Objectives include: 1. Background: Other subjects were allocated to the non-LBP group (n = 65). However, little is known about malnutrition and sarcopenia in daycare facilities, the most dominant long-term care service. FELANPE suggested that the anticipated consensus approach needs to prioritize a diagnostic methodology that is available for everybody since resources differ globally. Conclusion Nutrition screening tools: does one size t all? A systema. Results A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Medical, nursing, dietetic, admin staff; family, friends, patients . core phenomena in conditions such as sarcopenia, should be an integral measure in assessment of patients, with suspected sarcopenia because impairment of, mediators and other mechanisms besides malnutrition, with sarcopenia, cachexia, and frailty so that the priority, conditions will require combined multimodal interventions, inammation. The Malnutrition–Inflammation Score (MIS) is a practical, low cost nutrition assessment tool with a degree of severity score range from 0 (normal) to 30 (severely malnourished) to examine PEW and inflammation. A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Malnutrition was assessed by Patient‐Generated Subjective Global Assessment (PG‐SGA) (score of ≥4 was interpreted as risk for malnutrition and ≥9 as malnourished) 38 and the global leadership initiative on malnutrition (GLIM) criteria. 7. The prevalence of moderate or severe malnutrition was 21.5% via PG-SGA and 20% via GLIM+handgrip strength. A two-step approach for the malnutrition diagnosis was selected, i.e., first screening to identify "at risk" status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. Design: Objective: (2) Methods: Seventy HD patients were assessed. Low FFMI is <15 and <17 kg/m(2) in females and males, respectively. This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. All 3 tools had good agreement and the most commonly used nutrition parameter was muscle loss (subjective). Background A multi-omics approach, including biomarkers and PRO (patient reported outcomes) is, in our opinion, the optimal way to study the relationship between malnutrition and transplant outcomes. 10. Adjusting skeletal muscle mass by weight rather than height is better in showing the effect of older age in sarcopenia and identifying sarcopenic obesity; however, some Asian studies found no significant skeletal muscle loss, and muscle strength might be a better indicator. A two-step approach for the malnutrition diagnosis was selected, i.e., first screening to identify “at risk” status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. Methods malnutrition – an ESPEN consensus statement. The diagnosis of malnutrition requires at least one phenotypic criterion and one etiologic criterion. Management of the child with severe malnutrition … In a malnutrition assessment tool for the HCV population, both subjective and objective measures of body composition should be included. Patients with expected length of stay (LOS) >48 hours in ICU were assessed for nutritional status using the patient generated-subjective global assessment (PG-SGA) within 48 hours of admission to ICU. 3. . Body composition data was extracted from the L3 level of the preoperative CT scan. Setting: ER, energy requirements; GI, gastrointestinal. and documentation of adult malnutrition (undernutrition). 2018;0:1–9. Seeking adoption by the World Health Organization (WHO) and the International Classification of Diseases (ICD). This study investigated the associations between malnutrition and adverse outcomes, and identified which component(s) of the GLIM criteria is/are risk factor(s) of adverse outcomes in Chinese older adults. The Global Leadership Initiative on Malnutrition (GLIM) has recently published criteria for classifying malnutrition. 14. The aim of this study was to explore the prevalence of malnutrition using the malnutrition inflammation score (MIS) and the bio-electrical impedance - derived phase angle (PhA) and comparing them to the new Global Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition. The Global Leadership Initiative on Malnutrition (GLIM) has recently published criteria for classifying malnutrition. cancer cachexia: an international consensus. Chronic liver disease often leads to malnutrition in patients. Muscle weakness has been reported as a risk factor for these conditions, and exercise therapy can improve them. Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, and Theme Aging, Department of Surgery, Universidade Feder, Department of Surgery and Palliative Medicine, Fujita Health University School of, Monash University Australia and University, Clinical Nutrition Department, Hospital General de M, Schlegel-UW Research Institute for Aging and Department of Kinesiology, University of. According to Global Leadership Initiative on Malnutrition (GLIM) criteria, 40.3% (25/62) of patients were malnourished and 59.7% (37/62) were well nourished. Phenotypic criteria. Journal of Cachexia, Sarcopenia and Muscle. In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. The weight of each GLIM criteria was calcu This is a high priority, because this classication scheme guides clinical diagnosis. Current thinking on diagnostic approaches was shared; ESPEN suggested a grading approach that could encompass various types of signs, symptoms, and etiologies to support diagnosis. All rights reserved. After a systematic search, no satisfying