Nutritional screening within the GLIM procedure—Part 1: Development of a conceptual definition of risk of malnutrition using a modified Delphi procedure

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.