Subjective Global Assessment Rating Research Articles

Pain and Palliative Management in Advanced Gastrointestinal Malignancies – How Are We Doing?

Aims: The aim of the study is to study the different methods and their efficacy in pain management in advanced gastrointestinal (GI) malignancies. Methods: The study included patients with advanced and inoperable GI malignancies. Demographic data, laboratory parameters and radiological investigations, baseline visual analog scale (VAS) score, and subjective global assessment (SGA) were recorded on the first contact along with details of medical, endoscopic, and palliative interventions as performed. Analgesic pain step ladder approach was followed for pain management. Follow-up to assess response was done using VAS score and SGA at the end of 3 months or death within this period. Results: Seventy-one patients were included. Most of them were elderly males. Out of 7 malignancies noted, hepatocellular carcinoma (HCC) was the most common tumor (41; 57.8%). Thirty-five patients (49.3%) had vascular invasion, while 29 (40.8%) had metastatic cancer. The most common vascular invasion was the portal vein (29; 40.8%). The liver was the most common metastatic site (12; 16.9%). The baseline mean VAS score was 5.13 ± 2.38 and the highest was in carcinoma gallbladder patients (8.0 ± 2.0). Most patients were having baseline SGA rating B (69%). Tramadol was the most commonly used analgesic (35.22%) followed by a combination of tramadol and fentanyl (26.76%). The most common palliation was transarterial chemoembolization in HCC (80.5%) and biliary self-expandable metallic stent in carcinoma pancreas (77.8%). There was a statistically significant reduction in VAS score in HCC (P < 0.001), carcinoma pancreas (P = 0.009), and colorectal cancer (P = 0.022). One-sixth patients moved from SGA rating B to rating A, 9.9% moved from SGA rating B to rating C, and 9.9% moved from SGA rating C to rating B. Conclusion: There was an improvement in quality of life at 3-month follow-up. There was significant pain improvement in the studied patients. However, almost one-third patients did not get adequate pain relief.

Established risk prediction models for the incidence of a low lean tissue index in patients with peritoneal dialysis

Objective The objective of this study is to investigate the incidence of low lean tissue index (LTI) and the risk factors for low LTI in peritoneal dialysis (PD) patients, including to establish risk prediction models. Methods A total of 104 PD patients were enrolled from October 2019 to 2021. LTI was measured by bioimpedance spectroscopy. Multivariate logistic regression and machine learning were used to analyze the risk factors for low LTI in PD patients. Kaplan–Meier analysis was used to analyze the survival rate of patients with low LTI. Results The interleukin-6 (IL-6) level, red cell distribution width (RDW), overhydration, body mass index (BMI), and the subjective global assessment (SGA) rating significantly differed between the low LTI and normal LTI groups (all p < 0.05). Multivariate logistic regression showed that IL-6 (1.10 [95% CI: 1.02–1.18]), RDW (1.87 [95% CI: 1.18–2.97]), BMI (0.97 [95% CI: 0.68–0.91]), and the SGA rating (6.33 [95% CI: 1.59–25.30]) were independent risk factors for LTI. Cox regression analysis showed that low LTI (HR 3.14, [95% CI: 1.12–8.80]) was the only significant risk factor for all-cause death in peritoneal dialysis patients. The decision process to predict the incidence of low LTI in PD patients was established by machine learning, and the area under the curve of internal validation was 0.6349. Conclusions Low LTI is closely related to mortality in PD patients. Microinflammatory status, high RDW, low BMI and low SGA rating are risk factors for low LTI in PD patients. The developed prediction model may serve as a useful tool for assessing low LTI in PD 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 nutritive status and its correction in oncological patients after operations in the hepatopancreatoduodenal zone