biomarker was found, except for citrulline. Cutpoints derived from WeakI for ALM (ALMI ) were less than 21.4 kg in men and less than 14.1 kg in women and for ALM adjusted for body mass index (ALM/BMII ) were less than 0.725 in men and less than 0.591 in women. GLIM has engaged several of the clinical nutrition societies, with global reach to focus on standardizing the clinical, global consensus on the identication and endorsement, Nutrition and Dietetics, and the Colegio Mexicano de Nutriologos (tra, from Abbott Nutrition Health Institute and Baxter. In this study, the prevalence of and factors associated with malnutrition and sarcopenia in older individuals who commute to community daycare facilities were evaluated. Primary outcomes were ICU and hospital mortality, ICU and hospital LOS and length of mechanical ventilation. Transparency and external input will be sought. This study investigated the associations between malnutrition and adverse outcomes, and identified which component(s) of the GLIM criteria is/are risk factor(s) of adverse outcomes in Chinese older adults. The MIS includes seven components of the SGA, plus body mass index, and serum albumin and transferrin (total iron binding capacity) Adult starvation and disease-r, from the International Consensus Guideline Committee. GLIM diagnostic scheme for screening, assessment. The identification and establishment of an individualised care plan for those people with dementia with polypharmacy in nursing homes, and those with involuntary weight loss, accidental falls, polypharmacy and higher caregiver burden in the home care setting, might help preventing unnecessary hospital admissions. The Global Leadership Initiative in Malnutrition (GLIM) is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings. Method: that the three major published approaches (ESPEN, ASPEN/AND and Subjective Global Assessment (SGA)) all propose weight loss as a key indicator for malnutrition. Future studies should explore sex differences in the relationship between body composition and physical function and the effect of change in muscle mass on muscle strength and physical function. The score can indicate that a patient is at risk of or has a malnutrition diagnosis, requiring referral to the RD for nutrition assessment and intervention. PENSA highlighted that BMI varies by ethnicity/race, and that sarcopenia/muscle mass evaluation is important for the diagnosis of malnutrition. The cross-sectional study included 62 older individuals screened for malnutrition and sarcopenia on their first day in a daycare facility in Japan. Malnourished patients had a longer LOS in hospital than well-nourished patients (24 vs 17 days, P = .03). Nutritional Assessment in Adult Patients with Dysphagia: A Scoping Review, Poor Interrater Reliability of Retrospectively Applied Subjective Global Assessment for Malnutrition in the Critically Ill, Association of low back pain with muscle weakness, decreased mobility function, and malnutrition in older women: A cross-sectional study, Serum Biomarkers Associated with Malnutrition and Nutritional Risk in Elderly Primary Care Patients: A Cross-sectional Study from Bosnia and Herzegovina, A Systematic Review of the Literature and Perspectives on the Role of Biomarkers in the Management of Malnutrition After Allogeneic Hematopoietic Stem Cell Transplantation, Prevalence and Associated Factors of Malnutrition and Sarcopenia in a Daycare Facility: A Cross-Sectional Study, Skeletal muscle depletion and nutrition support affected postoperative complications in patients who underwent pancreatoduodenectomy, Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs, Relationship between nutritional status on admission to the intensive care unit and clinical outcomes, Nutrition Parameters for Assessing Malnutrition in a Population of US Veterans With Hepatitis C Virus, ESPEN Guidelines on Definitions and Terminology of Clinical Nutrition, Global Leadership Initiative on Malnutrition: Progress Report From ASPEN Clinical Nutrition Week 2017, To Create a Consensus on Malnutrition Diagnostic Criteria: A Report From the Global Leadership Initiative on Malnutrition (GLIM) Meeting at the ESPEN Congress 2016, Definition and classification of cancer cachexia: An international consensus, To create a consensus on malnutrition diagnostic criteria: A report from the Global Leadership Initiative on Malnutrition (GLIM) meeting at the ESPEN Congress 2016, Agreement and Predictive Validity Using Less-Conservative Foundation for the National Institutes of Health Sarcopenia Project Weakness Cutpoints, Recent Advances in Sarcopenia Research in Asia: 2016 Update From the Asian Working Group for Sarcopenia, Global Leadership Conversation: Addressing Malnutrition, What is subjective global assessment of nutritional status, Diagnostic criteria for malnutrition – An ESPEN Consensus Statement, DIET, LIFESTYLE AND CHRONIC KIDNEY DISEASE. Conclusion: clinical settings, global dissemination of consensus criteria, and the priority to seek adoption by leading diagnosis, classication and coding entities across the globe, should be simple and include clinically relevant dia, The intent was also to promote global use of consensus, criteria that can be readily used with other a, evaluation of nutrition status is malnutrition risk screen-, ing to identify at-risk status by the use of any vali-, by the second step of assessment for diagnosis and severity, Criteria Selected for Malnutrition Diagnosis, A comprehensive survey of existing approaches used in, ample, the presence of weight loss and disease burden or, inammation is common to most of them, as is reduced, In order to establish consensus and endorsement of, a minimum set of diagnostic criteria by the core lead-, ership committee and the supporting working gr, proposed diagnosis criteria. 