Nutritional screening within the GLIM procedure—Part 2: Operationalization of the concept risk of malnutrition using a modified Delphi procedure

Background and aims: Within the original Global Leadership Initiative on Malnutrition (GLIM) procedure (2019), the step on nutritional screening was not further elaborated. A new GLIM Risk of Malnutrition Working Group has recently developed a consensus-based conceptual definition of “risk of malnutrition”. The present study aimed to operationalize this definition. Methods: This study consisted of: (1) a literature search to identify risk factors for malnutrition, and (2) a two-round online modified Delphi study. International professional experts (n = 113) in the field of malnutrition were invited to rate the importance of identified risk factors using a 9-point Likert scale. In questionnaire round 1, risk factors were rated “critically important” if ≥ 70% of the participants rated them 7–9, or “not important” if >30% rated them 1–3. The remaining risk factors were categorized as “undecided.” In questionnaire round 2, undecided risk factors were classified as “critically important” or “important, but not critical”, based on the same threshold. Results: The literature search revealed 64 risk factors that were included in the Delphi questionnaires. In questionnaire rounds one (n = 57 participants) and two (n = 46 participants), 29 risk factors (from the overarching risk categories unintentional weight loss, nutrition impact symptoms, disease-related factors, physical factors, psychological factors, decreased food intake, food assimilation, and poor diet) were deemed “critically important,” 10 “important, but not critical,” and 19 “substantially important.” Conclusion: In this study, we identified which risk factors are considered critical to operationalize “risk of malnutrition.” Screening for risk of malnutrition should take these relevant risk factors into account.