Surgical interventions in the hepatopancreatoduodenal zone in cancer patients are associated with high risk of nutritional deficiency in the postoperative period. This feature is due to both the volume of the operation itself (pancreatoduodenectomy), and the predominance of catabolic processes in the early postoperative period. In this regard, the monitoring of the main indicators of carbohydrate, protein and fat metabolism in the early postoperative period becomes fundamental for choosing the correct tactics of nutritional support for this patients. Aim. Improvement of the nutritional status of cancer patients after operations carried out in the hepatopancreatoduodenal zone in connection with malignant neoplasms by means of a comprehensive comparative analysis of the effectiveness of isolated enteral, isolated parenteral and mixed types of nutritional support in the early postoperative period. Material and methods. The examination included 40 patients with an average age of 44.5±6.8 years (15 men, 25 women). All patients for analysis were divided into two groups: the first, the main - patients receiving strictly enteral and/or probe nutrition (n=21), the second, control - isolated parenteral nutrition (n=19). The dynamic of the main predictors of nutritional status in the early postoperative period was assessed: the level of total blood protein, including albumin, lymphocyte count, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity, their ratio - the de Ritis coefficient (as indirect criterion of cytolytic syndrome), total bilirubin. The analysis included the time interval of the enteral and parenteral nutrition in the early postoperative period, together with the number of bed-days required to correct the nutritional status in these patients in an intensive care unit. To objectify and clarify the dynamics of the nutritional status of patients in the pre- and postoperative period, we used the generally accepted scales for assessing nutritional status - Subjective Global Assessment (SGA) Nutritional Risk Index (NRI). Results. According to the SGA and NRI rating scales, the overwhelming majority of patients in the main and control groups (85.7% and 94.7%, respectively) had a normal nutritional status before the operation. In the postoperative period, 4 (21%) patients in the control group showed signs of moderate malnutrition by day 12, which regressed after the enteral nutritional support was connected. There were no statistically significant changes in nutritional status in patients of the main group. The basal metabolic rate in patients of both groups had no statistical differences before surgery (2296±279 kcal/day). On the 15th day of the postoperative period, its increase by 394 kcal/day was recorded in the main group, in the control group an increase in the basal metabolic rate was observed only with the addition of the enteral component of nutritional support, on average, by 321 kcal/day. There was no statistically significant decrease in the level of blood lymphocytes in patients of the main group (p=0.289) in comparison with the traced tendency to lymphopenia (p=0.019) in patients of the control group. The patients of the main group showed a slower regression of the ALT activity, and, accordingly, less increase in the de Ritis coefficient. Conclusion. In patients operated in the hepatopancreatoduodenal zone due to malignant neoplasms, in the early postoperative period, the enteral administration of nutritional mixtures may be preferable, both as an isolated method of nutritional support and as a supplement to parenteral nutrition, given its positive effect on the gastrointestinal tract passage, the level of basal metabolism, the state of the protein-synthetic function of the liver and, indirectly, the degree of cytolytic syndrome.

Evaluation of nutritional status among patients undergoing hemodialysis: A single-center study

Background: Protein–energy malnutrition (PEM) is a highly prevalent problem affecting the survival of hemodialysis (HD) patients. This study evaluated the nutritional status of HD patients using various assessment methods. Methods: Nutritional status of HD patients was evaluated using assessment tools such as 3-day diet recall, subjective global assessment (SGA), and biochemical and anthropometric measurements. Further, correlation analysis was performed between nutritional marker (serum albumin) and other study variables such as hemoglobin (Hb), protein–calorie intake, and type of diet consumed by the patients. Results: Data from 40 adult patients (aged 22–74 years) on HD were analyzed. The results of our study showed the overall good nutritional status of HD patients. According to SGA ratings, majority of the patient population (82%) was in well-nourished state. Despite lower intake of proteins and calories, serum albumin levels were found to be within normal limits. No significant correlation was found between serum albumin levels and other study parameters, namely, protein intake/kg body weight (BW)/day (r = 0.056, P = 0.73), calorie intake/kg BW/day (r = −0.053, P = 0.74), and Hb levels (r = 0.27, P = 0.18). However, body mass index showed moderately positive correlation with triceps skinfold (r = 0.35, P = 0.03). Further, no significant relationship was observed between the type of diet consumed and serum albumin levels (P > 0.05). Conclusion: The results suggest overall good nutritional status and absence of relationship between nutritional marker, serum albumin, and PEM in HD patients.

Assessment of malnutrition and enteral feeding practices in the critically ill: A single-centre observational study.

