{
  "abstract": "The Global Leadership Initiative on Malnutrition (GLIM) consensus standardized malnutrition diagnosis, but incorporating low Body Mass Index (BMI) as a phenotypic criterion introduces a \"circularity bias\" in weight-stratified analyses and conceals \"hidden hunger\" in high-obesity populations. Using nationally representative data from the U.S. NHANES 1999-2020 (N = 23,363 adults), we propose a \"GLIM-adapted\" framework that excludes BMI--relying solely on weight loss and DXA-derived appendicular lean mass index (ALMI). Standard GLIM identified an 18.9% malnutrition prevalence, but low BMI was the sole indispensable phenotypic driver for only 233 individuals (5.2%). The GLIM-adapted framework maintained a highly comparable prevalence of 17.9% (n = 4,038). Thus, low BMI exhibits low diagnostic sensitivity in modern U.S. cohorts. Excluding BMI successfully bypasses circularity, unmasks qualitative muscle wasting under excess body weight, and establishes a robust, weight-independent standard for clinical and epidemiological research.",
  "abstract_shown": true,
  "affiliations": [
    "Mario Negri Institute, Italian Institute for Planetary Health"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "F. Orsini"
    },
    {
      "name": "a. novella"
    },
    {
      "name": "L. Pasina"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/bktvh90wwt8wh.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.04.26362229",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.04.26362229v1.full",
  "id": "bktvh90wwt8wh",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.04.26362229v1",
  "language": null,
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "nutrition"
    ],
    [
      "openalex",
      "2737|Nutrition and Health in Aging"
    ]
  ],
  "openalex": "W7212019800",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.04.26362229v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-04",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/bktvh90wwt8wh.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:04Z",
      "native_id": "10.64898/2026.09.04.26362229",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.04.26362229v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:nutrition",
      "subfield": "nutrition"
    }
  ],
  "title": "Malnutrition Diagnosis: Validation of a Weight Independent GLIM adapted Framework in U.S. Adults (NHANES 1999 2020)",
  "title_text": "Malnutrition Diagnosis: Validation of a Weight Independent GLIM adapted Framework in U.S. Adults (NHANES 1999 2020)",
  "type": "preprint",
  "updated_at": "2026-10-30T12:18:04Z",
  "url": "https://research.draconitic.com/paper/bktvh90wwt8wh",
  "venue": "medRxiv",
  "versions": []
}