etiology (either inflammation or reduced food intake/assimilation) …”

Section: Introductionmentioning

confidence: 99%

Serum Levels of Prealbumin and Albumin for Preoperative Risk Stratification

et al. 2019

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Preoperative risk stratification has long been developed as a strategy to predict postoperative outcomes and potentially alter or optimize comorbidities and modifiable risk. Malnutrition is among the most common potentially modifiable risk factors and the strongest predictor of poor postsurgical outcomes. Historically, malnutrition has been difficult to address for healthcare providers because of the lack of a cohesive definition. Adding to the confusion has been the use of serum levels of albumin and prealbumin as biomarkers for malnutrition; many fail to understand that these visceral proteins are only valid as markers of nutrition status while at homeostasis. Surgical need is often driven by both sterile and non-sterile inflammation, but during this pathologic mechanism, hepatic reprioritization shunts visceral protein synthesis, rendering albumin and prealbumin invalid as biomarkers for malnutrition. Ultimately, understanding these limitations and embracing better indicators of malnutrition will improve preoperative risk stratification. (Nutr Clin Pract. 2019;34:340-348)

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“…8 Another criteria for malnutrition proposed by the Global Leadership Initiative on Malnutrition in 2018 also included decreased muscle mass as one of the five items for diagnosing malnutrition. 9 Furthermore, sarcopenia, one of the most highlighted topics in geriatric nutrition, is suggested to occur with decreased muscle mass. 10,11 Imaging modalities, such as computed tomography, magnetic resonance imaging and dual energy X-ray absorptiometry, are considered the gold standard for evaluating muscle mass.…”

Section: Introductionmentioning

confidence: 99%

“…Calf circumference has been proven to be positively correlated to skeletal muscle mass, and might thus be a potential indicator of decreased muscle mass in clinical practice as an alternative to imaging modalities and bioimpedance analysis. 12,13 However, although calf circumference has been endorsed in as a reliable indicator for evaluating muscle mass, 8,9,14 its use remains controversial. 10 Edema can develop from malnutrition, and renal, hepatic and cardiac diseases, and as a side-effect of medications that increase fluid accumulation in the body; 15,16 thus, edema can increase calf circumference.…”

Section: Introductionmentioning

confidence: 99%

Impact of edema on length of calf circumference in older adults

Ishida

Maeda

Nonogaki

et al. 2019

Geriatrics Gerontology Int

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Aim Calf circumference, which is a known simple indicator of muscle mass, increases during edema. However, the extent to which edema increases calf circumference in older adults is unclear. Methods This retrospective cross‐sectional study included patients aged ≥65 years whose nutritional status was assessed by nutrition support teams. Two different types of matching models in each sex were created according to the presence of edema on the right lower limb. All models were adjusted by age, body height, handgrip strength and performance status. Sarcopenia was diagnosed based on both reduced calf circumference and decline of handgrip strength. The prevalence of sarcopenia was estimated before and after adjustment for increment of calf circumference. Results In total, 2101 patients were included. Multifactor matching models showed that the mean difference in calf circumference between pairs was 1.6 cm (95% confidence interval [CI] 1.1–2.1, P < 0.001) for women and 2.1 cm (95% CI 1.6–2.7, P < 0.001) for men. The propensity score matching model similarly showed a mean difference of 1.6 cm (95% CI 1.1–2.1, P < 0.001) for women and 2.0 cm (95% CI 1.5–2.6, P < 0.001) for men. The prevalence of sarcopenia before and after adjusting for an edema‐related increase in calf circumference was 42.6%/48.6% for women and 35.3%/38.5%–38.7% for men. Conclusions Edema in the lower limb increased the calf circumference by approximately 2 cm. When using calf circumference to assess muscle mass in patients with edema, the increase in circumference should be subtracted from the baseline circumference for an accurate assessment. Geriatr Gerontol Int 2019; 19: 993–998.

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GLIM Criteria for the Diagnosis of Malnutrition: A Consensus Report From the Global Clinical Nutrition Community

Cited by 764 publications

References 29 publications

Cancer‐Associated Malnutrition and CT‐Defined Sarcopenia and Myosteatosis Are Endemic in Overweight and Obese Patients

Cancer‐Associated Malnutrition and CT‐Defined Sarcopenia and Myosteatosis Are Endemic in Overweight and Obese Patients

Serum Levels of Prealbumin and Albumin for Preoperative Risk Stratification

Impact of edema on length of calf circumference in older adults

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