The subjective global assessment (SGA) is a nutrition assessment tool that refers to an overall evaluation of a patient's history and physical examination and uses structured clinical parameters to diagnose malnutrition. The SGA is known to be a reliable and valid tool that predicts morbidity and mortality associated with malnutrition. The objective of SGA is to identify patients likely to benefit from nutrition intervention and therefore to identify persons in whom inadequate nutrition intake or absorption explain features of malnutrition, including body wasting. There are other conditions that cause weight loss, muscle wasting, and fat loss, including cachexia and sarcopenia. Acknowledging that these 2 last conditions differ in their mechanism of body wasting and consequently in the outcomes of nutrition intervention, the practitioner needs a tool to identify when malnutrition is the dominating factor to explain body wasting. The SGA form has been revised to clearly reflect the key concepts behind the diagnosis of malnutrition and help to distinguish this condition from other wasting conditions. This review presents the revised SGA form and guidance document. Using case studies, it illustrates the 3 wasting conditions, their overlap, and how the SGA identifies malnutrition as a dominating factor of body wasting and thus individuals who require nutrition intervention.
subjective global assessment form pdf
In the present cross-sectional study, 349 patients were recruited. Nutrition assessment was performed using Patient-Generated Subjective Global Assessment (PG-SGA). In addition, National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and biochemical tests were performed.
Hence, there is a large body of data supporting the concept that nutrition evaluation in hospitalized stroke patients is critical and would give us a starting point to look at this issue as a priority [4, 5]. To this end, several tools have been developed to identify patients at risk of malnutrition and consider proper nutritional interventions. These tools are classified to objective and subjective evaluations. The objective one is based on the hematological and biochemical parameters. In this regard, the Patient-Generated Subjective Global Assessment (PG-SGA) is a widely used subjective nutritional screening tool including assessment of body weight, food intake, symptoms, relationship between disease and nutritional requirement, metabolism requirement, and physical examination [6, 7]. Accordingly, this study aimed to evaluate nutritional status of stroke patients at admission time and identified malnourished patients to estimate its relationship with clinical outcomes of stroke.
Patients living with cancer may have different nutritional challenges; early identification and treatment of malnutrition and disturbed metabolism are of critical importance. European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines strongly recommend to screen for risk of malnutrition in all cancer patients and further perform a nutritional assessment in patients at risk to identify those who are malnourished.1
Cooper B, Bartlett L, Aslani A, Allen B, Ibels L, Pollock C. Validity of subjective global assessment as a nutritional marker in end-stage renal disease. American Journal of Kidney Diseases. 2002;40(1):126-132. doi:10.1053/ajkd.2002.33921
Fontes D, Generoso S, Toulson Davisson Correia M. Subjective global assessment: A reliable nutritional assessment tool to predict outcomes in critically ill patients. Clinical Nutrition. 2014;33(2):291-295. doi:10.1016/j.clnu.2013.05.004
Malnutrition assessment is different from malnutrition screening in that an in-depth and comprehensive evaluation of nutritional status is performed; therefore, professional training is required to conduct malnutrition assessment and this process is usually completed by a trained registered dietitian (RD) [21]. Moreover, in the field of nutritional practice, the assessment tool should not only be used to diagnose malnutrition at the initial visit, but the same tool should also be used by RDs to compare the effect of nutritional intervention and to measure nutritional outcomes at re-assessment. There are three well-studied malnutrition assessment tools available for this purpose: the Mini Nutritional Assessment (MNA) [22, 23], the Subjective Global Assessment (SGA) [24] and the Patient-Generated Subjective Global Assessment (PG-SGA) [25].
When discrepancies of scoring of specific items existed, the two reviewers (YX and JV) revisited and discussed the full article to resolve the score by mutual agreement. Of the 34 articles evaluated using QA-CMS [12], only 5 (14.70%) papers described a thorough literature review of the studied tools in their introduction, including the currently known measurement properties and the gaps identified from the current literature review that resulted in the development of relevant research questions, and calculations to determine the optimum numbers of study subjects to participate in the study were performed in 6 papers (17%). However, most papers (28 out of the 34 studies) included an adequate description of the studied instruments, scoring, and statistical methodologies applied to examine the clinical measurement properties. Thirteen articles evaluated two or more psychometric properties, of which Lin et al. [32], Ghazi et al. [33], Soysal et al. [34], and Bauer et al. [35] provided a comprehensive review of the studied tool by concurrently examining three or more indicators of reliability and validity [12]. The overall administrative procedure to perform the outcome measure in an unbiased way was evaluated primarily based on 1) if a professionally trained dietitian or experienced clinician was hired to perform patient assessments, 2) if a standardized testing procedure was followed to perform anthropometric measures, 3) if the timing when these measures were performed was consistent for each study participant, and 4) if the time-interval to assess test-retest reliability or responsiveness to change was appropriate [12].
A comprehensive systematic review was performed to validate the clinical measurement properties of three malnutrition assessment tools: SGA, PG-SGA, and MNA. A broad range of clinical measurement properties was studied in this systematic review, including internal consistency, inter-rater reliability, test-retest reliability, construct validity, criterion validity, and responsiveness to change. Furthermore, studies conducted in diverse ethnicity and patient population groups were identified.
The advantage of SGA is its clinical utility. It is simple, quick, inexpensive, and has been widely accepted as a criterion to validate new tools developed for nutritional screening and assessment [19]. Most interestingly, SGA was recognized as a nutritional screening tool used to increase the Diagnosis Related Group based health care reimbursement in Europe [66] and the coding of malnutrition on a casemix-based hospital funding system in Singapore [67]. However, in addition to the need for ongoing training and practice to maintain the high accuracy of malnutrition diagnosis by SGA [62], this subjective assessment tool lacks responsiveness to change to detect the changes in nutritional status following intervention [60]. This disadvantage may limit its use in clinical practice to measure the effect of malnutrition treatment and it may reduce its selection for use as an outcome measure in future nutritional studies.
A critical review of the clinical measurement properties of three malnutrition assessment tools for use with patients in hospitals was performed. A total of 34 studies were eligible for review, of which 18 were rated to have an acceptable quality of clinical measurement study design. The reliability and validity of all three tools: SGA, MNA, and PG-SGA were assessed; all of them were easy to use, non-invasive, and cost-effective for assessing the malnutrition status of patients.
Because of the lack of a gold standard to define malnutrition, this review did not find sufficient evidence to suggest the criterion (concurrent) validity for these studied tools; however, region-specific malnutrition criteria selected to identify coding of malnutrition in inpatients which informs hospital reimbursement funding may be used as a benchmark in such circumstances to validate the tool use. A future study using sound methodological quality is needed to evaluate the responsiveness to change of these malnutrition assessment tools for the detection of a change in nutritional status.
GERO 511 Fundamentals of Clinical Nutrition Screening and Assessment Units: 4Terms Offered: SpExamines tools and resources used to evaluate the nutrition status of individuals across the lifespan including biochemical, anthropometric and subjective global assessment. Open only to graduate students. Registration Restriction: Open only to graduate students. Instruction Mode: Lecture Grading Option: Letter 2ff7e9595c
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