Comparison of two nutrition assessment techniques in hospitalized patients

OBJECTIVE: Different methods have been used to assess nutritional status in hospitalized patients, and there is no agreement as to which index best reflects nutritional status. The aim of this study was to determine the prevalence of malnutrition and compare the Subjective Global Assessment, Nutrition Risk Index, and non-nutritional factors in hospitalized patients. METHODS: This prospective study was done in the teaching hospital of Pamukkale University Medical School, Denizli, Turkey. Two hundred fifty-one consecutive patients hospitalized in medical and surgical wards were studied. On admission, the Subjective Global Assessment, Nutrition Risk Index, anthropometric measurements, and laboratory data were assessed. Differences between independent groups were assessed with Student's t test and one-way analysis of variance. Spearman's rank correlation coefficients were calculated for associations between scores and variables. Agreement between two assessment methods was analyzed by the K statistic. RESULTS: On admission, 30% of patients were malnourished according to the Subjective Global Assessment and 36% according to the Nutrition Risk Index. Body weight, albumin, lymphocyte, total cholesterol, and anthropometric data were lower in the malnourished patients according to both assessments (P < 0.01). Body weight loss and length of stay were higher in the malnourished patients according to both assessments (P < 0.01). Body weight, anthropometric data, albumin, and total cholesterol correlated inversely with nutritional status according to both techniques. Concordance was observed in 203 of the 251 (81%) patients with both assessments (K = 0.57, P = 0.000). CONCLUSIONS: Both tests correlated with each other with respect to age, length of stay, and anthropometric and laboratory data in hospitalized patients. Therefore, these two techniques can be used for nutritional assessment in hospitalized patients.     

Assessment of nutritional status on hospital admission: nutritional scores

Malnutrition is still a largely unrecognized problem in hospitals. Malnutrition in hospitalized patients is generally related to increasing morbidity and mortality, and costs and length of stay. The aim of this study was to assess the nutritional status of patients on admission to a general hospital using different nutritional scores and to test the sensitivity and specificity of these scores. Sample population included 60 patients (55% male; 45% female) selected (aged 65.6+/-15.9 y) at random by using a computer software program. The nutritional state assessment was performed within 48 h of admission, using different nutritional indices (Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Gassull classification, Instant Nutritional Assessment (INA) and a combined index). About 78.3% of patients were found to be malnourished on admission. The frequency of malnutrition degree varied from 63.3% as assessed by the SGA to 90% with the NRI. Malnutrition severity was not related to the diagnosis. However, an elderly population was associated with a higher prevalence of malnutrition. INA was the best single score to identify patients who are malnourished or at risk of malnutrition and who may benefit from nutrition support.     

Subjective Global Nutritional Assessment for children

BACKGROUND: Subjective Global Assessment (SGA), a method of nutritional assessment based on clinical judgment, has been widely used to assess the nutritional status of adults for both clinical and research purposes. OBJECTIVE: Foreseeing benefits of its use in children, we chose to adapt SGA and test its validity and reproducibility in the pediatric population. DESIGN: We prospectively evaluated the preoperative nutritional status of 175 children (aged 31 d to 17.9 y) having major thoracic or abdominal surgery with the use of Subjective Global Nutritional Assessment (SGNA) and commonly used objective measurements. Each child underwent nutritional assessment by 2 independent assessors, one performing measurements of anthropometrics and handgrip strength and one performing SGNA. To test interrater reproducibility, 78 children had SGNA performed by a third assessor. Occurrence of nutrition-associated complications was documented for 30 d postoperatively. RESULTS: SGNA successfully divided children into 3 groups (well nourished, moderately malnourished, severely malnourished) with different mean values for various anthropometric and biochemical measures (P < 0.05). Malnourished children had higher rates of infectious complications than did well-nourished children (P = 0.042). Postoperative length of stay was longer for malnourished children (8.2 +/- 10 d) than for well-nourished children (5.3 +/- 5.4 d) (P = 0.002). No objective nutritional measures showed association with outcomes, with the exception of serum albumin, which was not clinically predictive because mean concentrations were in the normal range irrespective of the presence or absence of complications. CONCLUSION: SGNA is a valid tool for assessing nutritional status in children and identifying those at higher risk of nutrition-associated complications and prolonged hospitalizations.     

