PhD project This research project is a doctoral research project within the national research school in nutrition and dietetics, Integrating Sustainability in Nutrition Care, InSyNC. The project aims to investigate and improve the assessment and diagnosing of malnutrition in clinical practice, with specific focus on the muscle mass assessment.
To diagnose malnutrition according to the Global Leadership Initiative on Malnutrition, GLIM, five different criteria need to be assessed, where muscle mass is one of them. The implementation of GLIM in clinical practice has not been straightforward, especially since all criteria should be assessed to ensure the validity of the malnutrition diagnosis. For example, assessing muscle mass requires skilled personnel and available methods and techniques. The overall aim is to investigate and improve the assessment and diagnosing of malnutrition, with specific focus on the muscle mass assessment.
Many diseases and conditions are associated with high prevalence of malnutrition. In chronic diseases, malnutrition often coexists with low muscle mass. Muscle mass decreases with age but can be further aggravated in patients with chronic or acute disease. Malnutrition and being at risk of malnutrition causes clinical adverse outcomes such as higher mortality, poor quality of life (QoL), physical impairment, and higher healthcare costs due to longer rehabilitation and hospitalization stays. These consequences of malnutrition are mainly associated with the loss of muscle mass. Examining and assessing muscle mass is therefore an important part of the malnutrition assessment and diagnosis as it is important to detect malnutrition early so it can be properly treated.
In 2019, leading nutrition societies around the world published a consensus, the Global Leadership Initiative on Malnutrition (GLIM) criteria, stating how malnutrition ought to be diagnosed. Since then, the GLIM criteria have found increasing acceptance, and research on the new framework has been extensive. The GLIM framework consists of in total five criteria: three phenotypic criteria (weight loss, low body mass index [BMI], and low muscle mass) and two etiologic criteria (low food intake or assimilation and acute or chronic inflammation or disease burden). Presence of one etiologic and one phenotypic criterion sets the diagnosis of malnutrition. Seeing that the GLIM criteria are new, operational differences can be found in studies that have used them to diagnose malnutrition and the implementation of the GLIM framework in clinical practice has not been straightforward, especially since all five criteria should be assessed to ensure its validity. Particularly, the assessment of the phenotypic criterion muscle mass holds hesitations towards its applicability and use since this assessment requires skilled personnel and available methods and techniques. More studies are needed to emphasize the benefits of assessing malnutrition and low muscle mass, and how these processes can be implemented in clinical practice.
This doctoral research project is divided into two parts. The first part will focus on the operationalization of the GLIM criteria in patients with chronic kidney disease. The second part aims to investigate and improve the use and assessment of muscle mass and, thus, the assessment and diagnosing of malnutrition in clinical practice. You can read more about the different projects on the links below.