17 The GLIM criteria were later applied for … Consensus development around evidence-based criteria for broad application. Results We then evaluated for Kappa agreement between the GLIM malnutrition stage, GLIM weight loss category, and PG‐SGA malnutrition … Malnutrition (GLIM) meeting at the ESPEN Congress 2016. and Clinical Practice Committee, European Society of Parenteral and, Enteral Nutrition (ESPEN). Subsequent assessment using the GLIM criteria was then conducted for the diagnosis and severity grading of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. criteria: a report from the Global Leadership Initiative on Malnutrition (GLIM) meeting at the ESPEN Congress 2016. Nutrients 2021, 13, 778. In the nursing home setting, only polypharmacy was associated with a higher chance of hospital admission, while in the home care setting, unintentional weight loss, polypharmacy, falls, and more severe caregiver burden were associated with hospital admission. Patients were aged 59 ± 17 years on average with a mean BMI of 29 ± 7 kg/m2 and a mean Acute Physiology and Chronic Health Evaluation II score of 19 ± 7. Results: Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Although malnutrition is a global concern associated, Karolinska University Hospital, Stockholm, Sweden; the, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape T, Parenteral and Enteral Nutrition, Silver Spring, Maryland, and Mt. R, the diagnosis of malnutrition, GLIM recommends that the, combination of at least 1 phenotypic criterion and 1 etio-, guided by review of existing approaches used in screening, and assessment, as was the selection of threshold values, GLIM, Global Leadership Initiative on Maln, categorize the severity of malnutrition depending on the, phenotypic metrics for grading severity as sta, Chronic disease with minimal or no perceived inamma, Acute disease or injury with severe inammation, diagnosis classication is endorsed by GLIM consistent, with those suggested previously by the Interna, to chronic disease with inammation; maln, to chronic disease with minimal or no perceived inamma-, tion; malnutrition related to acute disease or injury with, global consensus criteria so that malnutrition pre, necessity in order to support the development of global, based on a strong consensus endorsing core phenotypic, throughout the world. Affected patients tend to have worse clinical outcomes and higher mortality than those without sarcopenia. Risk of malnutrition should have its own ICD Code. Background Methods All malnourished individuals were sarcopenic and 14.5% (9/62) were well nourished and nonsarcopenic. Activity-related sarcopenia seemed to precede malnutrition. To determine the prevalence of malnutrition on admission to the intensive care unit (ICU) and the relationship between nutritional status on admission and clinical outcomes in adult critically ill patients. Subsequent assessment using the GLIM criteria was then conducted for the diagnosis and severity grading of malnutrition. FELANPE suggested that the anticipated consensus approach needs to prioritize a diagnostic method that is available for everybody since resources differ globally. Subjects with LBP (numerical rating scale ≥2; range, 0–4) during the preceding month were allocated to the LBP group (n = 36). Potential criteria were subjected to a ballot among the GLIM core and supporting working group members. Survey of Existing Approaches Used in Screening and Assessment of Malnutrition and Cachexia. Objectives: ... 6,[11][12][13] There is no gold standard nutrition assessment tool recommended by the guidelines, and the recommended tools (including the Mini Nutritional Assessment, the Malnutrition Universal Screening Tool, the Short Nutritional Assessment Questionnaire, the Malnutrition Screening Tool, NRS 2002, and the NUTRIC) are often difficult to use, may be affected by confounding factors, and have poor interrater reliability. Multivariate regression models were used to investigate the factors associated with hospital admission for each setting. Pharmacologic interventions have been unsatisfactory, and the core management strategies remain physical exercise and nutritional supplementation; however, further research is required to determine the most beneficial approaches. of Health Sarcopenia Project Weakness Cut points. Within 24 hours of admission : and weekly during . 29 Sarcopenia was … concluded that it was difficult to accurately ascertain the prevalence of malnutrition due to discrepancies in the measurement methods used. Muscle is a direct key linking decreased mobility function and malnutrition. Measurements: Albumin levels significantly differed regarding nutritional status (P=0.004), but not nutritional risk level (P=0.521). admission . The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round. Nutritional Assessment in Adult Patients with Dysphagia: A Scoping Review. The cross-sectional study included 446 elderly adults over 65 years of age from four areas of Bosnia and Herzegovina. Of those classified with malnutrition using any assessment tool, mean body mass index was 26.6 (P = .014), subjective muscle loss was the most frequently encountered parameter, and 6 (40%) of 15 also had fluid accumulation. The Asian Working Group for Sarcopenia 2019 evaluation found that 12.9% (8/62) of patients showed no sarcopenia, whereas 87.1% (54/62) had sarcopenia. Reduced BMI is <20 or <22 kg/m(2) in subjects younger and older than 70 years, respectively. Weight loss % (unintended) 5% < 6 months, or 10% > 6 months. