Editorial—Special Global Malnutrition Issue

Malnutrition is a global concern affecting >1 billion people caused by disease, starvation, war, aging, or natural disasters.1 According to the World Health Organization, one or more forms of malnutrition impact every country.1 A common belief historically is that malnutrition is seen mainly in children from developing countries or in those experiencing significant food insecurity from famine or war. However, as our colleagues and others in the nutrition community can attest, malnutrition can occur in our family members, those admitted to both acute care and long-term care hospitals as well as in the community. We certainly all recognize the landmark publication by Dr Charles Butterworth in 1974, “The skeleton in the hospital closet,” in which he provided a “call to action” to address the poor nutrition practices occurring in North American hospitals at that time.2 Despite our knowledge of disease-related malnutrition3 and our efforts to address it globally, its prevalence remains high and continues to be associated with adverse clinical outcomes.3-8 Multiple actions to address malnutrition have been developed and implemented across the globe. These include, among others, Nutrition Day, the worldwide 1-day audit on nutrition care9; the American Society for Parenteral and Enteral Nutrition's Malnutrition Awareness Week10; the development of a global diagnostic framework, the Global Leadership Initiative on Malnutrition (GLIM)11, 12; publication of the position paper “Clinical nutrition and human rights”13; and the Creating Alliances Nationally to address Disease-Related Malnutrition (CAN DReaM) initiative.14 These are notable efforts developed and implemented to help minimize malnutrition prevalence globally and its associated adverse outcomes. However, continued work is needed. This special issue of Nutrition in Clinical Practice, “Global Malnutrition,” is dedicated to further raising awareness among global clinical practitioners of the need to comprehensively screen, diagnose, and treat malnutrition in all clinical settings. In addition, it also seeks to highlight and share cutting-edge tools, processes, and procedures to support our malnutrition efforts, including artificial intelligence and machine learning to improve the efficiency and accuracy of our diagnostic tools. Several of the articles included in this special issue are broad-based in nature, including those by; Mogensen et al, “Malnutrition in patients with obesity”; Atkas et al, “Malnutrition in hospitalized patients with solid tumors: Screening, identification and diagnosis” and the 2024 Guenter Award lecture, “From curiosity and eagerness to passion: moving the malnutrition needle.” These articles provide guidance in addressing malnutrition focused on an interdisciplinary approach. The use of GLIM as a diagnostic framework continues to increase globally, and articles in this issue reflect that, including the vision of the GLIM authors for malnutrition to be identified and treated in patients with a variety of medical conditions, especially in countries with limited nutrition resources.11, 12 Jiang et al, Graciano et al, and Roberts et al, Jazinaki et al, and Souza et al, offer their efforts to validate this methodological approach in totality, with the use of a specific criterion (muscle mass) or via a process involving nutrition screening as a first step. The application of artificial intelligence in malnutrition diagnosis is a rapidly evolving research field. Chen et al presented their initiatives on using 3D facial information and AI tools to diagnose malnutrition. Commentaries by Jensen and Cederholm and Papoutsakis highlight two important aspects of malnutrition: how it intersects with other diseases and/or age-related conditions, including sarcopenia, cachexia, and frailty, in addition to the critical role of translating malnutrition care from the hospital to the community settings. Malnutrition in the pediatric population is not always well recognized. Multiple articles in this issue provide our readers with a better understanding of the challenges in addressing pediatric malnutrition, including malnutrition screening in the United States, the prevalence of pediatric malnutrition, etiologic factors specific to pediatric malnutrition, and the utility of mid-upper arm circumference in pediatric malnutrition assessment. Sarcopenia, as outlined by Jensen and Cederholm, in this issue, has an important overlap with malnutrition. Articles by Yalcin et al and Ribeiro et al, focus on this global disease state. Lastly, Da Pan, et al, and Schwartz, et al, provide details on nutrition risks in patients with tuberculosis and ethical competencies in decision-making in the use of artificially administered nutrition and hydration, respectively. It is our honor to have so many enthusiastic authors submitting their research to this special issue. We are also honored that leaders, scientists, and clinical practitioners shared their knowledge and expertise on how to address and minimize malnutrition globally. Ainsley Malone is a speaker for Abbott Nutrition Health Institute. The remaining authors declare no conflict of interest.