Global Assessment Of Nutritional Status Research Articles

Subjective Global Assessment of Nutritional Status among Chronic Kidney Disease Dialysis Patients: A Cross-sectional Study

Introduction: Nutritional status is compromised in End-Stage Renal Disease (ESRD) patients on dialysis. In order to predict the clinical outcomes of these patients, the diagnosis of nutritional status becomes extremely important. However, data related to parameters assessing nutritional status are limited. Aim: The aim of this study was to assess the nutritional status of dialysis patients with ESRD at the renal care unit of a tertiary care hospital. Materials and Methods:A cross-sectional study was conducted at the renal care unit of a tertiary care hospital from January 2016 to July 2016. Fifty individuals were divided into two groups: 30 stable ESRD patients on Haemodialysis (HD) and 20 stable ESRD patients on Continuous Ambulatory Peritoneal Dialysis (CAPD). Data were collected using a questionnaire regarding nutritional assessment, which comprised medical history, food intake history, anthropometry, biochemical investigations, and Subjective Global Assessment (SGA). Based on the SGA analysis of nutritional status, the patients were divided into Categories A, B, and C. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 22.0. Results: A total of 50 subjects were included in the final analysis - 30 patients in the renal dialysis group and 20 patients in the CAPD group. Body Mass Index (BMI) was significantly higher in the HD group (21.78±2.86 kg/m2 ) than in the CAPD group (20.87±2.63 kg/m2 ). In the HD group, the majority were in Category B (60%). In the CAPD group, the majority were in Category B (70%). The mean anthropometric measurements were significantly higher in Category A, followed by B and C (p<0.001). There was no significant difference across groups in biochemical parameters, except for serum albumin levels, which were significant. Serum albumin levels were highest in Category A, followed by Category B, and Category C in reverse for S. Prealbumin (mg/dl). Conclusion: There is a significant number of ESRD patients who have malnutrition as an additional burden. These results suggest that low BMI and low calorie intake are harmful to ESRD patients on HD, causing severe malnutrition. Optimal calorie intake could reduce malnutrition in these patients.

Subjective Global Assessment of Nutritional Status in Head and Neck Cancer Patients Treated with Radiotherapy – A Prospective Observational Study from North East India

Head and neck cancer (HNC) patients undergoing curative radiotherapy (RT) are at risk of malnutrition due to disease process as well as effects of therapy. Identifying the nutritional status of these patients at the earliest, helps to introduce adequate and timely interventions that can improve compliance and outcomes of treatment. Various tools for nutritional assessment in cancer patients have been proposed. In this prospective observational study we used the Subjective Global Assessment (SGA) questionnaire in a cohort of HNC patients receiving definitive RT at a regional cancer center of North East India. Recording of data was done at baseline, at two weekly intervals during treatment, at end of radiotherapy (EORT) and at follow-up upto 6 months. We observed that despite proper nutrition counseling, our patients suffered from malnutrition throughout their course of RT, which was at its peak by EORT but gradually improved over six months of follow-up. Pain on eating and swallowing were the most debilitating symptoms which caused significant decline of nutrient intake, body fat and muscle mass among patients together with deteriorating SGA ratings. Our results will hopefully help us design better strategies for nutrition management while delivering curative (chemo)radiotherapy for HNC patients of this region- which has one of the highest incidences of HNC in the world.

Assessment of Nutritional Status of Hospitalized Children:A Comparison of STRONGkids and Anthropometry

