GLIM criteria for the diagnosis of malnutrition in patients with cirrhosis: A narrative review.

BACKGROUND

This narrative review aims to describe and discuss the validity of the Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with cirrhosis.

METHODS

The literature search was performed in PubMed and EMBASE between May and August 2024 and updated in January 2025, including original studies published in English in which patients with cirrhosis were assessed according to the GLIM framework.

RESULTS

Seventeen studies with data from 4275 patients were included. There were substantial differences in the use of the GLIM criteria among studies. Overall, the prevalence of malnutrition by the GLIM framework when all the criteria were considered ranged between 21% and 65.1% and was frequently lower when compared to the prevalence by other tools. Sensitivity and specificity of the GLIM criteria in comparison to standard tools were tested in four studies, and none achieved the minimum requirements to determine adequate concurrent validity. In contrast, the diagnosis of malnutrition by the framework demonstrated adequate predictive validity in six studies (HR/OR 2.1-7.2).

CONCLUSION

In patients with cirrhosis, the prevalence of malnutrition is generally lower when assessed using the GLIM criteria compared with standard tools. Evidence on concurrent validity is currently limited, with existing studies showing insufficient sensitivity and specificity in relation to the Subjective Global Assessment. However, malnutrition defined by GLIM independently predicts adverse clinical outcomes in this population. Future research should focus on the current gaps and on the adequate use of the criteria to strengthen their clinical applicability in nutritional assessment and management of cirrhosis.