The Subjective Global Assessment Predicts In-Hospital Mortality Better than Other Nutrition-Related Risk Indexes in Noncritically Ill Inpatients Who Receive Total Parenteral Nutrition in Spain (Prospective Multicenter Study)

Malnutrition in hospitalized patients is associated with an increased risk of death and complications. The purpose of this study was to determine which nutrition-related risk index predicts mortality better in patients receiving total parenteral nutrition. This prospective, multicenter study involved noncritically ill patients who were prescribed total parenteral nutrition. Data were collected on Subjective Global Assessment (SGA), Nutritional Risk Index, Geriatric Nutritional Risk Index, body mass index, albumin and prealbumin, as well as in-hospital mortality, length of stay, and infectious complications. Of the 605 patients included in the study, 18.8% developed infectious complications and 9.6% died in the hospital. SGA, albumin, Nutritional Risk Index and Geriatric Nutritional Risk Index were associated with longer hospital stay. Prealbumin levels were associated with infectious complications. Multiple logistic regression analysis showed (after adjustment for age, sex, C-reactive protein levels, mean blood glucose levels, use of corticoids, prior comorbidity, carbohydrates infused, diagnosis, and infectious complications) that the SGA, Geriatric Nutritional Risk Index, body mass index, albumin, and prealbumin were associated with an increased risk for in-hospital mortality. SGA was the tool that best predicted mortality and adequately discriminated the values of the other nutrition-related risk indexes studied. The SGA is a clinically effective and simple tool for nutrition assessment in noncritically ill patients receiving total parenteral nutrition and detects the risk of inpatient mortality better than others.     

Use of Nutritional Scores to Predict Clinical Outcomes in Chronic Diseases

Many hospitalized patients are malnourished, and the relationship between malnutrition and patient outcome is well established. To determine which patients are at nutritional risks, clinical scores are probably more accurate than using a single nutritional parameter. Among the numerous scores published, both the Prognostic Nutritional Index and the Subjective Global Assessment were prospectively validated. One is based on objective measurements, whereas the second is based on medical history and physical examination. The Nutritional Risk lndex has been used in many studies including the "Veterans Study'. The Mini Nutritional Assessment is a promising score for evaluating malnutrition in the elderly. The development of nutritional scores for use by nurses may facilitate screening of a large number of hospitalized patients.     

Hospital length of stay and nutritional status

PURPOSE OF REVIEW: This review looks at the recent medical literature on the association between hospital length of stay and nutritional status. RECENT FINDINGS: Simple anthropometric parameters underestimate the nutritional risk in hospitalized patients. The Malnutrition Universal Screening Tool and Nutritional Risk Screening are simple screening tools that identify patients who require further monitoring. Recent weight loss appears to be the most important single indicator of nutritional status. Body composition measurements identify patients with muscle mass depletion and excess body fat, both of which are significantly associated with increased length of stay. The Subjective Global Assessment is useful at detecting patients with established malnutrition and the Mini Nutritional Assessment for the elderly is useful at detecting patients who need preventive nutritional measures. The Nutritional Risk Index, which incorporates albumin and weight loss, appears to capture both nutritional risk and poor clinical outcome. SUMMARY: Nutritional risk is associated with the length of stay in hospital. The choice of nutritional screening and assessment tools depends on the type of institution (university hospital versus community hospital), the patient populations (acute care versus intermediary care; general hospital versus elderly population) and the resources available.     