AbstractIntroduction Malnutrition is defined as an imbalance between requirements and intake of energy and/or nutrients that affect the growth—physical and cognitive functions. It is a major public health problem worldwide especially in children under five years. It includes under-nutrition either stunting, wasting, or micronutrient deficiencies and overweight or obesity. Several nutritional screening tools had been designed to detect nutritional risk of hospitalized children at an early stage. There are six tools, however, there is no consensus on which is the best tool to be used. In clinical practice, the most frequently used screening tools are: Screening of Risk for Nutritional Status and Growth (STRONGkids) and the Subjective Global Assessment of Nutritional Status (SGA). The study aimed to assess the nutritional status of hospitalized children at the time of admission and to evaluate the usefulness of STRONGkids.Patients and Methods A cross sectional study was conducted in Benghazi Medical Center (BMC), from July 2020 to November 2020. A total of 116 under five children admitted to the hospital were included in the study.Result and Discussion The study showed that 53.45% of children were males and 46.55% were females and showed that by using STRONGkids score, 42.2% of children were at low risk of malnutrition, 50.0% at medium risk, and 7.8% at high risk. There was an accordance between result of STRONGkids and weight for age, p = 0.000, similarly for height for age and weight for height.conclusion The STRONGkids screening tool could be used as an initial screening tool for children on admission to provide the right intervention at the right time.

Undernutrition and Cachexia in Patients with Decompensated Heart Failure and Chagas Cardiomyopathy: Occurrence and Association with Hospital Outcomes.

ResumoFundamento Problemas nutricionais são comuns em pacientes com insuficiência cardíaca (IC) e estão associados a um prognóstico ruim. É relevante mencionar que algumas populações de pacientes, como os com Doença de Chagas, são normalmente excluídas da maioria das análises.Objetivo Buscamos analisar a ocorrência de desnutrição e caquexia em pacientes com Doença de Chagas durante episódios de IC descompensada (ICD) em comparação a outras etiologias, e investigar a influência desses achados em desfechos hospitalares.Método Realizamos um estudo de série de casos consecutivos com pacientes hospitalizados com ICD. Os pacientes foram submetidos à Avaliação Nutricional Subjetiva Global (ASG), além de medidas antropométricas e laboratoriais, e foram avaliados para a ocorrência de caquexia, baixa massa muscular e força. Estudamos a ocorrência de morte e transplante cardíaco de urgência durante a internação.Resultados Ao todo, 131 pacientes foram analisados e 42 (32,1%) tinham Doença de Chagas. Pacientes com Doença de Chagas apresentavam índice de massa corporal (IMC) menor (22,4 kg/m2 [19,9-25,3] vs. 23,6 kg/m2 [20,8-27,3], p=0,03), maior frequência de desnutrição (76,2% vs 55,1%, p=0,015) e mais ocorrências de morte ou transplante (83,3% vs. 41,6%, p<0,001). Observamos que, dentre os pacientes com etiologia da Doença de Chagas, a ocorrência de morte ou transplante cardíaco esteve associada com desnutrição (3 [42,9%] pacientes com alta hospitalar vs. 29 [82,9%] pacientes que morreram ou receberam transplante cardíaco, P=0,043).Conclusões Ao todo, nossos resultados indicam que pacientes com Doença de Chagas internados com ICD costumam apresentar problemas nutricionais, principalmente desnutrição. É importante mencionar que este achado esteve associado à ocorrência de morte e transplante cardíaco durante a internação.

Association of subjective global assessment of nutritional status with gut microbiota in hemodialysis patients: a case-control study.

Protein-energy wasting (PEW) is prevalent and associated with adverse outcomes in patients with chronic kidney disease (CKD). However, the pathogenesis of PEW in CKD patients has not been fully identified. The gut microbiota has been implicated in the regulation of host metabolism and energy balance. Therefore, we aimed to explore the association between nutritional status and the composition of the gut microbiota in hemodialysis patients. Gut microbial diversity and taxonomy were examined in 88 hemodialysis patients with PEW (n = 22) and normal nutritional status (n = 66) who were matched 1:3 for age and sex. Nutritional status was assessed by using the 7-point subjective global assessment (SGA) score (1-3 = severe PEW; 4-5 = moderate PEW and 6-7 = normal nutrition). The gut microbiota was assessed by 16S ribosomal RNA gene sequencing. Patients with normal nutritional status had a significantly higher body mass index and physical activity and serum albumin levels, but significantly lower levels of inflammatory cytokines than patients with PEW. The most striking finding was that the α-diversity of the gut microbiota was significantly lower in patients with PEW. In a multivariate analysis, the SGA score was independently and positively associated with α-diversity (P = 0.049). Patients with or without PEW were different with respect to the principal coordinate analysis of β-diversity. Notably, the relative abundance of Faecalibacterium prausnitzii, a butyrate-producing bacteria, was markedly reduced in patients with PEW. In hemodialysis patients, PEW assessed with the SGA was associated with gut dysbiosis.

