Nutritional screening within the GLIM procedure-Part 1: Development of a conceptual definition of risk of...

This article presents the results of the modified Delphi study conducted by the GLIM Risk of Malnutrition Working Group to develop a consensus-based conceptual definition of "risk of malnutrition", as first step in revising the GLIM screening procedure.

Focus groups with nutritional care experts and patient/older adult representatives, and a literature exploration informed 46 statements on risk of malnutrition. Malnutrition experts (n = 112) evaluated these statements, using a five-point Likert scale. Statements with ≥75% agreement were accepted; those with ≥75% disagreement and/or neutrality were rejected. Remaining statements were marked "undecided" and re-evaluated in later rounds.

In three questionnaire rounds (response rates 63%, 59%, and 54%), 26 statements were ultimately accepted to shape the conceptual definition of "risk of malnutrition". The GLIM Working Group and patient/older adult representatives reviewed the pre-final professional and layperson versions. Risk of malnutrition was defined as: A dynamic state, with or without unintentional weight loss, in which an individual has one or more risk factors, that is, nutrition impact symptoms, and/or disease-related, physical, psychological, social, demographic, and economic risk factors, that may result in malnutrition and may negatively impact clinical outcomes. In the layperson version, sentences were simplified to aid comprehension.

GLIM has developed the first global (professional and layperson) conceptual definition of risk of malnutrition. This definition will guide future nutritional screening recommendations and a more preventive malnutrition approach. It also implies that screening tools covering "risk of malnutrition" should no longer be validated against signs or the diagnosis of malnutrition.