Background and Aims:Early identification of malnutrition among hospitalised patients is essential to institute appropriate patient-specific nutritional strategies. This study was conducted to evaluate the nutritional status of medical patients at admission to the adult intensive care unit (ICU) and to identify factors which prevent attainment of daily feeding goals in them.Methods:This was a 1 year prospective, observational study on 200 medical adult ICU patients. The study was carried out based on daily documentation. The primary outcome was the nutritional status of medical Patients at admission to the adult ICU. The tests for statistical analysis used were independent t test, Chi-square test, Fisher's exact test and multivariate logistic regression analysis.Results:Out of the 200 patients in our study, 45%, 48.5% and 9% of patients had mild, moderate and severe malnutrition, respectively, corresponding to subjective global assessment (SGA) rating A,B and C, respectively. The most common reasons for non-attainment of daily feeding goals were delayed feed procurement (17.57%), and feeds being held for procedures (16.36%). The overall mean length of ICU stay was 8.63 ± 7.26 days, and the ICU mortality rate was 47.5% (95/200). Patients with SGA rating B and C at admission had higher risk of mortality in the ICU, with an adjusted odds ratio of 3.54 (95% confidence interval [CI]- 1.71–7.33, P = 0.001) and 11.11 (95% CI-2.26–54.66, P = 0.003), respectively.Conclusion:Malnutrition is commonly present at admission among medical ICU patients, and is associated with higher ICU mortality.

Accuracy and confidence of allied health assistants administering the subjective global assessment on inpatients in a rural setting: a preliminary feasibility study.

Malnutrition has a significant impact on patient outcomes and duration of inpatient stay. However, conducting timely nutrition assessments can be challenging for rural dietitians. A solution could be for allied health assistants (AHAs) to assist with these assessments. The present study aimed to assess the accuracy and confidence of AHAs trained to conduct the subjective global assessment (SGA) compared with dietitians. A non-inferiority study design was adopted. Forty-five adult inpatients admitted to a rural and remote health service were assessed independently by both a trained AHA and dietitian within 24 hours. The order of assessment was randomised, with the second assessor blind to the outcome of the initial SGA. Levels of agreement were examined using kappa and percent exact agreement (PEA; set a priori at ≥80%). Rater confidence after each assessment was assessed using a 10-point scale. Agreement for overall SGA ratings was high (kappa = 0.84; PEA 84.4%). PEA for individual sub-components of the SGA ranged from 66.4 to 86.7%. Where discrepancies were identified in global SGA ratings, AHAs provided a more severe rating of malnutrition than dietitians. AHAs reported significantly lower confidence than dietitians (t = 4.49, P < 0.001), although mean confidence for both groups was quite high (AHA=7.5, dietitians = 9.0). Trained AHAs completed the SGA with similar accuracy to dietitians. Using AHAs may help facilitate timely nutrition assessment in rural health services when a dietitian is not physically present. Further investigation is required to determine the benefits of incorporating this extended role into rural and remote health-care services.

Effects of nutritional intervention in head and neck cancer patients undergoing radiotherapy: A prospective randomized clinical trial.

Head and neck malignant tumors have numerous locations of the disease. After patients receive radiotherapy, their nutritional status is very poor, thus the curative effect is unsatisfactory. The aims of the present study were to investigate and analyze the nutritional status of patients with head and neck cancer undergoing radiotherapy (RT) in order to provide positive nutrition intervention for assisting the radiotherapy effect. A total of 40 patients with head and neck cancer were selected using a method of subjective global assessment (SGA) to assess nutritional status, including calorie intake and energy expenditure. In a randomized, controlled study, 20 patients received intensive dietary counseling and nutritional therapy (G1) and 20 received regular dietary as controls (G0) preradiotherapy and postradiotherapy. The primary endpoint was calorie intake and energy expenditure. The secondary endpoint was SGA rating with nutritional therapy. At the end of RT, energy intake showed a net increase in G1 (1,691±301 kcal) compared with that in G0 (1,066±312 kcal) (P<0.05); energy expenditure increased in G1 (1,673±279 kcal) compared with G0 (1,490±298 kcal) (P<0.05). The prevalence of severe malnutrition following radiotherapy was significantly different between the two study groups (10 patients in G0 and 4 patients in G1; P<0.05). The number of the normal malnutrition patients postRT in G0 decreased from 4 to 2 and conversely, in G1 it increased from 3 to 6 (P<0.05). In conclusion, patients with head and neck cancer were most malnutritioned, which impacted on clinical outcome. Timely nutritional intervention can effectively prevent weight loss and muscle wasting. Additionally, it may improve quality of life by decreasing the frequency of severe malnutrition.

APPETITE PREDICTS INTAKE AND NUTRITIONAL STATUS IN PATIENTS RECEIVING PERITONEAL DIALYSIS.

