Registered Dietitian II Lehigh Valley Health Network Emmaus, Pennsylvania
Demonstrate understanding of the sensitivity and similarities between AND/ASPEN and GLIM PEM guidelines.
Background: Since the publication of the Academy of Nutrition and Dietetics (AND) and American Society for Parenteral and Enteral Nutrition (ASPEN) protein-energy malnutrition (PEM) identification consensus statement in 2012, it was expected that the identification guidelines would evolve as the tool was put into practice and further researched. As a result, the creation of the Global Leadership Innovation on Malnutrition (GLIM) criteria consensus statement was published in 2019 intertwining international expertise and adjusting indicators for PEM identification with the addition of BMI.
Methods: To determine sensitivity between AND/ASPEN and alternative PEM identification guidelines, sixty-one acute care patients at a Pennsylvania teaching hospital with two or more positive indicators for PEM using AND/ASPEN criteria (thirty-one with severe PEM) were also evaluated for PEM using GLIM, World Health Organization (WHO) and European Society for Parenteral and Enteral Nutrition (ESPEN) malnutrition criteria.
Results: Sensitivity was calculated to be 90.2% (GLIM), 44.3% (ESPEN) and 29.5% (WHO). There was a 31.1% agreement in patients with moderate PEM indication between AND/ASPEN and GLIM criteria and 32.8% agreement with severe PEM indication with an 8.2% increase in severity of PEM and a 27.8% decrease in severity under GLIM.
Conclusion: The GLIM criteria being the most sensitive compared to AND/ASPEN also shares the most similarities. While the GLIM criteria has the intention of becoming the new international best practice standard, the skill set gained from using AND/ASPEN guidelines is still valuable and relevant as ASPEN was influential in GLIM’s creation and publication.