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Borda, M. G., Landi, F., Cederholm, T., Venegas-Sanabria, L. C., Duque, G., Wakabayashi, H., . . . Aarsland, D. (2025). Assessment and management of frailty in individuals living with dementia: expert recommendations for clinical practice. The Lancet Healthy Longevity, 6(1), Article ID 100666.
Open this publication in new window or tab >>Assessment and management of frailty in individuals living with dementia: expert recommendations for clinical practice
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2025 (English)In: The Lancet Healthy Longevity, ISSN 2666-7568, Vol. 6, no 1, article id 100666Article in journal (Refereed) Published
Abstract [en]

Frailty complicates the care of individuals with dementia, increasing their vulnerability to adverse outcomes. This Personal View presents expert recommendations for managing frailty in individuals with dementia, aimed at health-care providers, particularly those in primary care. We conducted a rapid literature review followed by a consensus process involving 18 international experts on dementia and frailty. The experts identified key areas, including diagnosis of frailty, assessment of nutritional status and nutritional management, physical activity, prevention of falls, and polypharmacy management. The recommendations emphasise early identification of frailty and a comprehensive, interdisciplinary approach to care that aims to maintain the individual’s daily functioning, quality of life, and independence. The recommendations highlight the importance of tailored interventions, regular monitoring, and the integration of psychosocial support into the therapeutic approach. These recommendations address a crucial gap in existing clinical guidelines, offering practical guidance for clinicians managing frailty in individuals with dementia.

Place, publisher, year, edition, pages
Elsevier, 2025
National Category
Geriatrics
Identifiers
urn:nbn:se:uu:diva-549020 (URN)10.1016/j.lanhl.2024.100666 (DOI)001423528700001 ()39736268 (PubMedID)2-s2.0-85213574030 (Scopus ID)
Available from: 2025-01-30 Created: 2025-01-30 Last updated: 2025-04-14Bibliographically approved
Vieira, F. T., Godziuk, K., Barazzoni, R., Batsis, J. A., Cederholm, T., Donini, L. M., . . . Prado, C. M. (2025). Hidden malnutrition in obesity and knee osteoarthritis: Assessment, overlap with sarcopenic obesity and health outcomes. Clinical Nutrition, 48, 111-120
Open this publication in new window or tab >>Hidden malnutrition in obesity and knee osteoarthritis: Assessment, overlap with sarcopenic obesity and health outcomes
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2025 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 48, p. 111-120Article in journal (Refereed) Published
Abstract [en]

Background & aims

Malnutrition may be a hidden but relevant health condition in individuals with obesity and osteoarthritis. The Global Leadership Initiative on Malnutrition (GLIM) consensus includes muscle mass as one of the key phenotypic criteria, potentially enhancing its ability to detect malnutrition in individuals with obesity. We comprehensively profiled the nutritional status of individuals with obesity and advanced knee osteoarthritis and explored associations with health outcomes.

Methods

Data from the Prevention Of MusclE Loss in Osteoarthritis (POMELO) study was used, which included individuals with knee osteoarthritis and BMI≥35 kg/m2. Nutritional status was evaluated using the GLIM and sarcopenic obesity (SO) criteria. Low muscle mass (dual-energy x-ray absorptiometry), inflammation (C-reactive protein [CRP]), low muscle strength (handgrip/BMI), objective physical function (chair-stand test, 6-min walk test), and self-reported measures (quality of life, arthritis symptoms, and self-efficacy) were evaluated. Linear regressions were performed between GLIM-malnutrition and health outcomes, adjusted by age.

Results

Forty-six individuals (73.9% female, age 64.2 ± 6.7 years, BMI 42.4 ± 4.7 kg/m2) were included. Regarding nutritional status, 26.1% were classified with malnutrition (i.e., defined by the combination of low muscle mass and elevated CRP concentration), 26.1% with SO, and 13% shared both conditions. Individuals with malnutrition presented with worse self-reported physical function (WOMAC function: 38.0 ± 6.6 vs. 32.0 ± 12.5, p = 0.04) and lower arthritis self-efficacy (‘other symptoms’ component: 5.1 ± 1.9 vs. 6.3 ± 1.7, p = 0.04) compared to those without malnutrition. A trend was identified for lower quality of life (visual analog scale 46.8 ± 12.3 vs. 58.3 ± 20.5, p = 0.06) in those with malnutrition. Poor lipid control (R2 = 0.15, β = 0.76, 95% CI 0.08–1.44, p = 0.030), body fat (R2 = 0.14, β = 5.56, 95% CI 1.01–10.11, p = 0.018), and poor arthritis self-efficacy (R2 = 0.09, β = −1.23, 95% CI -2.39–0.06, p = 0.040) were also associated with malnutrition.

