Global Leadership Initiative on Indications to Nutritional Therapy and Support (GLINTS): A consensus report from the global clinical nutrition community.

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.