Subjective Global

Assessment
Sukma Ihsan Rasyid
PPDS Ilmu Bedah FK ULM
Pendahuluan
Nutritional status is one of the important chains in patient
management.
affect the general state of health
healing from trauma or procedures
causing infection and healing of infection.
A state of malnutrition is found in nearly 30% of hospitalized patients
and is associated with clinical complications, increased morbidity and
mortality, length of stay, cost of care, and poor quality of life.
SGA One method to measure nutritional status and is quite
comprehensive
Nutrition Screening

≠
Nutrition Assessment
Better Practice…

Assessmen
Screening At risk
t
Nutrition Screening: What is it?
• A process to identify an individual who is:
 At risk of malnutrition (risk factors are present that
impair intake and/or increase the body’s needs for
nutrients and/or energy)
 Malnourished
 Likely to benefit from further nutrition assessment
and treatment

• It is a rapid and simple process conducted by admitting or

front line staff, typically a nurse not a nutrition professional.

A.S.P.E.N. 2010 / ADA EAL © 2012 / Chen et al. 2001 / ADA 2003 / ESPEN 2008 /
Reuben, 1995 /Mueller et al., 2011 / Kondrup et al., 2003 / Chen et al., 2001
Why screening is relevant…
• Malnutrition has negative consequences
• Treatment can improve malnutrition and
consequent health outcomes
• Malnutrition is prevalent enough that it makes
sense to screen
• Malnutrition is under-recognized outside of the
dietetic/nutrition professional community

Laur & Keller, 2017

(unpublished)
 Main considerations in selecting a
screening tool
• Easy • Implemented as part of
• Front-line personnel can a general work-up
use • Data readily available
• Uses existing personnel, • Appropriate for the
processes setting in which it is to
• Inexpensive to collect on be used
all clients • Specific to the
• On electronic medical population
chart
Subjective Global Assessment
(SGA)
• SGA is the gold standard for diagnosing
malnutrition in hospital.
• SGA predicts a variety of nutrition related
outcomes and this has been demonstrated in
several studies worldwide
• Trained professionals assess food intake,
functional status, and body composition.
Subjective Global Assessment:
Components
History: Changes in dietary intake
Gastrointestinal and other symptoms that impair food
intake/absorption
Functional capacity
Potential stress of disease and/or cachexia
Changes in weight over past 6 months
Trajectory of recent changes

Physical: Loss of subcutaneous fat: triceps, chest, trunk

Muscle wasting: deltoids, quadriceps, biceps, …
Edema: ankle, sacral, ascites; clarifies potential cause of
weight changes
Detsky et al.1987 JPEN
SGA
 7 point SGA
with Assesment
Example Chart
SGA A (Well Nourished)
• no decrease in food intake
• < 5% weight loss
• no/minimal symptoms affecting food intake
• no deficit in function
• no deficit in fat or muscle mass
OR
An individual with some criteria for SGA B or C but with recent adequate food
intake; non-fluid weight gain; significant recent improvement in symptoms
allowing adequate oral intake; significant recent improvement in function; and
chronic deficit in fat and muscle mass, but with recent clinical improvement in
function.
SGA B (Moderately
Malnourished)
• definite decrease in food intake
• 5% - 10% weight loss without stabilization or gain
• mild/some symptoms affecting food intake
• moderate functional deficit or recent deterioration
• mild/moderate loss of fat and/or muscle mass
OR
An individual meeting criteria for SGA C but with improvement
(but not adequate) of oral intake, recent stabilization of weight,
decrease in symptoms affecting oral intake, and stabilization of
functional status.
 SGA C (Severely Malnourished)
• severe deficit in food/nutrient intake
• > 10% weight loss which is ongoing
• significant symptoms affecting food/nutrient intake
• severe functional deficits

OR
Recent significant deterioration obvious signs of fat
and/or muscle loss.
Why should we use SGA?
An example from the Nutrition Care in Canadian Hospitals study

• SGA when adjusted for other covariates predicts

• Length of stay (Allard et al., JPEN 2015)
• As relevant as key predictors such as age, disease state for key
health outcomes (Allard et al., JPEN 2015)
• Only food intake and handgrip add to the predictive ability of SGA
for the outcomes of length of stay and readmission (Jeejeebhoy et al.,
AJCN 2015)

• Other objective indicators do not add to the predictive value of

SGA (Jeejeebhoy et al., AJCN 2015)
• SGA is the start of a comprehensive assessment, which will include
other indicators and investigations to determine micronutrient
malnutrition, cause of malnutrition etc.
Summary
• Malnutrition is prevalent in hospital and detection and
diagnosis are needed for treatment.
• Screening ensures malnourished patients are not
missed.
• Screening ≠ Assessment
• Screening should be followed by diagnosis and
treatment if malnutrition is present.
• SGA is the gold standard for diagnosing malnutrition in
hospital.