New guidance on diagnosing malnutrition in critically ill adults

The Global Leadership Initiative on Malnutrition (GLIM) has published new guidance statements for diagnosing malnutrition in adults with critical illness in the Journal of Parenteral and Enteral Nutrition.  Penn Nursing’s, Charlene Compher, PhD, RD, LDN, FASPEN, was the lead author for this new guidance that has global implications.The guidance, developed by a panel of 36 clinical nutrition experts, aims to provide a consistent approach to identifying malnutrition in this vulnerable population. GLIM is a collaboration of major global clinical nutrition societies whose joint mission is to improve the diagnosis and management of malnutrition worldwide.

“These new guidance statements represent a critical step forward in how we address malnutrition in critically ill patients,” said Compher, who is the Shearer Chair of Healthy Community Practices, Professor of Nutrition Science, and Director of Nutrition programs in the Department of Biobehavioral Health Sciences. “By providing clear recommendations for assessment and reassessment, we can improve the timeliness and management of nutrition interventions, ultimately leading to better outcomes for our patients.”

The GLIM criteria, which consider both phenotypic (e.g., weight loss, low muscle mass) and etiologic (e.g., inflammation, inadequate food intake) factors, are highlighted in the guidance.

Key recommendations include:

• Assessment for pre-existing malnutrition within 48 hours of ICU admission, or within 4 days if not feasible initially.
• Re-evaluation of all patients every 7-10 days to identify developing malnutrition.
• Evaluation of muscle mass as soon as feasible and again after 7-10 days.
• Re-evaluation of nutrition status before ICU discharge and during follow-up clinical visits.

The authors emphasize that consistent assessment and reporting of malnutrition variables are essential for advancing research and improving patient care.