Newsletter

[ Vol. 10 No. 3 ] (September - December 2009 )
Bedside clinical assessment - subjective global assessment

Khursheed Jeejeebhoy¹, Marianna Sioson², Maria Chan^3
1Gastroenterology Division, St Michael’s Hospital, Toronto, Ontario, Canada
²St Luke’s Medical Center, Quezon City, Philippines
³Department of Nutrition & Dietetics, The St George Hospital, New South Wales, Australia

A clinical method for evaluating nutritional status, termed subjective global assessment (SGA), encompasses historical, symptomatic, and physical parameters. The history used in the SGA focuses on five areas. The percentage of body weight lost in the previous 6 months. The pattern of loss is also important and it is possible for a patient to have significant weight loss but still be considered well nourished if body weight (without edema or ascites) recently increased. For example, a patient who has had a 10% body weight loss but regained 3% of that weight over the past month, would be considered well nourished. Dietary intake is classified as normal or abnormal as judged by a change in intake and whether the current diet is nutritionally adequate. The presence of persistent gastrointestinal symptoms, such as anorexia, nausea, vomiting, diarrhea, and abdominal pain, which have occurred almost daily for at least 2 weeks, is recorded. The patient’s functional capacity is defined as bedridden, suboptimally active, or full capacity. The last feature of the history concerns the metabolic demands of the patient’s underlying disease state. Examples of high stress illnesses are burns, major trauma and severe inflammation, such as acute colitis. Moderate stress diseases might be a mild infection or limited malignant tumor.

The features of the physical examination are noted as normal, mild, moderate, or severe alterations. They are:

• Loss of subcutaneous fat measured in the triceps region and the midaxillary line at the level of the lower ribs.
• Muscle wasting in the temporal areas and in the deltoids and quadriceps, as determined by loss of bulk and tone detectable by palpation.
• The presence of edema in the ankle and sacral regions and the presence of ascites are noted
• Mucosal and cutaneous lesions are recorded, as are color and appearance of the patient’s hair.

The findings of the history and physical examination are used to categorize patients as being well nourished (category A), having moderate or suspected malnutrition (category B), or having severe malnutrition (category C). The rank is assigned on the basis of subjective weighting, Baker et al. and Detsky el al. found that the use of SGA in evaluating hospitalized patients gives reproducible results and there was more than 80% agreement when two blinded observers assessed the same patient,

1. Baker, J.P., Detsky, A.S., Wesson, D.E., Wolman, S.L, Stewart, S., Whitwell, J., Langer, B., and Jeejeebhoy, K.N. Nutritional assessment: a comparison of clinical judgment and objective measurements. N Engl J Med 306:969, 1982
2. Detsky, A.S., McLaughlin, J.R., Baker, J.P., Johnston, N., Whittaker, S., Mendelson, R.A., and Jeejeebhoy, K.N. What is subjective global assessment of nutritional status? JPEN 11:8, 1987.

From   
PENSA 2009
“Energizing Nutrition Support Practice for Life”
June 5-7 2009, Shangri-La Hotel, Kuala Lumpur, Malaysia 
Page: 33