Sub-optimal nutrition status is common amongst patients receiving peritoneal dialysis (PD) and leads to poor clinical outcome. This population experiences multi-factorial challenges to achieving optimal nutritional status, particularly driven by inadequate intake. The aim of this investigation was to identify factors associated with inadequate protein intake and sub-optimal nutritional status in patients undergoing PD. This was a cross-sectional study of 67 adult patients receiving PD (mean age 59 ± 14 years; 57% male) within a single centre. Participants were consecutively recruited and interviewed by renal dietitians, collecting: Subjective Global Assessment (SGA); quality of life (using EQ-5D); dietary intake (via dietary interview); and appetite (using Appetite and Diet Assessment Tool). Participant demographics were obtained via survey or medical charts. Main outcome measures were inadequate dietary protein intake (<1.1 g/kg adjusted body weight/day) and malnutrition (as defined by SGA rating B or C). Overall, 15 (22%) patients were malnourished and 29 (43%) had inadequate protein intake. Poor appetite (anorexia) was reported in 62% (18/29) of participants with inadequate protein malnourished patients reported anorexia versus 12 (23%) of the well-nourished patients (p = 0.0001). Anorexia was a key risk factor for inadequate protein intake and malnutrition in patients undergoing PD. These findings highlight a need to closely monitor patients with appetite disturbances.

Assessment of Nutritional Status of Patients with Chronic Hepatitis C and HCV-Related Cirrhosis in the Compensated Stage

<i>Background and Aim:</i> Malnutrition is prevalent among patients with chronic liver disease. We aimed to assess the nutritional status of HCV-related compensated cirrhosis and chronic HCV-infected patients compared to healthy control subjects and to compare the different methods used for nutritional assessment namely the anthropometric measures and the Subjective Global Assessment (SGA). <i>Patients and Methods: </i> A total of 120 subjects were recruited. 40 patients with hepatitis C- related compensated liver cirrhosis in Group I, 40 patients with chronic hepatitis C in Group II and 40 age - and sex- matched healthy Egyptian volunteers in Group III. Thorough history taking, physical examination and detailed nutritional assessment were performed including a 24- hour dietary recall. Evaluation of nutritional status was done using different anthropometric measures and the Subjective Global Assessment (SGA). <i>Results: </i> Chronic HCV patients were found to have lower mean daily caloric intake (1858.70±630.2 Kcal/day) as compared to patients with compensated cirrhosis (1923.75±595.8 Kcal/day). The diagnosis of severely malnourished was detected with an increased frequency in the cirrhotic patients by the triceps skin fold thickness (TST) method (52.5%) as compared to mid-arm muscle circumference (MAMC) (30%) and the sub-scapular skin fold thickness (15%). In the chronic HCV patients, an increased frequency of diagnosis of malnutrition was detected by the MAMC% (57.5%) as compared to the other anthropometric indices. Based on the SGA rating, moderate degree of malnutrition was detected in 37.5% of cirrhotic patients and only 27.5% of chronic HCV patients, however, severe degree of malnutrition was not diagnosed in any of the subjects. The majority of the patients with compensated HCV related cirrhosis and chronic HCV group as well as controls were found to be overweight 67.5%, 62.5% and 62.5% respectively. There was a highly significant positive correlation between the BMI and the TST, MAC, MAMC, and sub-scapular skin fold thickness in the three studied groups. <i>Conclusion: </i> Overweight was prevalent among patients with chronic HCV and compensated cirrhosis. SGA underestimated the degree and prevalence of malnutrition as compared to TST, MAMC and sub-scapular skin fold thickness in the liver cirrhosis, chronic hepatitis C and healthy control groups.

Subjective global assessment and prealbumin levels of esophageal cancer patients undergoing concurrent chemoradiotherapy.

