Global Leadership Initiative on Malnutrition (GLIM) Criteria

GLOBAL LEADERSHIP INITIATIVE ON MALNUTRITION (GLIM) CRITERIA

Bridging the gap between screening and diagnosis.

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WHAT IS THE GLIM CRITERIA? HOW TO USE THE GLIM FRAMEWORK GRADING MALNUTRITION SEVERITY USING GLIM IN PATIENT HEALTH RECORDS DOWNLOADABLE GLIM GUIDE RELATED RESOURCES

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WHAT IS THE GLIM CRITERIA?

The Global Leadership Initiative on Malnutrition (GLIM) criteria is a consensus-based framework for diagnosing malnutrition in adults - developed by collective leadership of ASPEN, ESPEN, FELANPE and PENSA.¹

Provides a minimum set of practical indicators for malnutrition diagnosis

Can be used across different healthcare settings

Designed to be used alongside validated screening and assessment tools

Diagnosing malnutrition is crucial to appropriate, timely treatment, while empowering patients to participate in their healthcare journey.²

HOW IT WORKS

GLIM provides a two-step approach to diagnosing malnutrition:^3,4

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RISK SCREENING  

Using validated tools to identify risk of malnutrition

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DIAGNOSTIC ASSESSMENT  

Applying GLIM diagnostic indicators (phenotypic and aetiologic criterion) to determine malnutrition severity.

Malnutrition is confirmed if at least one phenotypic and one aetiologic criterion is met. Severity of malnutrition can then be determined based on phenotypic criteria.

RISK SCREENING

AT RISK FOR MALNUTRITION

 + Use validated screening tools

DIAGNOSTIC ASSESSMENT

ASSESSMENT CRITERIA

+ use validated screening tools

+ PHENOTYPIC
  • Non-volitional weight loss
  • Low body mass index
  • Reduced muscle mass

+ AETIOLOGIC
• Reduced food intake or assimilation
• Disease burden /
inflammatory condition

DIAGNOSIS

MEETS CRITERIA FOR MALNUTRITION DIAGNOSIS 

+ Requires at least 1 phenotypic criterion and 1 aetiologic criterion

SEVERITY GRADING

DETERMINE SEVERITY OF MALNUTRITION

 + Severity determined based on phenotypic criterion

Diagram adapted from Cederholm, 2019³

HOW TO USE THE GLIM FRAMEWORK

Nutritional screening/assessment can be performed using any validated screening tool to identify patients who may be at risk of malnutrition.⁴

Malnutrition screening/assessment tools may include:^4,5

'Must' ('Malnutrition Universal Screening Tool')
Subjective Global Assessment
Patient-Generated Subjective Global Assessment
Mini Nutritional Assessment

The framework for diagnosing malnutrition in adult patients includes five key indicators that can be used during routine clinical practice. After comprehensive nutritional assessment has been conducted, clinicians can use these criterion to perform a more comprehensive diagnosis of malnutrition.⁴

The below tables outline the key GLIM diganostic criteria. During nutritional assessment, check if any of the below are present.

Phenotypic criteria⁴

Unintentional weight loss	Identify whethere there has been any unitentional weight loss using the below timeframes: • > 5% within past 6 months • > 10% beyond 6 months
BMI (kg / m²)	Assess BMI according to age: • < 20 if patient is < 70 years • < 22 if patient is ≥ 70 years
Muscle mass	Assess reduced muscle mass based on valid body composition assessment methods, such as: • Physical exam • Dual-energy absorptiometry • Bioelectrical impedance analysis • Ultrasound • Computer tomography • Magnetic resonance imagine • Mid upper arm circumference • Calf circumference

Aetiologic criteria^4,6

Reduce food intake or assimilation

Assess reduced food intake or assimilation using either quantitative or qualitative reports, for example 3-day food record, food frequency questionnaire or patient self-report. Considerations may include:
• Ingestion ≤ 50% of needs from 1 to 2 weeks
• Any reduction in food intake for >2 weeks
• Whether the patient has any gastrointestinal symptoms that may impact food intake or absorption, such as:

Dysphagia
Nausea
Vomiting
Diarrhoea
Constipation
Abdominal pain

• The presence of any malabsorptive disorders, such as:

Intestinal failure
Pancreatic insufficiency

• Post-operative bariatric surgery Whether there are any other clinical situations affecting food intake, such as:

Oesophageal strictures
Gastroparesis
Intestinal pseudo-obstruction

Disease burden / Inflammation

Understand whether there may be presence of inflammation or disease burden from acute of chronic injury/disease:

Acute: Major infection, burns or trauma
Chronic: Malignant disease, COPD, congestive heart failure, chronic kidney disease

Consider conducting supporting laboratory tests, where necessary, such as:

C-reactive protein
Albumin
Pre-albumin

Muscle screening tools are easy to use in clinical settings as they are quick and easy to implement and do not require specialist nutritional training or complex equipment.⁷

Various reliable screening methods exist to assess the risk of loss of muscle/muscle function.⁸

Find out more about how to screen/assess for loss of muscle/muscle function.