Use of subjective global assessment to identify nutrition-associated complications and death in geriatric long-term care facility residents

OBJECTIVE: The primary objective of this study was to assess the use of Subjective Global Assessment to identify nutrition-associated complications and death in a geriatric population. A secondary objective was to evaluate the ability of Subjective Global Assessment to identify geriatric residents of long-term care facilities who were undernourished or at risk for developing undernutrition. METHODS: Fifty-three consecutive residents who were > or = 65 years of age and had been residing in a long-term care facility for < 2 weeks were enrolled in the study. The Subjective Global Assessment Classification technique was performed according to the procedure outlined by Detsky and colleagues. Residents were classified as well-nourished (A), mild/moderately undernourished (B) or severely undernourished (C). In addition, a Subjective Global Assessment Composite Score was derived. Subjective Global Assessment measures were compared with two traditional objective measurements of nutritional status: serum albumin and serum total cholesterol. Outcome measurements of nutrition-associated complications were determined over a 3-month period by recording the incidence of major infections, decubitus ulcers, nutrition-related hospital readmissions, and mortality. RESULTS: Sixteen residents (30.2%) were categorized as Subjective Global Assessment class A, 28 residents (52.8%) were class B, and 9 residents (17%) were class C. A significant association was found between nutritional status as determined by Subjective Global Assessment Composite Score and nutrition-associated complications (p<0.05). Subjective Global Assessment Classification was related to death (p<0.05) with severely undernourished residents having the highest mortality rate. Hypoalbuminemia only demonstrated a significant relationship with nutrition-associated complications (p<0.05), whereas hypocholesterolemia was associated with death (p<0.05). CONCLUSIONS: Subjective Global Assessment of nutritional status appears to be a simple, noninvasive and cost-effective tool for assessing nutritional status of geriatric residents in long-term care facilities. This assessment tool is also beneficial for identifying patients with increased risk of nutrition-associated complications as well as death.     

Evaluation of nutritional screening tools for patients scheduled for cardiac surgery

ObjectiveThe aim of this study was to assess the prognostic value of different nutritional screening tools in patients undergoing cardiopulmonary bypass with regard to an adverse clinical course.MethodsThis prospective cohort study analyzed 894 adult patients who underwent cardiopulmonary bypass. Patients were screened using four nutritional screening tools: Nutritional Risk Screening 2002 (NRS-2002), the Malnutrition Universal Screening Tool (MUST), the Mini-Nutritional Assessment (MNA), and the Short Nutritional Assessment Questionnaire (SNAQ). Nutritional status was assessed using the Subjective Global Assessment. In-hospital mortality, postoperative complications, length of stay in the intensive care unit, and length of hospitalization were analyzed.ResultsThe sensitivities of the SNAQ, MUST, and NRS-2002 to detect the malnutrition confirmed by the Subjective Global Assessment were 91.5%, 97.9%, and 38.3%, respectively, and the MNA showed a sensitivity of 81.8% for the elderly. Malnutrition detected by the SNAQ, MUST, and NRS-2002 was associated with postoperative complications (odds ratios [ORs] 1.75, 1.98, and 1.82, respectively) and a stay in the intensive care unit longer than 2 d (ORs 1.46, 1.56, and 2.8). Malnutrition as detected by the SNAQ and MUST was also associated with prolonged hospitalization (ORs 1.49 and 1.59). According to multivariate logistic regression analysis, postoperative complications were independently predicted by the European System for Cardiac Operative Risk Evaluation (OR 1.1, P < 0.0001), cardiopulmonary bypass time (OR 1.01, P < 0.0001), and malnutrition identified by the MUST (OR 1.2, P = 0.01).ConclusionThe MUST independently predicts postoperative complications. The SNAQ and MUST have comparable accuracy in detecting malnutrition. Whether preoperative nutritional therapy would improve the outcome in malnourished patients needs to be studied.     