Risk for undernutrition and development of pressure injury in hospitalised patients in Brazil: Multicentre prospective cohort study.

Although pressure injury (PI) is preventable, the number of patients developing this type of injury is still high. In this prospective cohort study, we aimed to assess whether high risk for undernutrition was a risk factor for PI in 1937 patients aged ≥18 at six hospitals in Sao Paulo, Brazil. Patients' risk for undernutrition was assessed using three unique screening tools. Risk for PI was assessed using the Braden Scale. Data were analysed using Poisson regression with robust variance (95% CI, P ≤ .05). While 57.1% of patients were at risk for undernutrition in the Nutritional Risk Screening (NRS 2002), only 36.8% and 2.6% were at risk in the Braden Scale Nutrition Subscale (BSNS) and Subjective Global Assessment of Nutritional Status (SGANS), respectively. The cumulative incidence rate was 5.9%. Of those who developed PI, 91.2%, 56.2%, and 18.4% were at risk for undernutrition in the NRS 2002, BSNS, and SGANS scales, respectively. We found a significantly higher risk for PI in patients who were at risk for undernutrition compared with those who were not at risk, supporting previous evidence about the role of undernutrition as a key risk factor for PI in hospitalised patients.

The association of klotho protein and nutrition status for maintenance hemodialysis patients

Objective To explore the association between klotho protein and nutrition status for maintenance hemodialysis patients. Methods From June 2016 to November 2016, 100 patients who received maintenance hmodialysis were divided into three groups, group A: 28 cases in good nutrition group, group B: 44 cases in mild and moderate malnutrition group, and group C: 28 cases in severe malnutrition group in our hospital and 60 health controls were enrolled in our study. Subjective global assessment of nutritional status(SGA) was used to assess the nutrition status between two groups, the level of serum klotho protein was measured by ELISA, and other related· biochemical indexes were detected. Pearson correlative analysis was used to analyze the relationship between serum klotho protein and related biochemical indexes. Results There was a significant difference of the incidence of malnutrition between study group and control group (72%>18.32%, P<0.05), and there was significant difference of biochemical indexes among different nutrition status of groups A, B and C (P<0.05), compared with A group, the level of ALB, Hb, MAMC, klotho protein and BMI were lower in group B and C, and the level of PTH and FGF-23 was higher (P<0.05). Compared with group B, the level of Scr, ALB, Hb, MAMC, klotho protein was lower, and the level of PTH and FGF-23 was higher (P<0.05). Serum klotho protein was positively related with ALB, MAMC and Hb (P<0.05), and negatively related with Scr, BUN, FGF23 and PTH (P<0.05), while there was no relationship between serum klotho protein and BMI (P=0.165). Conclusions There is a high incidence of malnutrition in maintenance hemodialysis patients, and the low expression of serum klotho protein may be related with maintenance hemodialysis patients, which may provide a new basis for the diagnosis and treatment of malnutrition in uremic patients. Key words: Renal Dialysis; Proteins; Nutritional Status

Maximal expiratory pressure predicts mortality in patients hospitalized in medical and surgical wards.