To evaluate the nutritional status of patients undergoing chemoradiotherapy for esophageal cancer using subjective global assessment (SGA) and association of prealbumin levels to nutritional status. A prospective study was performed on 154 patients with esophageal cancer who were treated with concurrent chemoradiotherapy at center of radiation oncology in Huai'an First People's Hospital from January 2012 to May 2013. The patients' nutritional status after receiving concurrent chemoradiotherapy were evaluated using SGA tool. Serum total protein, prealbumin, albumin and other biochemical nutrition parameters including triglyceride, total cholesterol, cholesterol and glucose were determined before beginning and after the end of radiotherapy. Malnutrition developed in 129 (83.8%) patients. According to SGA results, 16.2%, 66.2%, and 17.6% of patients were classified as A, B, or C, respectively. Loss of subcutaneous fat or muscle wasting (odds ratio [OR] 11.522); increased metabolic demand/ stress (OR 8.637); ankle, sacral edema, or ascites (OR 3.229) and weight loss ≥5% (OR 2.294) were significantly associated with malnutrition (SGA B or C; p < 0.001). Prealbumin level after the end of radiotherapy was significantly lower in patients with malnutrition (17 ± 5 g/ dl vs. 21 ± 5 g/dl, p = 0.005), but it showed no difference before beginning radiotherapy (24 ± 4 g/dl vs. 22 ± 5 g/ dl, p > 0.05). On the other hand, there was no significant difference in term of other nutrition parameters whether before beginning or after the end of radiotherapy (p > 0.05). The prevalence of malnutrition was high in esophageal cancer patients undergoing concurrent chemoradiotherapy. The results serve as a basis for implementation of nutrition intervention to patients being treated at radiotherapy departments. Prealbumin showed relation with SGA rating and should be considered as a sensitive nutritional biomarker for evaluating nutritional status of esophageal cancer patients undergoing concurrent chemoradiotherapy.

Role of Nutrition Impact Symptoms in Predicting Nutritional Status and Clinical Outcome in Hemodialysis Patients: A Potential Screening Tool

This study aims to establish the utility of the Nutrition Impact Symptoms (NIS), a part of the Patient-Generated Subjective Global Assessment (PG-SGA) as a nutritional screening tool in patients receiving hemodialysis (HD). This was a prospective observational study. The study took place in a single public tertiary in-center dialysis facility in Australia. Patients included 213 individuals receiving maintenance HD for at least 3 months who were older than 18 years of age (mean age, 58.9 ± 16.3 years; 55.4% [n = 118] male patients). Malnutrition, which was classified by the Subjective Global Assessment rating (SGA, B or C) and the nutrition-related clinical outcome (decline in weight [>5%], SGA, reduction in serum albumin [>5 g/L]), or 12-month mortality. Patients assessed as malnourished totaled 23.5% (n = 50). Total PG-SGA and NIS scores showed a comparable ability to predict malnutrition (area under the curve, 0.93 [95% confidence interval {CI}, 0.90-0.97] and 0.86 [95% CI, 0.80-0.93], respectively). NIS (score ≥2) was independently related to poor nutrition-related clinical outcome (odds ratio [OR], 3.03; 95% CI, 1.47-6.20) and mortality (OR, 1.11; 95% CI, 1.03-1.20) adjusted for age, dialysis vintage, serum albumin level, and comorbidities. NIS score is a promising nutritional screening tool for the identification of patients receiving hemodialysis who are at risk of malnutrition and poor clinical outcome. Further research is required to investigate the reliability and utility of this tool in a larger population group.

NUTRITION AND HEMODIALYSIS: THE ASSOCIATION OF DIETITIAN INTERVENTION TOWARDS ACHIEVING QUALITY PATIENT DIALYSIS OUTCOMES

The National Kidney Foundation has recognized nutritional interventions as building blocks of better dialysis outcomes. This study investigated the influence of Dietitian Intervention on mortality, adherence to dialysis prescriptions, and Quality Patient Dialysis Outcomes. The Subjective Global Assessment (SGA) tool was used to identify ratings and these ratings were associated to the tendency of risk towards mortality using a hazard ratio of 95% confidence interval in cox regression using SPSS v.19. Results revealed that respondents who marked significantly as C (1) in the Functional Capacity Items – Dysfunction ( sp =1.45) showed highest risk (17.5% risk) towards mortality. This implied that these individuals despite of Dietitian Interventions, mortality were increased related to co-morbidities. Respondents who had changes on eating habits in a typical breakfast, lunch, dinner compared from the last 6 months and those who, during physical examination, had ankle edema showed higher risk ( sp =1.40) towards mortality at 3.44%. Respondents who showed a B (2) on metabolic demand (stress) and those with muscle wasting (quadriceps, deltoids) showed a 2.14% mortality risk ( sp =1.37); lower than those with dysfunction. Results further indicated that respondents who have higher spKt/V ( sp =1.58) showed an SGA rating of A (3) and noted to have lowest risks towards mortality and other co-morbidities. Quality Dialysis Patient Outcomes Hazard Ratio (95% Confidence Interval) SGA Rating Correlation DESCRIPTION Indicators Sp Kt/V (<1.2 = >1.2) 1.58 0.87 STRONG Dysfunction 1.22 0.66 STRONG Changes of Eating Habits 1.36 0.72 STRONG Metabolic demand 1.36 0.78 STRONG In conclusion, an influence of Dietitian Intervention was notable to all patients receiving dialysis treatments. The Clinical Dietitian’s facility in assisting dialysis patients on the proper diet to be taken associated to condition will enable the individual to lower mortality risk ratio.

