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Objectives: The Global Leadership Initiative on Malnutrition (GLIM) is a framework for diagnosing malnutrition. The applicability of GLIM in patients receiving dialysis remains insufficiently explored. This study aimed to identify the most prevalent phenotypic criteria, assess whether dialysis per se can be used as the sole etiological criterion, and evaluate dietitians' perceptions of GLIM's feasibility in clinical practice.

Methods: In this exploratory mix-method study, adult patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) were recruited from six Swedish dialysis centers. Malnutrition was diagnosed and graded according to GLIM. Phenotypic criteria included unintentional weight loss, low body mass index, and low muscle mass assessed by calf or arm muscle circumference. Two etiologic models were applied: (I) reduced dietary intake or inflammation, and (II) dialysis as the sole disease-related burden. Renal dietitians conducted assessments and completed a questionnaire on feasibility.

Results: Ninety-three patients were included (HD n = 57, PD n = 36), median age 74 y; 60% were male and 43% had diabetes. Low muscle mass was the most prevalent phenotypic criterion (49%). Malnutrition prevalence was 42% using model I and 55% using model II. Ten dietitians completed the assessments, with a median time of 15 minutes. Facilitators included clear guidelines, appropriate equipment, and organizational support. Assessment was also perceived as motivating for patients.

Conclusions: The prevalence of malnutrition among dialysis patients using GLIM varied between 42% and 55% depending on the etiological model. Low muscle mass was the most common phenotypic criterion. GLIM appeared feasible for routine use in dialysis care.

Anthocyanins are dietary flavonoids shown to have a therapeutic capacity to mitigate inflammation and oxidative stress. The present secondary analyses from the "Anthocyanins in People at Risk for Dementia Study" were aimed at (I) determining the intervention's effect on blood-based markers of cardiovascular disease and inflammation and (II) evaluating whether baseline factors such as age, sex, inflammation, or cardiometabolic score may moderate the intervention's effect on inflammatory status. This study was an ancillary, 24-week randomized, double-blind, placebo-controlled Phase II trial. Sub-sample participants (n = 99), aged 60-80 years with mild cognitive impairment or cardiometabolic disorders, were randomized to receive either 320 mg/day of anthocyanins or placebo. The biomarkers analyzed included inflammatory biomarker assessment (IL - 6, IL - 8, IL - 10, IL - 1b, TNF - α, IFN - γ), and C-reactive protein (CRP), as well as albumin, thrombocytes, cholesterol, LDL, HDL, and triglycerides, which were longitudinally compared between both groups. Baseline characteristics were balanced between the groups. ANCOVA analyses reveal 24-week differences favoring the anthocyanin treatment in LDL cholesterol levels (ƞp² = 0.078; p = 0.015), cardiometabolic score (ƞp² = 0.073; p = 0.021), CRP levels (ƞp² = 0.417; p = 0.0001), IL - 6 (ƞp2 = 0.085; p = 0.015), IL - 1b (ƞp² = 0.058; p = 0.037), and Inflam z-score 5 (ƞp² = 0.059, p = 0.004). Moderation analysis demonstrated that the inflammatory score at baseline was a significant predictor of the effect of the intervention on the CRP levels. Anthocyanin supplementation reduces CRP and cardiovascular disease biomarkers in individuals at risk of dementia, especially when there is increased inflammation at baseline. ClinicalTrials.gov study identifier: NCT03419039.

Background: Sarcopenic obesity (SO) is characterized by excess adiposity and reduced muscle mass and function. In 2022, the Sarcopenic Obesity Global Leadership Initiative (SOGLI) proposed a diagnostic algorithm to standardize SO identification by integrating screening, diagnostic assessment, and staging.

Aim: This review evaluates the application of the SOGLI algorithm, identifying strengths, limitations, and potential areas for refinement.

Methods: A narrative review with systematic citation tracking was conducted (April 2022-August 2025). Literature searches in PubMed, Scopus, and Web of Science identified original studies in adults (>= 18 years) explicitly using the SOGLI algorithm. Data on screening, diagnostic tools, staging, prevalence, and comorbidities were synthesized.

Results: Seventy-two studies applied the SOGLI algorithm, showing heterogeneous approaches across clinical settings. For obesity screening, about half used both body mass index and waist circumference, while sarcopenia screening tools were less frequently reported. For SO diagnosis, bioelectrical imped-ance analysis was the most common method for body composition assessment, while muscle function was predominantly assessed via hand-grip strength. SO staging was reported in 19% of studies, most often as Stage II. Application of the algorithm consistently confirmed associations between SO and chronic disease burden, functional decline, and increased mortality.