the prognostic value of maximal inspiratory and expiratory pressures on functional capacity and mortality of hospitalized patients are not well established. to evaluate the prognostic value of respiratory pressures in hospitalized patients. patients admitted to a general hospital in Santiago-Chile were prospectively studied. Within 48 hours of admission, handgrip strength and inspiratory and expiratory pressures were measured. Subjective global assessment of nutritional status (SGA) was determined and Apache II score was calculated. Functional status was assessed using the Karnofski index. Patients were followed for a period of 30 days. Mortality and decline in functional capacity, defined as a reduction in at least two stages of the Karnofski index were determined. Normal values for handgrip strength and respiratory pressures were obtained in 366 healthy subjects aged 20 to 89 years, thus the results obtained in patients were expressed as age and sex matched z-scores. one hundred and eight patients were recruited and 18 had to be excluded. Thus, 90 patients aged 58 ± 16 years (46 females) were studied. During the observation period, six patients died and nine experienced a decline in functional status. Patients who died had significantly lower maximal inspiratory and expiratory pressures, hand grip strength and worse SGA. Logistic regression analysis only accepted maximal expiratory pressure expressed as z-score as a predictor of mortality. In addition, it was the only significant predictor of death or functional decline. maximal expiratory pressure on admission was a predictor of death or functional decline at 30 days.

Associação entre diferentes métodos de avaliação nutricional em pacientes com HIV/AIDS em um hospital público

Objective: To assess the nutritional status of individuals diagnosed with HIV/AIDS hospitalized in a public infectious diseases reference hospital, verifying the association between the different screening methods and the anthropometric evaluation. Methods: Descriptive, quantitative and cross-sectional study that evaluated 30 patients with HIV/AIDS in 2016, admitted within 72 hours in a public infectious diseases reference hospital of Fortaleza, Ceara, with data collection consisting in the application of subjective nutritional screening tools (MUST: Malnutrition Universal Screening Tool; ANSG: Subjective Global Assessment of Nutritional Status; and NRS-2002: Nutritional Risk Score-2002) and anthropometric measurements carried out for calculation of the Body Mass Index (BMI) and the Arm Circumference (AC), with subsequent classification according to the parameters described in the literature. The association between subjective and objective methods was evaluated using Fisher’s exact test, with p≤0.05. Results: Individuals of both genders, aged between 23 and 55 years, participated in the research. The BMI ranked 40.1% of them with thinness, while the AC diagnosed 89.3% (n=25) of the sample with malnutrition. Among the methods, MUST and NRS-2002 identified a higher percentage of patients at risk or with high nutritional risk. There was association only between the variables BMI and SGA (p=0.018), BMI and NRS-2002 (p=0.002), and BMI and MUST (p=0.018). Conclusion: The study found association between the three subjective methods and the assessment using the BMI. However, NRS-2002 and MUST proved more capable of identifying nutritional risk in comparison to SGA.

Patient-Generated Subjective Global Assessment of nutritional status in pediatric patients with recent cancer diagnosis.

The subjective global assessment (SGA) is a simple, sensitive tool used to identify nutritional risk. It is widely used in the adult population, but there is little evidence on its effectiveness in children with cancer. This cross-sectional study was undertaken to demonstrate significant correlation between a simplified version of the Patient-Generated SGA (PG-SGA) and anthropometric assessment to identify nutritional status in children recently diagnosed with cancer. The nutritional status of 70 pediatric cancer patients was assessed with the PG-SGA and anthropometric measurements. The relation between the assessments was tested with ANOVA, independent samples t-test, Kappa statistic, and non-parametric Spearman and Kendall correlation coefficient. The PG-SGA divided the patients into four groups: well nourished, mildly, moderately and severely malnourished. The prevalence of malnutrition according to the PG-SGA was 21.4%. The correlations (r ≥ 0.300, p < 0.001) and the concordance (k ≥ 0.327, p < 0.001) between the PG-SGA and anthropometric indicators were moderate and significant. The results indicate that the PG-SGA is a valid tool for assessing nutritional status in hospitalized children recently diagnosed with cancer. It is important to emphasize that the subjective assessment does not detect growth retardation, overweight or obesity.