PREVALENCE OF COMPROMISED NUTRITIONAL STATUS IN HOSPITALISED PATIENTS WITH ACUTE AND CHRONIC RENAL FAILURE

Restrictive renal diet (low protein, low potassium, low phosphate and low salt) is frequently ordered for patients with acute and chronic renal failure. This is however not necessary for all renal patients, who are at risk of compromised nutrition. Nutritional status of 60 patients (35 males, 25 females; mean age: 67±17; mean BMI: 23.4±4.6 kg/m 2 ) with renal failure was assessed using the Subjective Global Assessment (SGA). 53%, 45% and 2% of patients were classified as well nourished, mild-moderately malnourished and severely malnourished respectively. SGA ratings had the strongest correlation with serum albumin (r=−0.226, p=0.082) compared with age (r=0.153, p=0.243), BMI (r=−0.204, p=0.139) and eGFR (r=−0.055, p=0.679). Patients with acute and chronic renal failure were equally likely to have compromised nutritional status. Similarly there was no difference in nutritional status between patients with and without dialysis (p=0.498). In conclusion, the prevalence of compromised nutritional status in hospitalized renal patients was high at 47%. Dietetic intervention is necessary to prevent further decline in nutritional status of this group of patients. Dietary restrictions should be personalized and based on biochemical profile.

Nutrition Assessment in Critically Ill Patients

The aim of this study was to assess whether subjective global assessment (SGA) is useful in identifying malnutrition and outcomes in the intensive care unit (ICU). After obtaining institutional approval, 124 consenting patients were enrolled in this study. Patients were evaluated at admission using clinical data, SGA, height, weight, triceps skinfold thickness (TSF), mid-arm circumference (MAC), Acute Physiology and Chronic Health Evaluation (APACHE II), and Simplified Acute Physiologic Score (SAPS). Patients were classified as well nourished, moderately malnourished, or severely malnourished with SGA. According to SGA, 62% (n = 77) of the patients were classified as well nourished, 26% (n = 33) as moderately malnourished, and 11% (n = 14) as severely malnourished. Body weight, body mass index (BMI), MAC, TSF, and mid-arm muscle circumference (MAMC) were lower, whereas APACHE II and SAPS II scores and mortality were higher in the malnourished groups compared with the well-nourished group. The SGA rating correlated significantly with age, body weight, percentage of weight loss, serum albumin level, APACHE II and SAPS II scores, and mortality. Anthropometrics data were correlated with SGA. Mortality rate was correlated with high APACHE II score, SAPS II score, days in the ICU and low BMI, MAMC, and serum albumin level. The results support that SGA is simple and may predict the patient's outcomes in the ICU.

Serum albumin concentration and clinical assessments of nutritional status in hospitalized older people: different sides of different coins?

