Malnutrition Diagnosis: Validation of a Weight Independent GLIM adapted Framework in U.S. Adults (NHANES 1999 2020)
- 1Mario Negri Institute, Italian Institute for Planetary Health
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.
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BibTeX
@misc{orsini2026malnutrition,
title = {{Malnutrition Diagnosis: Validation of a Weight Independent GLIM adapted Framework in U.S. Adults (NHANES 1999 2020)}},
author = {F. Orsini and a. novella and L. Pasina},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.04.26362229},
url = {https://www.medrxiv.org/content/10.64898/2026.09.04.26362229v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Malnutrition Diagnosis: Validation of a Weight Independent GLIM adapted Framework in U.S. Adults (NHANES 1999 2020)
AU - F. Orsini
AU - a. novella
AU - L. Pasina
PY - 2026
DA - 2026/09/04
PB - medRxiv
DO - 10.64898/2026.09.04.26362229
UR - https://www.medrxiv.org/content/10.64898/2026.09.04.26362229v1
AB - 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.
ER -