Avaliação Nutricional de indivíduos internados em um hospital geral

The evaluation of the nutritional status is important to detect malnourished patients or patients having risk of malnourishment.Malnutrition is associated to a higher risk of infection, metabolic complications, prolonged hospitalizations and morbimortality.The aim in this study was to evaluate the nutritional status of individuals interned in a hospital and compare the measuredcorporal weight with the weight estimated by formulas. The study was cross-sectional, done during three months withpatients admitted in a general hospital by the Health Public Service from Brazil (SUS), health plans or private payment. Thenutritional assessment was done in all the individuals admitted in the hospital during the period of study (n = 51), and we didan anthropometric assessment, biochemical analysis and subjective global assessments. Data analysis consisted in frequencydistributions and measurements of central tendency and dispersion. Comparisons of means were also done. The results revealeda high prevalence of anemia in the individuals (56.9%); most of them (74.6%) showed leukocytes within the normalrange and lymphocytes (65.5%) below the desirable range. The anthropometric assessment identified a great many individualsas having excess of body weight (45.1%). Concerning the subjective global assessment of nutritional status, the majoritypresented eutrophy (92.2%). It was not observed any difference between body weights assessed and body weights estimatedby predictive equations, being this useful for use in bedridden patients. Nutritional assessments performed immediately assistedin identifying patients at nutritional risk or malnourished, allowing the establishment of appropriate nutritional therapy.

Validity of the Braden Nutrition Subscale in predicting pressure ulcer development.

The purpose of this study was to analyze the validity of the nutrition subscale from the Braden Scale for Predicting Pressure Sore Risk in hospitalized patients. A prospective, quasi-experimental, repeated-measures design guided data collection and analysis. One hundred seventy adult patients from 2 private hospitals located in urban areas in Southeastern Brazil, with a Braden Scale score of 18 or less, and who agreed to participate in the study were assessed between January and August 2006. Participants were primarily male (57.0%) and had a mean age of 67.0 ± 15.4 years (mean ± SD). Objective assessment and subjective global assessment of nutritional status were performed on admission. Every 2 days, patients deemed at potential risk for pressure ulcer development underwent evaluation of protein-energy intake, skin assessment, and repeated risk assessment for pressure ulcer development via the Braden Scale. Univariate and multivariate logistic regression analyses were used to assess the predictive power of nutritional variables related to risk for pressure ulcer development. The mean length of stay among patients was 17.8 ± 16.8 days. Multivariate regression analysis revealed that serum albumin levels (odds ratio = 5.226; P < .001) and subjective global nutritional assessment (odds ratio = 3.246; P < .001) were the best nutritional predictors of pressure ulcer development. We did not find the Braden nutrition subscale score to be predictive for pressure ulcer development in hospitalized patients. Serum albumin levels and subjective global nutritional assessment were the best nutritional predictors of pressure ulcer development.

Evaluation of nutritional indicators and body composition in patients with advanced liver disease enrolled for liver transplantation

Malnutrition is prevalent in patients with advanced liver disease (LD) related to multifactorial causes. Fluid retention can underestimate the nutritional status based on anthropometric measures. We evaluated nutritional indicators and body composition (BC) in patients with liver cirrhosis and correlated them with LD severity. Forty three patients with LD enrolled for liver transplantation were evaluated by Anthropometric measures, subjective evaluation (Global Assessment of Nutritional Status - SGA) and biochemical indicators. Single-frequency electrical bioimpedance (SFE-BIA) was used to evaluate body composition (BC). It measured resistance (R), reactance (Xc) and the phase angle (PA). LD severity was estimated by Child-Pugh and Meld criteria (Model for End-Stage Liver Disease). Child-Pugh index between patients was 7.11 ± 1.70 and Meld was 12.23 ± 4.22. Arm Circumference, Arm Muscle Circumference and Arm Muscle Area, SGA, hemoglobin, hematocrit and albumin showed better correlation with disease severity. Xc and PA showed correlation both with Meld and Child-Pugh score when BC were evaluated. PA was depleted in 55.8% of the patients. Diagnosis of malnutrition varied according to the method. Global assessment of nutritional status showed better correlation with disease severity than with objective methods. Single-frequency electrical bioimpedance for body composition analysis in cirrhotic patients must be cautiously used; however, primary vectors seems to be valid and promising in clinical practice.