Association Between Nutritional Status,Inflammatory Condition,and Prognostic Indexes with Postoperative Complications and Clinical Outcome of Patients with Gastrointestinal Neoplasia

The aim of this study is to describe and relate nutritional and inflammatory status and prognostic indexes with postoperative complications and clinical outcome of patients with gastrointestinal malignancies. Twenty-nine patients were evaluated; nutritional assessment was carried out by subjective and objective parameters; albumin, pre-albumin, C-reactive protein (CRP), and alpha-1-acid glycoprotein (AGP) were determined. To assess prognosis, the Glasgow scale, the Prognostic Inflammatory Nutritional Index (PINI), and CRP/albumin ratio were used; the clinical outcomes considered were hospital discharge and death. A high Subjective Global Assessment (SGA) score was associated with the occurrence of postoperative complications: 73% of the patients with postoperative complications had the highest SGA score, but only 6% of those without postoperative complications had the highest SGA score (P < 0.001). Greater occurrence of death was observed in patients with a high SGA score, low serum albumin, increased CRP, PINI > 1, and Glasgow score 2. There was a positive correlation between weight loss percentage with serum CRP levels (P = 0.002), CRP/albumin (P = 0.002), PINI (P = 0.002), and Glasgow score (P = 0.000). This study provides evidence that the assessment of the nutritional status and the use of prognostic indexes are good tools for predicting postoperative complications and clinical outcome in patients with gastrointestinal neoplasia.     

Nutrition screening tools for hospitalized patients.

There is agreement among international nutrition organizations and healthcare accrediting organizations that nutrition screening is essential to identify patients needing further nutrition assessment to determine appropriate nutrition intervention. Numerous nutrition screening tools are used in hospitals, but many, if not most, have never been validated for the care setting, patient population, or outcome they strive to identify. Thus, it is unclear if they appropriately identify patients who truly need further nutrition assessment and, potentially, intervention. Several nutrition screening tools reported in the literature have been validated in a variety of care settings and patient populations and have been shown to achieve the desired outcome. These tools include the Malnutrition Universal Screening Tool, Nutritional Risk Screening 2002, Mini Nutritional Assessment, Short Nutritional Assessment Questionnaire, Malnutrition Screening Tool, and the Subjective Global Assessment. It is important for clinicians to understand how the tools were validated and for which population and care setting they were developed, and to determine if the tool might be appropriate for use in their institution.     

Comparison between Nutritional Risk Tools and Parameters Derived from Bioelectrical Impedance Analysis with Subjective Global Assessment

BackgroundNutritional risk and malnutrition are highly prevalent among hospitalized patients. As a result, several methods have been developed to produce an adequate nutritional diagnosis.ObjectiveWe aimed to assess the relationship between nutritional risk tools and parameters derived from bioelectrical impedance analysis with a Subjective Global Assessment (SGA).DesignA cross-sectional study was conducted from April to September 2010.Participants/settingThe study included 124 patients admitted to the Surgical Clinic I, University Hospital, Federal University of Santa Catarina, Florianópolis, Brazil, to undergo elective surgery.Main outcome measuresWe utilized SGA and Nutritional Risk Screening 2002 (NRS 2002), Nutritional Risk Index (NRI), Fat-Free Mass Index (FFMI), Fat Mass Index (FMI), body cell mass as a percentage of the total weight (%BCM), and standardized phase angle (SPA).Statistical analysis performedThe agreement was tested by κ coefficient, while bivariate associations were tested by Mann-Whitney U test.ResultsPrevalence of nutritional risk by NRS 2002 and NRI or malnutrition by SGA, FFMI, FMI, %BCM, and SPA was 19.3%, 69.5%, 35.5%, 12.9%, 8.1%, 46.8%, and 4.8%, respectively. The best agreement was between SGA and NRS 2002 (κ=.490), possibly because they constitute similar instruments. Patients identified as malnourished by SGA (B+C) showed considerably lower values of FFMI, FMI, BCM, and SPA.ConclusionsThe results suggest that the NRS 2002 and parameters derived from bioelectrical impedance analysis identify patients with impaired nutritional status.     