Conclusions

Participants presented with high malnutrition rates (1 out of 4), and half of them also had SO. Malnutrition was associated with abnormal metabolic parameters, lower arthritis self-efficacy, and worse self-reported physical function. An early nutritional assessment and intervention may be imperative for individuals with osteoarthritis and obesity to mitigate health consequences.

Place, publisher, year, edition, pages
Elsevier, 2025
Keywords
Malnutrition, GLIM, Sarcopenic obesity, Obesity, Osteoarthritis, Muscle mass
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-555391 (URN)10.1016/j.clnu.2025.03.019 (DOI)001465501800001 ()40187021 (PubMedID)2-s2.0-105001739834 (Scopus ID)
Available from: 2025-04-28 Created: 2025-04-28 Last updated: 2025-04-28Bibliographically approved
Compher, C. W., Fukushima, R., Correia, M. I., Gonzalez, M. C., Mckeever, L., Nakamura, K., . . . Uyar, M. (2025). Recognizing malnutrition in adults with critical illness: Guidance statements from the Global Leadership Initiative on Malnutrition. JPEN - Journal of Parenteral and Enteral Nutrition, 49(4), 405-413
Open this publication in new window or tab >>Recognizing malnutrition in adults with critical illness: Guidance statements from the Global Leadership Initiative on Malnutrition
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2025 (English)In: JPEN - Journal of Parenteral and Enteral Nutrition, ISSN 0148-6071, E-ISSN 1941-2444, Vol. 49, no 4, p. 405-413Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2025
Keywords
Global Leadership Initiative on Malnutrition, ICU, muscle mass, malnutrition
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-557165 (URN)10.1002/jpen.2748 (DOI)001481291500008 ()40162679 (PubMedID)
Available from: 2025-05-26 Created: 2025-05-26 Last updated: 2025-05-26Bibliographically approved
Fukushima, R., Compher, C. W., Correia, M. I., Gonzalez, M. C., McKeever, L., Nakamura, K., . . . Uyar, M. (2025). Recognizing malnutrition in adults with critical illness: Guidance statements from the Global Leadership Initiative on Malnutrition. Clinical Nutrition, 49, 202-208
Open this publication in new window or tab >>Recognizing malnutrition in adults with critical illness: Guidance statements from the Global Leadership Initiative on Malnutrition
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2025 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 49, p. 202-208Article in journal (Refereed) Published
Abstract [en]

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 hours of ICU admission when feasible (100% agreement) or within 4 days (94% agreement). 2. To identify the development and progression of malnutrition, we suggest reevaluation 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 prior to and after ICU discharge, we suggest reevaluating nutritional status prior to 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 at 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. (c) 2025 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Place, publisher, year, edition, pages
Elsevier, 2025
Keywords
ICU, Malnutrition, Global Leadership Initiative on Malnutrition, Muscle mass
National Category
Nutrition and Dietetics Nursing
Identifiers
urn:nbn:se:uu:diva-558963 (URN)10.1016/j.clnu.2025.03.011 (DOI)001493807700001 ()40169339 (PubMedID)2-s2.0-105001566652 (Scopus ID)
Available from: 2025-06-12 Created: 2025-06-12 Last updated: 2025-06-12Bibliographically approved
Cederholm, T., Jensen, G. L., Correia, M. I., Gonzalez, M. C., Fukushima, R., Pisprasert, V., . . . Compher, C. (2025). The GLIM consensus approach to diagnosis of malnutrition: A 5-year update. Clinical Nutrition, 49, 11-20
Open this publication in new window or tab >>The GLIM consensus approach to diagnosis of malnutrition: A 5-year update
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2025 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 49, p. 11-20Article in journal (Refereed) Published
Abstract [en]

Background

The Global Leadership Initiative on Malnutrition (GLIM) introduced an approach for malnutrition diagnosis in 2019 comprised of screening followed by assessment of three phenotypic criteria: weight loss, low BMI, and low muscle mass, and two etiologic criteria: reduced food intake/assimilation, and inflammation/disease burden. This planned update reconsiders the GLIM framework based on published knowledge and experience over the past five years.

Methods

A GLIM working group (n = 43 members) conducted a literature search spanning 2019–2024 using the keywords “Global Leadership Initiative on Malnutrition or GLIM”. Prior GLIM activities providing guidance for use of the criteria on muscle mass and inflammation were reviewed. Successive rounds of review and revision were used to achieve consensus.