Conclusions: The SOGLI algorithm represents a major advance, with 72 studies adopting it in two years. Some inconsistencies in screening and staging suggest opportunities for refinement. These findings support its validity, while further standardization and integration of novel biomarkers could enhance its clinical effectiveness. 

Introduction

Although frailty is considered a potentially modifiable risk factor for dementia, its influence on health outcomes in individuals with established dementia remains unclear. This study aims to systematize the current evidence to understand the impact of frailty on the development of adverse outcomes in older adults with dementia.

Methodology

We conducted a systematic review to investigate which adverse outcomes in 65 years or older adults with dementia are influenced by frailty. A comprehensive search was conducted across three databases—MEDLINE, EMBASE, and Cochrane—to identify relevant studies addressing this research question as of November 2024. Studies were considered for inclusion if they were observational studies or clinical trials involving individuals with dementia, assessed frailty within this population, and documented adverse health outcomes. Two independent and blinded researchers performed screening, data extraction, and risk of bias assessment. PROSPERO register CRD42024543327.

Results

Our search identified 5891 articles, from which 12 were included after screening and eligibility assessment (n = 172,025 participants). Alzheimer's disease was the most studied type of dementia, and the prevalence of frailty ranged from 8% to 65.9%. The reported adverse outcomes associated with frailty in patients suffering from dementia were mortality, institutionalization, functional and cognitive decline, neuropsychiatric symptoms, reduced quality of life, caregiver burden, and hospitalization.

Discussion

Understanding frailty in older adults with dementia may inform improved care strategies. Our findings suggest that higher levels of frailty are associated with an increased risk of adverse health outcomes.

Background & aims: Providing clear guidance for nutritional interventions is a precondition for the fight against the consequences of (risk of) malnutrition/undernutrition. Therefore, a group of international experts representing major global and regional clinical nutrition societies decided to clarify indications for nutritional therapy and support. The initiative was named the Global Leadership Initiative on Indications to Nutritional Therapy and Support (GLINTS).

Methods: The study used a modified Delphi methodology to develop expert consensus. Eight major statements were formulated. The process combined quantitative scoring of agreement with qualitative free-text feedback to support the revision of statements between rounds. The modified Delphi process was conducted through three sequential web-based survey rounds administered using Qualtrics (Qualtrics, Provo, UT), allowing iterative refinement of the statements and reassessment of agreement after structured panel feedback.

Results: Consensus was reached on indications for nutritional therapy/support: (i) malnutrition/undernutrition defined by the GLIM criteria, (ii) risk of malnutrition/undernutrition, and (iii) reduced oral intake. Enteral tube feeding is indicated when oral nutritional intake provides less than 50% of estimated energy and nutrient requirements and no significant improvement in intake is expected. Intestinal failure is an indication for parenteral nutrition, and supplemental parenteral nutrition may be used when oral and/or enteral nutrition fails to provide adequate energy and protein intake despite appropriate optimization strategies. All statements reached the level of consensus at 85% or greater.

Conclusions: Consensus on when to start nutritional therapy/support was reached by the modified Delphi process. These defined and agreed recommendations may contribute to better nutritional care. (c) 2026 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

The GLIM malnutrition diagnostic framework includes the etiologic criterion for reduced dietary intake or assimilation (i.e., digestion or absorption). This criterion required further specification to support consistent use in clinical practice. Three rounds of a modified Delphi was undertaken to develop consensus on guidance to support identification of this criterion. A working group (n = 10) developed surveys iteratively. Invited global experts with diverse disciplines and practice contexts (n = 30) fully completed surveys; consensus was determined at 75% agreement. Three surveys and rounds of voting resulted in 15 guidance statements. Notable points include: (a) using usual intake as the comparator for reduced dietary intake rather than energy requirement, (b) use of gastrointestinal symptoms and nutrition impact symptoms to determine challenges with absorption or assimilation, rather than solely gastrointestinal conditions, and (c) using clinical judgment to determine severity of these symptoms. The final criterion is "less than or equal to 50% dietary intake in the last week or any reduction in intake greater than 2 weeks OR severe gastrointestinal or nutrition impact symptoms (e.g., dysphagia, nausea, vomiting, diarrhea) as a result of an acute or chronic condition or therapy." Future work should confirm the feasibility of this criterion in clinical practice and its criterion validity within the GLIM framework.

Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. The objective of this guide was to provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. As a result we provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counselling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. As a conclusion a range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.

