Subjective Global Assessment

A useful instrument for assessing nutritional status in the hospitalized patient is the subjective global assessment (SGA) (Brugler et al., 2005). The SGA incorporates five features of the history and four components of the physical examination findings, enabling the physician to make a rapid determination of a patient's nutritional status (Fig. 37-3). The history components are weight loss, food intake, presence of significant GI symptoms, functional status or energy level, and metabolic demand of the underlying disease state. The physical components are depletion of subcutaneous fat, muscle wasting in the quadriceps and deltoid muscles, edema, and ascites. Each component is evaluated as category A (patient well nourished), B (mildly malnourished), or C (severely malnourished).

Weight loss is one of the most important components of the assessment. Generally, if the patient loses at least 5% of body weight over 2 weeks, the ranking in that category is B; a 10% loss puts the patient in category C.

After completing the assessment, the clinician makes a global judgment about the overall status. This is not a numeric assessment, but rather is based on the clinician's sense of the overall nutritional picture, mainly through evidence of weight loss, poor intake, muscle wasting, and loss of subcutaneous fat. This instrument has been validated with

SUBJECTIVE GLOBAL ASSESSMENT SCORING SHEET

Patient name:

Patient ID:

Date:

Part 1: Medical history 1. Weight change

A. Overall change in past 6 months:

SGA Score kgs.

B. Percent change:

C. Change in past 2 weeks:

2. Dietary intake

A. Overall change:

_ Increase

_ No change

_ Decrease

B. Duration:

No change Change

Weeks

. Full liquid diet . Starvation

C. Type of change:

-Suboptimal solid diet -

_Hypocaloric liquid _

3. Gastrointestinal symptoms (persisting for >2 weeks)

_None _ Nausea _Vomiting _Diarrhea .

4. Functional impairment (nutritionally related)

A. Overall impairment: None

_ Moderate

Severe Improved No change _ Regressed

Anorexia

B. Change in past 2 weeks:

SGA Score

Anorexia

ABC

1 1

Part 2: Physical examination

5. Evidence of:

Loss of subcutaneous fat Muscle wasting Edema

Ascites (hemo only)

SGA Score

SGA Score

Loss of subcutaneous fat Muscle wasting Edema

Ascites (hemo only)

Normal

Mild

Moderate

Severe

Part 3: SGA rating (check one)

A. □ Well-nourished B. □ Mildly-moderately malnourished C. □ Severely malnourished

Figure 37-3 Subjective global assessment (SGA). (From Kalantar-Zadeh K, Kleiner M, Dunne E, et al. Total iron-binding capacity-estimated transferring correlates with nutritional subjective global assessment in hemodialysis patients. Am J Kidney Dis i998;3i:263-272; and Brugler L, Stankovic AK, Schlefer M, Bernstein L A simplified nutrition screen for hospitalized patients using readily available laboratory and patient information. Nutrition 2005;21:650-658.)

trained clinicians (Baker et al., 1982a, 1982b; Detsky et al., 1984) but not with untrained physicians.

Other assessment tools have been proposed and may eventually be validated (Brugler et al., 2005). Most of these take into account the same key factors: risk for malnutrition based on preexisting conditions, oral intake, need to heal wounds, and biochemical or hematologic parameters, such as serum albumin level and total lymphocyte count. The family physician can find most of these data readily and obtain a reasonable assessment of nutritional status.

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Breaking Bulimia

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