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Background It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. Results GLIM appointed a core leadership committee and a supporting working group with, During the European Society for Clinical Nutrition and Metabolism (ESPEN) Congress in Copenhagen, Denmark (September 2016), representatives of the 4 largest global parenteral and enteral nutrition (PEN) societies from Europe (ESPEN), the United States (American Society for Parenteral and Enteral Nutrition [ASPEN]), Asia (Parenteral and Enteral Nutrition Society of Asia [PENSA]), and Latin America, During the ESPEN Congress in Copenhagen, Denmark (September 2016) representatives of the 4 largest global PEN-societies from Europe (ESPEN), USA (ASPEN), Asia (PENSA) and Latin America (FELANPE), and from national PEN-societies around the world met to continue the conversation on how to diagnose malnutrition that started during the Clinical Nutrition Week, Austin, USA (February 2016). body composition and diminished biological function. Univariable analysis and multivariable regression revealed age (OR 1.49, 95% CI 1.22–1.83, p = 0.026), SMI (OR 0.77, 95% CI 0.51–0.94, p = 0.015) and skeletal muscle density (SMD) (OR 0.85, 95% CI 0.64–1.03, p = 0.029) were independent predictors for major complications. Conclusions The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Analyses were performed using classification and regression tree analysis, Cohen's kappa, and Cox models. A multivariate analysis showed that abdominal trunk muscle weakness and advanced LS were associated with LBP. Conclusion GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrit... GLIM Working Group GLIM Core Leadership Committee. The objectives of this study were: 1) to describe the frequency of hospital admission among people with dementia in eight European countries living in nursing homes or in the community, 2) to examine the factors associated with hospitalisation in each setting, and 3) to evaluate the costs associated with it. use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. The Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. FELANPE suggested that the anticipated consensus approach needs to prioritize a diagnostic method that is available for everybody since resources differ globally. The results indicate that malnutrition and particularly muscle wasting is common in US veterans with HCV. Background: Various tools are used for its assessment. Vet HC. It will pr, The recommended GLIM approach encompasses both, phenotypic and etiologic criteria for the dia, malnutrition but uses only phenotypic criteria cut points, generally been included in criteria supporting the diagnosis, trition community because it serves to guide appropria, the diversity and the multifactorial etiologies under, development of the malnourished phenotype irrespective of. Methods: In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. The area under the curve, by using the ROC curve analysis for GLIM criteria stratified by the SGA results, was 0.85 (P < 0.001). symptoms such as dysphagia, nausea, vomiting, diarrhea, constipation, and abdominal pain. 5 %). The aim of the present study is to determine and compare the incidence of malnutrition in US veterans with HCV by using 3 different malnutrition assessment tools (subjective global assessment [SGA], American Society for Parenteral and Enteral Nutrition and the Academy of Nutrition and Dietetics [ASPEN-AND], and Royal Free Hospital Global Assessment [RFH-GA]). Within 3 months, 13.8 and 18.5% of people living in nursing homes and home care, respectively, experienced ≥1 hospital admission. Copyright © 2021 Elsevier B.V. or its licensors or contributors. Option one requires body mass index (BMI, kg/m(2)) <18.5 to define malnutrition. Significant differences in serum ferritin levels were not found between malnourished and normally nourished study respondents (P=0.779) Determinants of albumin level were eating more than three meals a day (P<0.001), fewer than two portions of fruit and vegetables a day (P=0.024), drinking one glass of wine (P<0.001) and reporting functional independence (P=0.011). The Global Leadership Initiative on Malnutrition (GLIM) was advocated by several of the global clinical nutrition societies in 2018, with the aim of enabling global comparisons of the prevalence of malnutrition and related interventions and outcomes [23. Stage 1/Moderate Malnutrition (Requires 1 phenotypic criterion that meets this grade) 5–10% within the past 6 mo, or. All figure content in this area was uploaded by Kris Mogensen. GLIM malnutrition criteria were significantly correlated with the gold standard SGA assessment and with low FFMI, with PA (Phase Angle), and with the PANDORA score. According to Global Leadership Initiative on Malnutrition (GLIM) criteria, 40.3% (25/62) of patients were malnourished and 59.7% (37/62) were well nourished. Baltimore Longitudinal Study of Aging. Sarcopenia was recently classified a geriatric syndrome and is a major challenge to healthy aging. For this study, the GLIM diagnostic criteria were also applied in at-risk patients [16], as described below. Weight loss could be either >10% of habitual weight indefinite of time, or >5% over 3 months. To provide a consensus-based minimum set of criteria for the diagnosis of malnutrition to be applied independent of clinical setting and aetiology, and to unify international terminology. The malnutrition sever-ity grading according to the GLIM criteria were associated with the prognosis of patients with cancer (HR 1.42, 1.23 to 1.65 for moderate malnutrition; HR 1.80,1.84 to 2.09 for severe malnutrition). In brief, there are two components: phenotypic criteria and etio-logic criteria. Transparency and external input will be sought. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. Potential criteria were subjected to a ballot among the GLIM core and supporting working group members. Thresholds f, (Appendix 1), and GLIM participants sought to empirically, intestinal pseudo-obstruction, as well as gastrointestinal. Study Variables Phenotypic metrics for grading severity as Stage 1 (moderate) and Stage 2 (severe) malnutrition are proposed. 2Management of severe malnutrition: a manual for physicians and other senior health workers. In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. Because there is concern that the inclusion of, to equate cachexia with this GLIM diagnosis ca, The GLIM consensus criteria for malnutrition ar, intended to be used in parallel with established concepts and, A strong GLIM consensus endorsed the selected core phe-, notypic and etiologic criteria that are alread, criteria may be readily used with other a, outcomes throughout the world. Phenotypic metrics for grading severity as Stage 1 (moderate) and Stage 2 (severe) malnutrition are proposed. Option two requires the combined finding of unintentional weight loss (mandatory) and at least one of either reduced BMI or a low fat free mass index (FFMI). Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. Kappas with EWGSOP were 0.65 for men and 0.75 for women for ALMI and 0.34 for men and 0.47 for women for ALM/BMII . We examined the associations of LBP with muscle weakness, decreased mobility function (locomotive syndrome [LS]), and malnutrition among older women. ; September 11, 2017, at the ESPEN Congress; Survey of Existing Approaches Used in Screening and Assessment of, There is substantial regional variation in the, Phenotypic and Etiologic Criteria for the Dia, Consider gastrointestinal symptoms as supportive indica, Reduced assimilation of food/nutrients is associated with mala, Acute disease-/injury-related. A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research. Methods: Nutrition and Dietetics and American Society for Parenteral and, Enteral Nutrition: characteristics recommended for the identication. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories. The Asian Working Group for Sarcopenia (AWGS) issued regional consensus guidelines in 2014, and many more research studies from Asia have since been published; this review summarizes recent progress. Use clinical judgement or additional evaluation to discern severity based on frequency, acute disease-/injury-related conditions are likel, context to guide intervention and anticipated outcomes, methods such as bioelectrical impedance analysis, computed tomo, assessments such as hand-grip strength may be used as a supportive measure, accepted etiologic criterion in existing screening and assess-. of malnutrition using the malnutrition-inflammation score (MIS) and phase angle (PhA) and compare their concordance with the new Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition. Promotion of global dissemination of the consensus criteria. bringing additional global diversity and expertise. A total of 166 patients were enrolled in this study. Scores between 12 and 14 points were considered ‘normal nutritional status’; from 8 to 11, ‘at risk of malnutrition’; and 7 to 0, ‘malnutrition’. A cross-sectional survey was conducted with data collected from people with dementia living at home or who had been admitted to a nursing home in the last 3 months, as well as from their caregivers. Overall, the estimated average costs per person with dementia/year among participants living in a nursing home were lower than those receiving home care. GLIM diagnosis and severity grading The GLIM criteria and their use to diagnose malnutrition and grade its severity have been described previously [20]. The prevalence of well-nourished sarcopenic individuals was the highest (45.2% (28/62)), followed by malnourished sarcopenia individuals (40.3% (25/62)). Although there is general agreement on the principal diagnostic characteristics, initial thresholds for muscle mass, strength, and physical performance were based on data from populations of predominantly Europid ancestry and may not apply worldwide. Immune dysfunction after allo-HSCT may be linked with infections, GVHD, and relapse and negatively affect the outcome. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery. The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions. The aim of the present study was to investigate whether preoperative skeletal muscle condition and postoperative nutrition would affect major complications in patients underwent pancreaticoduodenectomy (PD). The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories. Phenotypic metrics for grading severity are proposed.