The GLiM represents the rock types of the Earth surface with 1,235,400 polygons. A new high resolution global lithological map (GLiM) was assembled from existing regional geological maps translated into lithological information with the help of regional literature. Understanding these processes at the global scale requires a high resolution description of lithology. It plays a key role in many processes at the Earth surface, especially the fluxes of matter to soils, ecosystems, rivers, and oceans. If only stage 2 is documented, it must be clarified as severe for correct coding of E43 (severe malnutrition).Lithology describes the geochemical, mineralogical, and physical properties of rocks. #Meaning of glims codeMalnutrition stage is not an indexed term so if stage 1 is documented, code E46 (unspecified malnutrition) may be used. However, world-wide nutritional research has validated the contribution of GLIM BMI ranges to malnutrition and confirmed their adverse health consequences in acutely and chronically ill hospitalized patients.įrom a coding perspective, GLIM identifies only moderate and severe malnutrition. The GLIM BMI criteria may at first seem overstated since the CDC definition of "normal" in the general healthy population is 18.5 to 24.9. While not specifically mentioned by GLIM, SIRS criteria could also be used to identify systemic inflammation. C-reactive protein (CRP) is preferred but low albumin/prealbumin are also included. Biomarkers are recommended to confirm chronic or severe systemic inflammation. This is a much-needed provision that incorporates recent research showing the central role systemic inflammation plays in the development of malnutrition. In addition, the GLIM Etiology criteria for acute disease/injury includes confirmation of severe systemic inflammation (in contrast to ASPEN). More stringent criteria for severe malnutrition reduces over-diagnosis and compliance exposure. The GLIM criteria are less subjective, more clinically intuitive and include weight loss, muscle mass, and BMI parameters that are more consistent with the traditional concepts of non-severe and severe malnutrition.įor example, muscle mass assessment is much more robust than in ASPEN recommending calf/arm circumference, physical findings and measurement of hand grip strength. While the ASPEN criteria is effective for diagnosing malnutrition, it was less so for defining severe malnutrition. The GLIM criteria offer some advantages over the 2012 ASPEN Malnutrition Consensus criteria. As an alternative, calf or arm circumference and physical exam findings may be used along with calibrated hand-grip strength which is correlated with muscle mass. *To measure muscle mass, GLIM recommends use of DEXA, bio-electrical impedence analysis (BIA), ultrasound, CT or MRI, but these are costly and impractical. Severe deficit (per validated assessment methods*) Mild-to-moderate deficit (per validated assessment methods*) Severity of malnutrition is based on phenotypic criteria only, and requires 1 phenotypic criteria that meets these thresholds: Moderate (stage 1) malnutrition Reduced by objective measures and/or physical examĬhronic GI disorders with adverse nutrition impactĪcute disease/injury with severe systemic inflammation, or GLIM Malnutrition criteria Phenotypic Criteria Get our CDI Pocket Guide® for more information about the GLIM and ASPEN criteria for malnutrition. The diagnosis of malnutrition requires at least 1 phenotypic criterion and 1 etiologic criterion. The GLIM definition of malnutrition is based on 5 diagnostic criteria: 3 phenotypic (clinical findings) and 2 etiologic (causes). The purpose of GLIM is to reach a global consensus on the identification and endorsement of criteria for the diagnosis of malnutrition in clinical settings. Leaders of the initiative included representatives from the American Society for Parenteral and Enteral Nutrition (ASPEN), European Society for Clinical Nutrition and Metabolism, Latin American Nutritional Federation, Parenteral and Enteral Nutrition Society of Asia. In 2018, the Global Leadership Initiative on Malnutrition (GLIM) published in the Journal of Parenteral and Enteral Nutrition a consensus recommendation “ GLIM Criteria for the Diagnosis of Malnutrition: A Consensus Report From the Global Clinical Nutrition Community.”
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