Malnutrition is common in hospitalized older people, and some have advocated routine nutritional screening. Serum albumin and clinically based measures such as the Subjective Global Assessment (SGA) are two potential methods of assessing nutritional status in hospitalized older people. Although both measures are strongly associated with prognosis, it is not clear whether they measure similar or different clinical constructs. Our goal was to assess the degree of clinical concordance between these measures. Cross-sectional study. The inpatient medical service of a university teaching hospital. Three hundred eleven older (aged > or =70) patients. We independently measured serum albumin and performed the SGA on 311 older medical patients (aged > or =70) shortly after hospital admission. The SGA classified patients as well nourished, moderately malnourished (generally 5% weight loss with mild examination findings), or severely malnourished (generally >10% weight loss with marked findings) based on findings from a directed history and examination. We compared the distribution of clinical rating in patients with differing albumin levels and examined diagnostic test characteristics of albumin as a predictor of malnutrition as diagnosed on clinical examination. The mean age of subjects was 79.9; 64% were women, 42% were African American. Discordance between albumin and the SGA was common. For example, 38% of patients with albumin levels of 4.0 g/dL or higher were at least moderately malnourished on the SGA, whereas 28% of patients with albumin levels lower than 3.0 g/dL were rated as well nourished. No choice of albumin level was associated with simultaneously acceptable sensitivity and specificity as a predictor of SGA ratings. The area under the receiver operating characteristic curve for albumin level as a predictor of SGA rating was 0.58, suggesting that the ability of either measure to predict the other measure is only marginally better than chance. Albumin levels and clinical assessments, two possible measures of nutritional status in hospitalized older people, are often discordant. To some extent, this reflects limitations in both measures as markers of nutritional status. However, it also demonstrates that, in this population, albumin and clinical assessments of nutritional status reflect fundamentally different clinical processes.

What is Subjective Global Assessment?

Presented and described in detail is a clinical technique called subjective global assessment (SGA), which assesses nutritional status based on features of the, history and physical examination. Illustrative cases are presented. To clarify further the nature of the SGA, the method was applied before gastrointestinal surgery to 202 hospitalized patients. The primary aim of the study was to determine the extent to which our clinicians' SGA ratings were influenced by the individual clinical variables on which the clinicians were taught to base their assessments. Virtually all of these variables were significantly related to SGA class. Multivariate analysis showed that ratings were most affected by loss of subcutaneous tissue, muscle wasting, and weight loss. A high degree of interobserver agreement was found (kappa = 0.78, 95% confidence interval 0.624 to 0.944, p &lt; .001). We conclude that SGA can easily be taught to a variety of clinicians (residents, nurses), and that this technique is reproducible. (Journal of Parenteral and Enteral Nutrition 11:8–13, 1987)

Subjective Global Assessment Compared to Prognostic Nutritional Index in Cancer Patients

Malnutrition is a common problem in cancer patients and, if untreated, can lead to cancer cachexia and poor response to therapies. Subjective Global Assessment (SGA) has been shown to be valid and comparable with objective measures such as the Prognostic Nutritional Index (PNI) in general surgery patients. The purpose of this study was to determine the reproducibility of SGA ratings of gynecologic oncology patients between two raters, and to determine whether SGA was comparable to PNI as a tool for nutritional assessment of cancer patients. Sixty-seven consecutive patients admitted to the hospital gynecologic oncology service were assessed by a dietitian using PNI. Fifty-six of these patients were assessed using SGA by a second dietitian and a pharmacist who were blinded to medical records and the PNI results. Both PNI and SGA scores were categorized into severely and moderately malnourished or well-nourished. Reproducibility of SGA raters and the consistency between SGA versus PNI were assessed with a weighted Kappa statistic. There was a high level of agreement (83.9%) between the two SGA raters (weighted Kappa=0.797; 95% confidence intervals 0.67-0.92). In comparing SGA and PNI, there was less agreement (57%) (weighted Kappa=0.0435; 95% confidence intervals 0.28-0.59). There was moderate agreement between SGA and the individual variables of PNI: SGA vs. albumin (r=0.493), SGA vs. transferrin (r=0.353) and SGA vs. triceps skinfold (r=0.427). In summary, there was a high level of agreement between independent SGA raters, moderate agreement between SGA and PNI methods, and moderate agreement of SGA with individual PNI variables. For this heterogenous population, a combination of nutritional assessment methods may be preferred.

What is subjective global assessment of nutritional status?

Presented and described in detail is a clinical technique called subjective global assessment (SGA), which assesses nutritional status based on features of the history and physical examination. Illustrative cases are presented. To clarify further the nature of the SGA, the method was applied before gastrointestinal surgery to 202 hospitalized patients. The primary aim of the study was to determine the extent to which our clinician's SGA ratings were influenced by the individual clinical variables on which the clinicians were taught to base their assessments. Virtually all of these variables were significantly related to SGA class. Multivariate analysis showed that ratings were most affected by loss of subcutaneous tissue, muscle wasting, and weight loss. A high degree of interobserver agreement was found (kappa = 0.78, 95% confidence interval 0.624 to 0.944, p less than 0.001). We conclude that SGA can easily be taught to a variety of clinicians (residents, nurses), and that this technique is reproducible.