AAIM vs. GLIM: Evaluating the Best Tool for Diagnosis of Severe and Other Forms of Malnutrition

By Brian Murphy

AAIM or GLIM… which is the better tool for diagnosing severe and other forms of malnutrition? A question not without its share of controversy.

For U.S. hospitals and healthcare organizations, the answer is AAIM, according to my recent guest on Off the Record, ECU Health Adult Clinical Dietitian Supervisor Ashley Strickland.

These acronyms by the way are as follows:

• AAIM=Academy of Nutrition and Dietetics (Academy)/American Society for Parenteral and Enteral Nutrition indicators to diagnose malnutrition
• GLIM=Global Leadership in Malnutrition tool for diagnosing malnutrition in adults

Listen to her rationale in the audio clip below. In short, Ashley believes AAIM is a better fit for the U.S. population, as opposed to the broader international focus of GLIM. AAIM has now also been fully validated, per a study published February 6, 2024 in the Journal of the Academy of Nutrition and Dietetics (see below).

Unfortunately, auditors will use both criteria (as well as older, outdated methods of diagnosis) to deny claims. Which we get into on the show. A must-listen for CDI and coding professionals, IMO. You’ll find the link to the show below.

Accurate diagnosis of malnutrition is vital. Per the Journal of the Academy of Nutrition and Dietetics, “underdiagnosis and undertreatment of malnutrition is consequential. Both adult and pediatric patients with malnutrition have significantly worse outcomes, including longer hospital stays, higher risk of readmission, greater mortality, and higher hospital costs, than patients with similar clinical conditions who are not malnourished. In addition, inconsistent coding of a malnutrition diagnosis results in inadequate reimbursements to hospitals for patient care.”

After I published this James Kennedy, MD, added additional insight on capturing the full spectrum of severe malnutrition, noting that new ICD-10-CM code E88.A, Muscle Wasting Disease, adds additional weight. See link below to Society of Sarcopenia, Cachexia, and Wasting Disorders (SCWD).

From that article: “Two common but distinct conditions characterized by a loss of skeletal muscle mass are sarcopenia and cachexia. Sarcopenia, cachexia, and anorexic disorders (protein-energy malnutrition) represent the major causes of muscle-wasting disorders.”

Capturing “Muscle Wasting Disease”, its components and its consequences (e.g., functional quadriplegia) paints a more complete picture of patient incapacitation, per Kennedy. Since ICD-10-CM codes for sarcopenia do not impact risk models, whereas E88.A does, stating “Muscle wasting disease due to sarcopenia” is more favorable and accurate terminology in the medical record.

References

• Academy of Nutrition and Dietetics Nutrition Research Network: Clinical Outcomes Associated With Malnutrition Diagnosed by the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Indicators of Malnutrition: A Systematic Review of Content Validity and Meta-Analysis of Predictive Validity: https://www.jandonline.org/article/S2212-2672(24)00052-2/abstract
• Listen to the full episode of Off the Record with Ashley Strickland here: https://podcasts.apple.com/ph/podcast/malnutrition-deep-dive-a-conversation-with-ecu/id1641739619?i=1000648221809
• GLIM criteria for the diagnosis of malnutrition—A consensus report from the global clinical nutrition community: https://pubmed.ncbi.nlm.nih.gov/30920778/
• Society of Sarcopenia, Cachexia, and Wasting Disorders (SCWD), “Muscle Wasting Disease (MWD) in Cachexia and Sarcopenia”: https://society-scwd.org/muscle-wasting/