Looking Back to Move Forward

Looking Back to Move Forward

Assessment of nutritional status at the time of diagnosis in patients treated for head and neck cancer

To evaluate the nutritional status at the time of diagnosis of patients treated for head and neck cancer. Single-centre prospective study. Nutritional assessment comprised: clinical interview, physical examination, and a laboratory work-up. Clinical interview assessed: reference weight, diet, calorie intake, causes of weight loss, use of dietary supplements. A subjective global assessment of nutritional status (Detsky index) was established on the basis of clinical interview. The patient's height and weight were determined and serum albumin was assayed. Weight loss, body mass index, and Buzby index were then calculated. Two groups of malnourished patients were distinguished: moderately malnourished (group 1), severely malnourished (group 2). Variables were compared between the two groups by Chi(2) test. One hundred and sixty-nine patients were included in the study: 145 had a history of smoking and alcohol abuse, 82 (48.5%) were malnourished and 47 of them were classified in group 1. All patients of group 1 had a normal or pureed diet. 21 (69%) patients of group 2 had a pureed or liquid diet. The mean daily calorie intake was 31kcal/kg/24h for group 1 and 20kcal/kg/24h for group 2. The main causes of weight loss were pain and dysphagia. Dietary supplements were not used by any of the patients in group 1 and by four (13%) patients in group 2. The concordance between the Detsky index and objective nutritional status was 92% for the overall population. Malnutrition was significantly more frequent among males (P=0.01), alcohol users (P=0.02), elderly subjects (P=0.01), patients with pharyngeal tumour (P=0.03), and patients with advanced tumour stage (P=0.01). The prevalence of malnutrition among patients with head and neck cancer is high. Assessment of nutritional status and appropriate management must be part of the initial work-up of these patients.

Self-Rated Appetite as a Predictor of Mortality in Patients With Stage 5 Chronic Kidney Disease

To investigate the level of anorexia and its correlation with mortality in chronic kidney disease stage 5 patients not yet on dialysis (CKD5-ND) and in those with stage 5 chronic kidney disease undergoing dialysis (CKD5-D). In an observational study, self-rated appetite (as part of a subjective global assessment of nutritional status), along with anthropometrics and biochemical markers of nutritional status, was analyzed in relation to survival. In a subgroup of patients, appetite change after start of dialysis was studied prospectively. Two hundred eighty CKD5-ND (40% female; age 54 ± 12 years; glomerular filtration rate 7 ± 2 mL/minute) and 243 CKD5-D patients (116 hemodialysis and 127 peritoneal dialysis [PD]; 44% female; age 54 ± 12 years; dialysis vintage time 12 ± 2 months) who had been on dialysis for about 1 year were studied. CKD5-ND patients with poor appetite (50%) had a higher prevalence of cardiovascular disease, lower body weight and serum creatinine level, and higher C-reactive protein. CKD5-D patients with poor appetite (33%) had impaired subjective global assessment of nutritional status and lower body weight, fat body mass, handgrip strength, hemoglobin, and serum albumin level. In aKaplan-Meier analysis, appetite was not associated with survival difference, whereas in the Cox proportional hazards model with competing risk analysis, poor appetite increased mortality risk in PD patients but not in hemodialysis and CKD5-ND patients. In CKD5-ND patients, self-rated appetite was not an independent predictor of 48-months survival, whereas there was a significant increase in mortality risk in PD patients with poor appetite.

Regarding the article ‘Subjective global assessment of nutritional status in children’ by Mahdavi et al.

Regarding the article ‘Subjective global assessment of nutritional status in children’ by Mahdavi <i>et al</i>.