La malnutrición (o desnutrición) y la deshidratación son frecuentes en las personas mayores, y la obesidad es un problema creciente. Sin embargo, faltan estrategias adecuadas y efectivas para contrarrestarlas en la práctica clínica. El objetivo de esta guía fue proporcionar recomendaciones para la nutrición clínica e hidratación en la población adulta basadas en la evidencia científica, con el fin de prevenir y/o tratar la malnutrición y la deshidratación. Además, se abordó si las intervenciones para perder peso en las personas mayores con sobrepeso u obesidad son adecuadas. Esta guía fue desarrollada según el procedimiento operativo estándar para las guías y documentos de consenso de ESPEN, con una búsqueda sistemática de la literatura basada en 33 preguntas clínicas en formato PICO (Población, Intervención, Comparación y Resultado). La calidad de la evidencia se evaluó con el sistema SIGN. Las recomendaciones fueron desarrolladas y consensuadas mediante un proceso compuesto por múltiples etapas. En cuanto a resultados se desarrollaron 82 recomendaciones basadas en la evidencia para la atención nutricional en las personas mayores, cubriendo 4 temas principales: cuestiones básicas y principios generales; recomendaciones para las personas mayores con riesgo de malnutrición o con malnutrición; recomendaciones para las personas mayores con enfermedades específicas y recomendaciones para prevenir, identificar y tratar la deshidratación. En general, se recomienda que a todas las personas mayores se les realice un cribado (o tamizaje) de malnutrición para identificar tempranamente un riesgo existente. La nutrición oral se puede apoyar mediante intervenciones de enfermería, educación, consejo nutricional, modificación de alimentos y el uso de suplementos (o complementos) nutricionales orales. La nutrición enteral debe iniciarse si la alimentación por vía oral es insuficiente o imposible. La nutrición parenteral debe iniciarse si la nutrición enteral es insuficiente o imposible y el pronóstico general es favorable. Se deben evitar las restricciones dietéticas; en las personas mayores con problemas de salud relacionados con la obesidad, las dietas para bajar de peso solo deben considerarse en combinación con el ejercicio físico. Debe considerarse a todas las personas mayores como en riesgo de deshidratación debido a una baja ingesta y debe animárseles a consumir suficientes líquidos. Por lo general, las intervenciones serán individualizadas, integrales y parte de un enfoque de equipo multimodal y multidisciplinar. Como conclusión existe una amplia variedad de intervenciones eficaces para respaldar una nutrición e hidratación adecuadas en las personas mayores, con el objetivo de mantener o mejorar el estado nutricional, el curso clínico y la calidad de vida. Estas intervenciones deben ser implementadas en la práctica clínica y utilizarse de manera sistemática.

INTRODUCTION

Residents in long-term institutional care (LTIC) settings are at risk of malnutrition, sarcopenia, and frailty. In the Older Persons Exercise and Nutrition (OPEN) randomized study, the impact of exercise and nutrition was analyzed. This secondary analysis focused on caregiver time (CGT).

METHODS

The 3-month intervention included repeated sit-to-stand exercises and two protein-enriched supplements daily. CGT was assessed in both dementia and somatic units using the Resource Utilization in Dementia instrument. Non-linear methods were applied due to skewed data.

RESULTS

The sample consisted of 102 persons (intervention group [IG] n = 52, control group [CG] n = 50). CGT in the IG was significantly lower at follow-up, adjusted for baseline CGT, in the dementia units, that is, 55 min/day and resident, compared to 83 min/day in the CG (odds ratio 0.668 [0.473–0.945]; p = 0.022).

DISCUSSION

A structured exercise and nutrition program was associated with reduced CGT in the dementia, but not the somatic, LTIC units.

CLINICAL TRIAL REGISTRATION

This study has been registered with the number protocol of ClinicalTrials.gov Identifier: NCT02702037.

The assessment of body composition has long been a fundamental component of research and is gaining increasing adoption in clinical practice. This growing interest has drawn new professionals to the field and increased emphasis on its clinical relevance and applications. However, the diversity of assessment techniques and inconsistent terminology create challenges, highlighting the urgent need for harmonized approaches across research and healthcare settings. Commonly employed methods include bioelectrical impedance approaches, dual-energy X-ray absorptiometry, and computerized tomography, with ultrasound emerging as an increasingly prominent tool. These methods are featured in guidelines for diagnosing conditions such as low muscle mass, malnutrition, sarcopenia, and sarcopenic obesity, among others. This second narrative review in a series, developed by an international panel of experts, focuses on these widely accessible assessment tools that align with clinical recommendations. It presents foundational knowledge, discusses validity and reliability considerations, and offers practical advice on terminology, measurement protocols, data interpretation, and longitudinal monitoring. The report also addresses current limitations and identifies areas needing further research. Our goal is to provide clear, evidence-based guidance that is useful for both experienced practitioners and those newly engaging with body composition assessment. We urge organizations, journals, and stakeholders across the body composition field to adopt the proposed principles and standards to support consistency, transparency, and scientific rigor in both research and clinical care.

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.