Results

More than 400 scientific reports are published in peer-reviewed journals, forming the basis of 10 systematic reviews, some including meta-analyses of GLIM validity that indicate strong construct and predictive validity. Limitations and future priorities are discussed. Working group findings suggest that assessment of low muscle mass should be guided by experience and available technological resources. Clinical judgement may suffice to evaluate the inflammation/disease burden etiologic criterion. No revisions of the weight loss, low BMI, or reduced food intake/assimilation criteria are suggested. Following two rounds of review and revision, the working group secured 100 % agreement with the conclusions reported in the 5-year update.

Conclusion

Ongoing initiatives target priorities that include malnutrition risk screening procedures, GLIM adaptation to the intensive care setting, assessment in support of the reduced food intake/assimilation criterion, and determination of malnutrition in obesity.

Place, publisher, year, edition, pages
Elsevier, 2025
Keywords
Malnutrition, Screening, Assessment, Muscle, Inflammation
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-556095 (URN)10.1016/j.clnu.2025.03.018 (DOI)001472719600001 ()40222089 (PubMedID)2-s2.0-105002372414 (Scopus ID)
Available from: 2025-05-09 Created: 2025-05-09 Last updated: 2025-05-09Bibliographically approved
Kirk, B., Cawthon, P. M., Arai, H., Avila-Funes, J. A., Barazzoni, R., Bhasin, S., . . . Cruz-Jentoft, A. J. (2024). An executive summary on the Global conceptual definition of Sarcopenia. Aging Clinical and Experimental Research, 36(1), Article ID 153.
Open this publication in new window or tab >>An executive summary on the Global conceptual definition of Sarcopenia
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2024 (English)In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 36, no 1, article id 153Article, review/survey (Refereed) Published
Place, publisher, year, edition, pages
Springer, 2024
Keywords
Sarcopenia, Muscle mass, Muscle strength
National Category
Geriatrics Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:uu:diva-537520 (URN)10.1007/s40520-024-02798-4 (DOI)001281132800001 ()39066819 (PubMedID)
Available from: 2024-09-02 Created: 2024-09-02 Last updated: 2025-02-20Bibliographically approved
Hallberg, S., Söreskog, E., Borgström, F., Cederholm, T. & Hedström, M. (2024). Association between institutionalization by 4 months post-discharge walking capacity and lean body mass in elderly hip fracture patients: Evidence from a Swedish Registry Based Study. SAGE Open Medicine, 12
Open this publication in new window or tab >>Association between institutionalization by 4 months post-discharge walking capacity and lean body mass in elderly hip fracture patients: Evidence from a Swedish Registry Based Study
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2024 (English)In: SAGE Open Medicine, E-ISSN 2050-3121, Vol. 12Article in journal (Refereed) Published
National Category
Geriatrics
Identifiers
urn:nbn:se:uu:diva-549017 (URN)10.1177/20503121241258409 (DOI)
Available from: 2025-01-30 Created: 2025-01-30 Last updated: 2025-01-30Bibliographically approved
Mendonca, N., Avgerinou, C., Cavdar, S., Cederholm, T., Cruz-Jentoft, A. J., Torbahn, G., . . . Visser, M. (2024). Critical outcomes to be included in the Core Outcome Set for nutritional intervention studies in older adults with malnutrition or at risk of malnutrition: a modified Delphi Study. European Journal of Clinical Nutrition, 78(8), 663-669
Open this publication in new window or tab >>Critical outcomes to be included in the Core Outcome Set for nutritional intervention studies in older adults with malnutrition or at risk of malnutrition: a modified Delphi Study
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2024 (English)In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 78, no 8, p. 663-669Article in journal (Refereed) Published
Abstract [en]

Introduction: As part of the development of an agreed minimum set of outcomes or Core Outcome Set (COS) for future nutritional intervention trials in older adults with malnutrition or at risk of malnutrition, this work reports on the Delphi surveys and final consensus. Methods: Outcomes from a scoping review were incorporated into a two-round Delphi survey. Researchers and healthcare professionals experienced in malnutrition in older adults were invited to take part in an online survey to rate 38 selected outcomes on a nine-point Likert scale ranging from 'not important' to 'critical' for their setting (community, hospital, or long-term care). Consensus for inclusion was reached when >= 75% (or >= 60% if a patient-reported outcome) of the participants scored the outcome as 'critical' and <15% as 'not important'. Resulting outcomes were voted for inclusion or exclusion in the COS in a final online consensus meeting. Results: Ninety-three and 72 participants from diverse professional backgrounds and countries participated in the 1st and 2nd Delphi round, respectively. After both rounds eleven outcomes met the inclusion criteria, largely irrespective of setting. Fifteen participants, representing academia, health care, health policy, industry, and PPI, voted in a final online consensus meeting resulting in ten outcomes: malnutrition status, dietary intake, appetite, body weight or BMI, muscle strength, muscle mass, functional performance, functional limitations, quality of life, and acceptability of the intervention. Conclusions: Ten outcomes will form the COS which is intended to be used by the scientific community in all future nutritional intervention studies for older adults with malnutrition or at risk of malnutrition. The subsequent phase will establish the appropriate methods to measure these outcomes.

