Global Leadership Initiative on Malnutrition Statement

In response to learning that some auditors are looking for use of the GLIM criteria in U.S. inpatient hospitals, the A.S.P.E.N. Malnutrition Coding and Reimbursement Task Force, which includes representation from the Academy, has issued the following statement on GLIM in order to better clarify how and where it should be used in clinical practice:

The Global Leadership Initiative in Malnutrition has identified the common malnutrition diagnosis criteria that are currently in use throughout the globe. These widely applied criteria were used to develop a construct for malnutrition diagnosis in adults in ambulatory and hospital clinical settings that would be feasible for application by clinicians with limited nutrition expertise around the globe. The focus of GLIM is on assessment tools and methods that are readily available. The GLIM consensus criteria seek to provide a global framework for malnutrition diagnosis that may be complemented where available by consultation of skilled nutrition practitioners to conduct comprehensive nutrition assessments.

• GLIM provides a framework to guide malnutrition diagnosis.
• GLIM is based upon the common phenotypic (body weight, body mass index, and lean mass) and etiologic criteria (reduced food intake or assimilation and disease burden/inflammatory condition) that are found in the leading approaches to malnutrition diagnosis.
• GLIM is fully congruent with established approaches like Academy/ASPEN criteria and Subjective Global Assessment (SGA).They share multiple variables and are not inconsistent. GLIM, Academy/ASPEN criteria or SGA may be used independently to diagnose malnutrition.
• GLIM can trigger a full nutrition assessment by skilled nutrition professionals as part of developing a malnutrition treatment plan.
• GLIM may be used in combination with other approaches and additional criteria of regional preference.
• In settings where skilled nutrition professionals are less available, GLIM could be used alone.
• It is important to the quality of patient care to recognize and treat malnutrition, no matter what tool is used.

Both the Academy/ASPEN and GLIM approaches are undergoing validation testing. Building upon the GLIM approach, it may ultimately be possible to derive a minimum dataset of key core criteria that will provide a framework to serve a broad range of practitioners in a variety of clinical nutrition settings. It is hoped that by collecting the core GLIM variables in a consistent manner, it will then be possible to compare prevalence, interventions, and outcomes on a global scale.

Practice Tools and Resources

• GLIM Criteria for the Diagnosis of Malnutrition: A Consensus Report from the Global Clinical Nutrition Community JPEN J Parenter Enteral Nutr. 2019 Jan;43(1):32-40.
• Free Access to the GLIM Consensus Paper