Subjective global assessment of nutritional status in children

This study was aimed to compare the subjective and objective nutritional assessments and to analyse the performance of subjective global assessment (SGA) of nutritional status in diagnosing undernutrition in paediatric patients. One hundred and forty children (aged 2-12 years) hospitalized consecutively in Tabriz Paediatric Hospital from June 2008 to August 2008 underwent subjective assessment using the SGA questionnaire and objective assessment, including anthropometric and biochemical measurements. Agreement between two assessment methods was analysed by the kappa (κ) statistic. Statistical indicators including (sensitivity, specificity, predictive values, error rates, accuracy, powers, likelihood ratios and odds ratio) between SGA and objective assessment method were determined. The overall prevalence of undernutrition according to the SGA (70.7%) was higher than that by objective assessment of nutritional status (48.5%). Agreement between the two evaluation methods was only fair to moderate (κ = 0.336, P < 0.001). The sensitivity, specificity, positive and negative predictive value of the SGA method for screening undernutrition in this population were 88.235%, 45.833%, 60.606% and 80.487%, respectively. Accuracy, positive and negative power of the SGA method were 66.428%, 56.074% and 41.25%, respectively. Likelihood ratio positive, likelihood ratio negative and odds ratio of the SGA method were 1.628, 0.256 and 6.359, respectively. Our findings indicated that in assessing nutritional status of children, there is not a good level of agreement between SGA and objective nutritional assessment. In addition, SGA is a highly sensitive tool for assessing nutritional status and could identify children at risk of developing undernutrition.

Early Assessment of Nutritional Status in Patients Scheduled for Colorectal Cancer Surgery

Nutritional support is important to optimize treatment outcomes in colorectal cancer surgery. Using retrospective review of patients' medical records, we sought to identify the kinds of nutritional problems patients with colorectal cancer reported on their first visit to the surgeon to support those at risk of malnutrition. After reviewing data from the Patient-Generated Subjective Global Assessment of Nutritional Status, patients had a supportive counseling meeting about nutrition with a nurse. Of the 153 patients, 65% were diagnosed with colon cancer and 35% with rectal cancer. Eighteen percent of those with colon cancer were overweight, and 12% were obese. Of those with rectal cancer, 10% were overweight, and 7% were obese. Weight loss was reported by 18% of the patients with colon cancer and by 12% of the patients with rectal cancer. To identify the patients who need nutritional support before colorectal cancer surgery, it is important to first identify the patients' nutritional status. When the focus is on surgery, it is possible that these problems are not mentioned if no questions are asked. Nutritional assessment at the outpatient department makes it possible to use the time lapse between examination and surgery to improve the nutritional status.

Subjective global assessment of nutritional status is strongly associated with mortality in chronic dialysis patients

Background: The subjective global assessment of nutritional status (SGA) is used to assess the nutritional status of chronic dialysis patients, but longitudinal data in relation to mortality risk are lacking.Objective: Our objective was to study the long-term and time-dependent associations of the SGA with mortality risk in chronic dialysis patients.Design: In a prospective, longitudinal, observational, multicenter study of incident dialysis patients, the 7-point SGA [7 = normal nutritional status; 1 = severe protein-energy wasting (PEW)] was assessed 3 and 6 mo after the start of dialysis and subsequently every 6 mo during 7 y of follow-up. With Cox regression analysis, we calculated hazard ratios (HRs) of the baseline and time-dependent SGA measurements, adjusted for age, sex, treatment modality, primary kidney diseases, and comorbidity.Results: In total, 1601 patients were included [mean (±SD) age: 59 ± 15 y; 61% men; 23% with moderate PEW (SGA4–5), and 5% with severe PEW (SGA1–3)]. There was a dose-dependent trend of the 7-point SGA with mortality. Compared with a normal nutritional status at baseline, SGA4–5 (HR: 1.6; 95% CI: 1.3, 1.9) and SGA1–3 (HR: 2.1; 95% CI: 1.5, 2.8) were associated with an increase in 7-y mortality. Time-dependently, these associations were stronger: SGA4–5 (HR: 2.1; 95% CI: 1.7, 2.5) and SGA1–3 (HR: 5.0; 95% CI: 3.8, 6.5).Conclusions: In dialysis patients, PEW at baseline assessed with SGA was associated with a 2-fold increased mortality risk in 7 y of follow-up. Time-dependently, this association was even stronger, which indicated that PEW was associated with a remarkably high risk of short-term mortality. These data imply that the 7-point SGA may validly distinguish different degrees of PEW associated with increasing risks of mortality.