Use of Subjective Global Assessment to Identify Nutrition-Associated Complications and Death in Geriatric Long-Term Care Facility Residents

Objective: The primary objective of this study was to assess the use of Subjective Global Assessment to identify nutrition-associated complications and death in a geriatric population. A secondary objective was to evaluate the ability of Subjective Global Assessment to identify geriatric residents of long-term care facilities who were undernourished or at risk for developing undernutrition.

Methods: Fifty-three consecutive residents who were ≥ 65 years of age and had been residing in a long-term care facility for < 2 weeks were enrolled in the study. The Subjective Global Assessment Classification technique was performed according to the procedure outlined by Detsky and colleagues. Residents were classified as well-nourished (A), mild/moderately undernourished (B) or severely undernourished (C). In addition, a Subjective Global Assessment Composite Score was derived. Subjective Global Assessment measures were compared with two traditional objective measurements of nutritional status: serum albumin and serum total cholesterol. Outcome measurements of nutrition-associated complications were determined over a 3-month period by recording the incidence of major infections, decubitus ulcers, nutrition-related hospital readmissions, and mortality.

Results: Sixteen residents (30.2%) were categorized as Subjective Global Assessment class A, 28 residents (52.8%) were class B, and 9 residents (17%) were class C. A significant association was found between nutritional status as determined by Subjective Global Assessment Composite Score and nutrition-associated complications (p<0.05). Subjective Global Assessment Classification was related to death (p<0.05) with severely undernourished residents having the highest mortality rate. Hypoalbuminemia only demonstrated a significant relationship with nutrition-associated complications (p<0.05), whereas hypocholesterolemia was associated with death (p<0.05).

Conclusions: Subjective Global Assessment of nutritional status appears to be a simple, noninvasive and cost-effective tool for assessing nutritional status of geriatric residents in long-term care facilities. This assessment tool is also beneficial for identifying patients with increased risk of nutrition-associated complications as well as death.     

Usefulness of oral mucosal epithelial cell apoptosis rate in nutritional assessment

OBJECTIVE: This preliminary study was designed to explore a new method for nutritional assessment by measuring oral mucosal cell apoptosis or proliferation. METHODS: Forty-two consecutive patients with gastrointestinal malignant tumors were hospitalized on the surgical wards and studied prospectively. Patient-Generated Subjective Global Assessment was used to identify malnourished patients. Anthropometric measurements including weight, body mass index, triceps skinfold thickness, and midarm muscle circumference were recorded. The serum proteins measured were retinol-binding protein (RBP), transferrin, prealbumin (PA), and albumin. Simultaneously, the rates of oral epithelial cell apoptosis and proliferation were measured by flow cytometry. Of the 20 malnourished patients, 14 were followed up in a serial study with a 3-d nutritional support therapy. Nutritional indices and oral epithelial cell apoptosis rate were measured after 3 d of nutritional support. RESULTS: Malnutrition was diagnosed in 20 of 42 patients (47.6%). Oral epithelial apoptosis and proliferation rates were significantly decreased (P < 0.01 and P < 0.05, respectively) in malnourished compared with non-malnourished patients, although there were no significant differences between their anthropometric data. Malnourished patients had lower serum levels of RBP, albumin, and PA and rates of oral epithelial cell apoptosis and proliferation. The rate of oral epithelial cell apoptosis positively correlated with serum RBP (R = 0.32, P < 0.05) and PA (R = 0.33, P < 0.05). The rate of oral epithelial cell apoptosis and serum RBP and PA increased significantly in the malnourished patients who received nutritional support for 3 days. CONCLUSIONS: Measuring the rate of oral epithelial cell apoptosis may be another non-invasive technique to determine nutritional assessment and is worthy of further exploration.     

Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer

OBJECTIVE: To evaluate the use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. DESIGN: An observational study assessing the nutritional status of patients with cancer. SETTING: Oncology ward of a private tertiary Australian hospital. SUBJECTS: Seventy-one cancer patients aged 18-92 y. INTERVENTION: Scored PG-SGA questionnaire, comparison of scored PG-SGA with subjective global assessment (SGA), sensitivity, specificity. RESULTS: Some 24% (17) of 71 patients were well nourished, 59% (42) of patients were moderately or suspected of being malnourished and 17% (12) of patients were severely malnourished according to subjective global assessment (SGA). The PG-SGA score had a sensitivity of 98% and a specificity of 82% at predicting SGA classification. There was a significant difference in the median PG-SGA scores for each of the SGA classifications (P<0.001), with the severely malnourished patients having the highest scores. Re-admission within 30 days of discharge was significantly different between SGA groups (P=0.037). The mortality rate within 30 days of discharge was not significantly different between SGA groups (P=0.305). The median length of stay of well nourished patients (SGA A) was significantly lower than that of the malnourished (SGA B+C) patients (P=0.024). CONCLUSION: The scored PG-SGA is an easy to use nutrition assessment tool that allows quick identification and prioritisation of malnutrition in hospitalised patients with cancer.     

Undernutrition risk screening and length of stay of hospitalized elderly

The purpose was to compare, in elderly hospitalized patients, the performance of widely used nutritional screening and assessment tools and anthropometric parameters with the Nutritional Risk Screening (NRS-2002); and to evaluate their independent association with length of hospital stay. Nutritional-status screening and assessment was carried out using NRS-2002, Mini Nutritional Assessment (MNA), Subjective Global Assessment (SGA), Malnutrition Screening Tool (MST), and anthropometry. Patients classified by NRS-2002 as undernourished had an independent higher risk of longer length-of-stay (> 8 days): Odds ratio = 2.25 (95% Confidence Interval = 1.03 to 4.88). Nutritional "risk" by NRS-2002 is an independent risk factor for a long length of stay in elderly hospitalized patients, an important outcome predictor in this population.     

Malnutrition determined by the patient-generated subjective global assessment is associated with poor outcomes in acute stroke patients

BACKGROUND & AIMS: The extent of malnutrition in hospitalised stroke patients and its influence on outcomes including hospital complications, length of stay and discharge destination are important issues. The aim of this study was to determine the nutritional status of patients admitted to an acute stroke unit and the association between nutritional status and health outcomes. METHODS: Nutritional status was determined prospectively using the scored patient generated subjective global assessment (PG-SGA) in patients (n=73) admitted to an acute stroke unit within 48 h of admission to an Australian private hospital. Outcome data were collected by retrospective audit. RESULTS: On admission, 19.2% of patients were malnourished and this was associated with a significantly greater PG-SGA score (15 vs. 5) and lower body weight (59.8 kg vs. 75.8 kg) compared to well-nourished patients. In terms of health outcomes, malnourished patients had longer length of stay (13 vs. 8 days), increased complications (50% vs. 14%), increased frequency of dysphagia (71% vs. 32%) and enteral feeding (93% vs. 59%). No association was found between nutritional status and serum albumin level or discharge destination. CONCLUSIONS: Malnutrition on admission to hospital after acute stroke is associated with poor outcomes including increased length of stay and increased prevalence of dysphagia and complications. The scored PG-SGA is a nutrition assessment tool that allows quick identification of malnourished stroke patients.     

Teaching medical students the subjective global assessment

OBJECTIVE: Clinical nutrition assessment is a clinical skill not taught in many medical schools in North America. The purpose of this study is to determine whether second-year medical students can be taught to perform a nutritional Subjective Global Assessment (SGA). METHODS: In this study, second-year medical students were given a didactic session and a bedside demonstration of the SGA. Subsequently, they performed an SGA on unknown patients and classified those patients into one of three categories: A) well nourished, B) moderately malnourished, or C) severely malnourished. This was compared with the assessments of clinical dietitians and a physician. RESULTS: After this instruction, medical students correctly identified malnourished individuals. They were less accurate in their subclassification between mildly and severely malnourished individuals. The degree of agreement with clinical dietitians and a physician was fair (kappa = 0.34). CONCLUSIONS: With a multidisciplinary team of physicians and clinical dietitians, medical students can be taught the SGA in a 3h format. This is an important clinical skill that emphasizes the importance of clinical nutrition and may help identify malnourished individuals early in the course of their hospitalization.     

