Recognizing malnutrition in adults with critical illness: Guidance statements from the Global Leadership Initiative on Malnutrition
Charlene Compher, Ryoji Fukushima, María Isabel Toulson Davisson Correia, Marı́a Cristina González, Liam McKeever, Kensuke Nakamura, Zheng‐Yii Lee, Jayshil J. Patel, Pierre Singer, Christian Stoppe, Juan Carlos Ayala, Rocco Barazzoni, Mette M. Berger, Tommy Cederholm, Kaweesak Chittawatanarat, Antonella Cotoia, Juan Carlos Lopez‐Delgado, Carrie P. Earthman, Gunnar Elke, Wolfgang H. Hartl, Mohd Shahnaz Hasan, Naoki Higashibeppu, Gordon L. Jensen, Kate Lambell, Charles Chin Han Lew, Jeffrey I. Mechanick, Marina Mourtzakis, Guillermo Contreras Nogales, Taku Oshima, Sarah J. Peterson, Todd W. Rice, Ricardo Schilling Rosenfeld, Patricia Sheean, Flávia Moraes Silva, Pei Chien Tah, Mehmet Uyar
Abstract
BACKGROUND: Patients with critical illness may present with disease-related malnutrition upon intensive care unit (ICU) admission. They are at risk of development and progression of malnutrition over the disease trajectory because of inflammation, dysregulated metabolism, and challenges with feeding. METHODS: The Global Leadership Initiative on Malnutrition (GLIM) convened a panel of 36 clinical nutrition experts to develop consensus-based guidance statements addressing the diagnosis of malnutrition during critical illness using a modified Delphi approach with a requirement of ≥75% agreement. RESULTS: (1) To identify pre-existing malnutrition, we suggest evaluation within 48 h of ICU admission when feasible (100% agreement) or within 4 days (94% agreement). (2) To identify the development and progression of malnutrition, we suggest re-evaluation of all patients every 7-10 days (97% agreement). (3) To identify progressive loss of muscle mass, we suggest evaluation of muscle mass as soon as feasible (92% agreement) and again after 7-10 days (89% agreement). (4) To identify the development and progression of malnutrition before and after ICU discharge, we suggest re-evaluating nutrition status before ICU discharge and during clinical visits that follow (100% agreement). CONCLUSION: Research using consistent etiologic and phenotypic variables offers great potential to assess the efficacy of nutrition interventions for critically ill patients with malnutrition. Assessment of these variables during and beyond the ICU stay will clarify the trajectory of malnutrition and enable exploration of impactful treatment modalities at each juncture. GLIM offers a diagnostic approach that can be used to identify malnutrition in critically ill patients.