Place, publisher, year, edition, pages
Springer Nature, 2024
National Category
Nutrition and Dietetics Nursing
Identifiers
urn:nbn:se:uu:diva-540904 (URN)10.1038/s41430-024-01444-6 (DOI)001230098500001 ()38783109 (PubMedID)
Funder
EU, Horizon 2020
Available from: 2024-10-24 Created: 2024-10-24 Last updated: 2025-02-11Bibliographically approved
Wunderle, C., Gomes, F., Schuetz, P., Stumpf, F., Austin, P., Ballesteros-Pomar, M. D., . . . Bischoff, S. C. (2024). ESPEN practical guideline: Nutritional support for polymorbid medical inpatients. Clinical Nutrition, 43(3), 674-691
Open this publication in new window or tab >>ESPEN practical guideline: Nutritional support for polymorbid medical inpatients
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2024 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 43, no 3, p. 674-691Article in journal (Refereed) Published
Abstract [en]

Background: Disease-related malnutrition in polymorbid medical inpatients is a highly prevalent syndrome associated with significantly increased morbidity, disability, short- and long-term mortality, impaired recovery from illness, and healthcare costs.

Aim: As there are uncertainties in applying disease-specific guidelines to patients with multiple conditions, our aim was to provide evidence-based recommendations on nutritional support for the polymorbid patient population hospitalized in medical wards.

Methods: The 2023 update adheres to the standard operating procedures for ESPEN guidelines. We undertook a systematic literature search for 15 clinical questions in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g., published guidelines), until July 12th, 2022. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations (including SIGN grading), which was followed by submission to Delphi voting. Here, the practical version of the guideline is presented which has been shortened and equipped with flow charts for patients care.

Results: 32 recommendations (7x A, 11x B, 10x O and 4x GPP), which encompass different aspects of nutritional support were included from the scientific guideline including indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. Here, the practical version of the guideline is presented which has been shortened and equipped with flow charts for patients care.

Conclusions: Recent high-quality trials have provided increasing evidence that nutritional support can reduce morbidity and other complications associated with malnutrition in polymorbid patients. The timely screening of patients for risk of malnutrition at hospital admission followed by individualized nutritional support interventions for at-risk patients should be part of routine clinical care and multimodal treatment in hospitals worldwide. Use of this updated practical guideline offers an evidencebased nutritional approach to polymorbid medical inpatients and may improve their outcomes.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Guideline, Polymorbid, Multimorbidity, Nutritional support, Hospitalized patients
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-525901 (URN)10.1016/j.clnu.2024.01.008 (DOI)001181768500001 ()38309229 (PubMedID)
Available from: 2024-04-04 Created: 2024-04-04 Last updated: 2025-02-11Bibliographically approved
Jensen, G. L. & Cederholm, T. (2024). Exploring the intersections of frailty, sarcopenia, and cachexia with malnutrition. Nutrition in clinical practice, 39(6), 1286-1291
Open this publication in new window or tab >>Exploring the intersections of frailty, sarcopenia, and cachexia with malnutrition
2024 (English)In: Nutrition in clinical practice, ISSN 0884-5336, Vol. 39, no 6, p. 1286-1291Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2024
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-549018 (URN)10.1002/ncp.11180 (DOI)001256956000001 ()38937080 (PubMedID)2-s2.0-85197413322 (Scopus ID)
Available from: 2025-01-30 Created: 2025-01-30 Last updated: 2025-01-31Bibliographically approved
Projects
Nutrition and ageing - epidemiological and experimental studies [2009-03880_VR]; Uppsala UniversitySarcopenia – novel understanding of occurrence, mechanisms and treatment of an emerging threat to independent living at old age [2011-01166_Forte]; Uppsala UniversityNutrition and ageing - epidemiological, expermental and clinical studies [2012-02799_VR]; Uppsala UniversitySarcopenia in old age and chronic disease - epidemiology, mechanisms and interventions [2015-02338_VR]; Uppsala University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3705-0725

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