Nutritional status of surgical patients and the relationship of nutrition to postoperative outcome.

A preoperative nutritional assessment including anthropometry, biochemical indices and global subjective assessment was performed for 127 patients admitted for elective gastrointestinal surgery. Of these, 24 were subjected to minor surgery, 65 to intermediate surgery and 38 to major procedures. Patients were followed postoperatively, recording complications or mortality. Intermediate and major surgery patients had lower triceps skinfold thickness and mid-arm circumference and greater weight loss than did minor surgery patients. Thirty-six percent of the patients suffered complications. No association was found between preoperative nutritional status and incidence of postoperative complications. Six patients died and they showed greater preoperative weight loss (21 +/? 6.5 vs 12 +/? 1.4%) and lower serum albumin levels (25 +/? 4 vs 35 +/? 1 g/l) than patients who survived complications. Global subjective assessment classified 43% of survivors as malnourished, compared to 100% of patients who died.     

Nutritional status of surgical patients and the relationship of nutrition to postoperative outcome.

A preoperative nutritional assessment including anthropometry, biochemical indices and global subjective assessment was performed for 127 patients admitted for elective gastrointestinal surgery. Of these, 24 were subjected to minor surgery, 65 to intermediate surgery and 38 to major procedures. Patients were followed postoperatively, recording complications or mortality. Intermediate and major surgery patients had lower triceps skinfold thickness and mid-arm circumference and greater weight loss than did minor surgery patients. Thirty-six percent of the patients suffered complications. No association was found between preoperative nutritional status and incidence of postoperative complications. Six patients died and they showed greater preoperative weight loss (21 +/- 6.5 vs 12 +/- 1.4%) and lower serum albumin levels (25 +/- 4 vs 35 +/- 1 g/l) than patients who survived complications. Global subjective assessment classified 43% of survivors as malnourished, compared to 100% of patients who died.     

How to perform Subjective Global Nutritional assessment in children

Subjective Global Assessment (SGA) is a method for evaluating nutritional status based on a practitioner's clinical judgment rather than objective, quantitative measurements. Encompassing historical, symptomatic, and physical parameters, SGA aims to identify an individual's initial nutrition state and consider the interplay of factors influencing the progression or regression of nutrition abnormalities. SGA has been widely used for more than 25 years to assess the nutritional status of adults in both clinical and research settings. Perceiving multiple benefits of its use in children, we recently adapted and validated the SGA tool for use in a pediatric population, demonstrating its ability to identify the nutritional status of children undergoing surgery and their risk of developing nutrition-associated complications postoperatively. Objective measures of nutritional status, on the other hand, showed no association with outcomes. The purpose of this article is to describe in detail the methods used in conducting nutrition-focused physical examinations and the medical history components of a pediatric Subjective Global Nutritional Assessment tool. Guidelines are given for performing and interpreting physical examinations that look for evidence of loss of subcutaneous fat, muscle wasting, and/or edema in children of different ages. Age-related questionnaires are offered to guide history taking and the rating of growth, weight changes, dietary intake, gastrointestinal symptoms, functional capacity, and any metabolic stress. Finally, the associated rating form is provided, along with direction for how to consider all components of a physical exam and history in the context of each other, to assign an overall rating of normal/well nourished, moderate malnutrition, or severe malnutrition. With this information, interested health professionals will be able to perform Subjective Global Nutritional Assessment to determine a global rating of nutritional status for infants, children, and adolescents, and use this rating to guide decision making about what nutrition-related attention is necessary. Dietetics practitioners and other clinicians are encouraged to incorporate physical examination for signs of protein-energy depletion when assessing the nutritional status of children.