WAYS TO SCREEN

The occurrence of acute or chronic disease, infection or injury that is usually associated with inflammatory activity may fulfill the aetiologic GLIM inflammation criterion, which means confirmation by laboratory markers is not always necessary. This may include the presence of:⁶

Conditions with severe acute inflammation - Severe infection, ARDS, major surgery, multi-trauma, severe burns
Conditions with moderate acute inflammation - COPD exacerbation, cancer, Crohn’s disease, infections, diabetes, wounds
Conditions with mild/moderate chronic inflammation - COPD exacerbation, cancer, Crohn’s disease, infections, diabetes complications

For conditions with no clear or perceptible inflammation, such as psychiatric disorders (anorexia nervosa, depression), malabsorptive, dysmotility or obstructive disorders, neurological conditions, measuring laboratory markers using CRP levels can support inflammation assessment.⁶

Application for CRP testing are as follows:⁶
For acute conditions - CRP levels x 10 upper reference value:

CRP 10-50 mg/L = moderate inflammation
CRP >50 mg/L = severe inflammation

For chronic conditions - Serial measures of CRP > upper reference value

CRP 3.0-9.9 mg/L = mild inflammation
CRP 10-50 mg/L = moderate inflammation

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MALNUTRITION DIAGNOSIS AND SEVERITY GRADING

Malnutrition diagnosis is confirmed when a patient meets at least 1 phenotypic and 1 aetiologic criterion.⁴

The table below outlines a simple way to determine malnutrition severity.⁴

Phenotypic Criteria	Unintentional weight loss (%)	Low BMI (kg / m²)	Reduced muscle mass
Stage 1: Moderate Malnutrition Patient requires 1 phenotypic criteria that meets this grade	5-10% in 6 months; or 10-20% in more than 6 months	<20 if <70 years; or <22 if ≥70 years	Mild-to-moderate deficit (per validated assessment methods outlined above)
Stage 2: Severe Malnutrition Patient requires 1 phenotypic criteria that meets this grade	> 10% in 6 months, or > 20% in more than 6 months	18.5 if <70 years; or <20 if ≥70 years	Severe deficit (per validated assessment methods outlined above)

Adapted from ESPEN Framework for Diagnosing Adult Malnutrition,2023⁴

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USING GLIM TO DIAGNOSE MALNUTRITION iN PATIENT ELECTRONIC HEALTH RECORDS

Healthcare professionals are now able to code the diagnosis of malnutrition in the patient’s electronic health record.^9,10

Diagnosis of malnutrition can be recorded at two levels on the patient record:¹⁰

• GLIM Stage 1: Moderate malnutrition

• GLIM Stage 2: Severe malnutrition

Muscle Screening Icon

Download this useful guide on how to use the GLIM criteria to support malnutrition diagnosis in your patients.

DOWNLOAD

Muscle Screening Icon

THE NEXT STEPS AFTER MALNUTRITION DIAGNOSIS

Once a diagnosis of malnutrition has been confirmed, healthcare professionals should consider strategies for optimising nutritional intake.¹¹ Depending on the patient's nutritional risk,* there may be different strategies for managing nutrition:¹¹

Dietary advice to optimise food intake

Oral nutritional supplements 

May be used alongside dietary advice when food intake is insufficient

Agreeing on realistic goals 

Involve the patient/carers to agree on a treatment plan and consider the impact of the disease and associated treatments

Choose the right ons for your patients

with our patient algorithm

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Vital 1.5kcal Case Study: Sue

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Footnotes:

ASPEN - American Society for Parenteral and Enteral Nutrition. ESPEN - European Society for Clinical Nutrition and Metabolism. FELANPE - Federación Latinoamericana de Terapia Nutricional, Nutrición Clínica y Metabolismo. PENSA - Parenteral and Enteral Nutrition Society of Asia. BMI - Body Mass Index COPD - Chronic Obstructive Pulmonory Disease. ARDS – Acute respiratory distress syndrome. CRP – C-reactive protein

*Assuming patient can take nutrition orally

References:

1. de van der Schueren MAE et al. Clin Nutr 2019;39(9):2872-2880.

2. Jain D. Journal of Pharmaceutical Research and Clinical Practice 2023;6(3):74-77

3. Cederholm T et al. Clin Nutr 2019;38:1-9.

4. ESPEN 2023. A Global Leadership Initiative on Malnutrition (GLIM): A Framework for Diagnosing Adult Malnutrition. Available online: https://www.espen.org/files/GLIM-2-page-Infographic.pdf Last accessed February 2025.

5. Lima J et al. Clin Nutr 2022;41(10):2325-2332

6. ESPEN, 2024. Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition. Available online: https://www.espen.org/images/files/ESPEN-Fact-Sheets/ESPEN-Fact-Sheet-GLIM-Inflammation.pdf Last accessed June 2025

7. Beaudart C. et al. Calcif Tissue Int 2019;105,1-14.

8. Cruz Jentoft A. et al. Age Ageing. 2019;48(1):16-31.

9. BDA, 2023. Capturing dietetic outcomes using the Model and Process. Available online: https://www.bda.uk.com/resource/capturing-dietetic-outcomes-using-the-model-and-process.html Last accessed Feburary 2025.

10. NHS Digital, 2025. SNOMED CT Browser. Available online: https://termbrowser.nhs.uk/?perspective=full&conceptId1=2492009&edition=uk-edition&release=v20241120&server=https://termbrowser.nhs.uk/sct-browser-api/snomed&langRefset=999001261000000100,999000691000001104 Last accessed February 2025

11. Malnutrition Pathway, 2021. Managing Adult Malnutrition in the Community. Available online: https://www.malnutritionpathway.co.uk/library/managing_malnutrition.pdf Last accessed May 2025

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