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Global consensus on malnutrition - GLIM criteria for diagnosis of malnutrition - A consensus report from the global clinical nutrition community

Representatives of the main scientific societies related to clinical nutrition around the world have approved a consensus document on malnutrition, the GLIM. The approval took place during the 40th Congress of the European Society for Clinical Nutrition and Metabolism (Espen), which took place in Madrid, Spain, in September this year.

The Prodiet Blog spoke to Sandra Justino, PhD in Nutrition and Clinical Clinical Nutritionist at the Intensive Care Center of the Hospital de Clínicas Complex of the Federal University of Paraná (UFPR), to understand how this initiative is applied in the global and national context.

Could you tell us more about GLIM?

A: The Global Leadership Initiative on Malnutrition (GLIM) brought together leading representatives from the major Global Clinical Nutrition Societies. The aim was to build a global consensus on criteria for diagnosing adult malnutrition in the clinical setting. After extensive work, the group of experts drew up a document that was approved during Espen and published in the journal Clinical Nutrition (2018), under the title: "GLIM criteria for diagnosis of malnutrition - A consensus report from the global clinical nutrition community"

What parameters do scholars use?

A: According to the document, a two-stage approach was initially selected for the diagnosis of malnutrition: a) screening to identify nutritional risk, in which a validated screening tool should be used; b) assessment for the diagnosis and classification of the severity of malnutrition.

Based on a pre-established methodology and an extensive review of research related to nutritional screening and assessment, the participants voted to select the five main criteria that should be considered in the assessment. These included three phenotypic criteria (non-voluntary weight loss, low BMI and reduced muscle mass) and two etiological criteria (reduced food intake or assimilation and inflammation). To diagnose malnutrition, at least one phenotypic criterion and one etiological criterion must be present. Only phenotypic criteria have been proposed for classifying the severity of malnutrition, as stage 1 (moderate) and stage 2 (severe). They recommended that the etiological criteria be used to guide the intervention and the expected results.

 

What are the next steps for its use?

A: This is a consensus and not an ordinance or law, for which it is possible to set a deadline to start. According to the document, the next steps would be to secure more collaboration and endorsements from the main nutrition societies and professionals and to promote dissemination, validation studies and feedback. It should be clarified that nutritional assessment is already part of the nutritionist's activities in the ordinances that regulate nutritional therapy (enteral and parenteral) in Brazil, whether aimed at patients in general or critically ill patients.

How important is it globally? 

This initiative provides an important contribution for professionals working in the field of nutrition, especially nutritionists, to establish a more global language, which can facilitate and improve patient care, especially when it involves several institutions. It will also enable the development and improvement of local or multicenter studies.

What about the Brazilian reality, especially in relation to the criteria for diagnosing malnutrition?

In our country, we will certainly find health institutions that already use or are able to implement protocols that take into account all the criteria established in the consensus, since they have the infrastructure and qualified professionals for such procedures. However, this is not the national reality. Naturally, the use of such equipment and/or instruments should be based on the reality of each location and the patient's clinical condition. For example: there are patients whose clinical conditions allow the use of any of the indicators, while patients in the ICU would already have some clinical limitations for this generalization.

I believe that there is a need for more awareness of the impact of malnutrition on the individual, such as: a compromised immune system, a high risk of surgical and infectious complications, a high risk of pressure damage, more time on mechanical ventilation, ICU and hospital stays, frequent readmissions, more outpatient care and more institutionalization. It is important to understand that each complication that is added worsens the patient's quality of life, which can take years to recover, often without them being able to return to work. In addition to the impact on patients and their families, this situation increases the cost to the health system, both in public and private healthcare. It is of fundamental importance that this awareness goes through all levels of society, not just the patient and their family. Certainly, diagnosing malnutrition is part of caring for our patients.  

 

Sandra Justino has a degree in Nutrition from the Federal University of Paraná (UFPR) and a PhD in Nutrition Sciences from the Federal University of São Paulo (Unifesp). She is currently a nutritionist at the Federal University of Paraná, in the Hospital de Clínicas Complex, working in the Intensive Care Center. She has experience in Clinical Nutrition, with an emphasis on Nutritional Therapy of the Critically Ill Patient. She is a member of the Brazilian Society of Parenteral and Enteral Nutrition (Braspen), the Nutrition Department of the Brazilian Intensive Care Medicine Association (AMIB), the Nutrition Department of the Intensive Care Society of Paraná (SOTIPA) and a member of the Brazilian Nutrition Association (ASBRAN).

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