The document discusses the benefits of subjective global assessment (SGA) for nutritional assessment. SGA uses both subjective and physical factors to evaluate a patient's nutritional status. It is easy to use, cost-effective, reproducible, and able to predict nutritional risk. Studies have found SGA to be highly specific, sensitive, predictive, and valid. SGA involves evaluating a patient's medical history, dietary intake, gastrointestinal symptoms, and physical exam looking at factors like weight loss, muscle wasting, and edema to determine if a patient is well-nourished, moderately malnourished, or severely malnourished. SGA provides a reliable method for assessing nutritional status in hospitalized patients.

1. Benefits of
Subjective Global Assessment
A new dimension in clinical nutrition
DR. Atta ur Rehman

2. Objective
 Demonstrate
benefits of
subjective
parameters for
nutritional
assessment

3. To be useful nutritional assessment tool
needs to meet the following criteria:
 easy to use,
 cost-effective
 reproducible
 able to predict the risk
 little interobserver variability

4. The SGA of nutritional status was
developed during the 1980s and has
been validated as a tool for triaging
patients in terms of their nutritional risk
and need for aggressive nutritional
support.
Ottery et al supplement to nutrition 1996

5. Broad Geographic
Coverage
 The American Dietetic Association, ASPEN
and ESPEN recommend the use of
SUBJECTIVE GLOBAL ASSESSMENT in
clinical settings.
 Being used in Europe, USA and Asia –pacific
region.

6. SUBJECTIVE GLOBAL
ASSESSMENT
 Specificity(82%)
 Sensitive(98-100%)
Bauer et al Eur.J.Cl.Nut (2002)
Mourao et al Nut.Hosp (2004)

7. High Predictive value for post-
operative infections
Reproducible technique
Predictive and valid
Reliable method of assessing
nutritional status of hospitalized
patients
(Detsky JPEN 1987)

8. What is Subjective Global
Assessment?
History
Physical Examination
SGA Rating
Detsky et al JPEN 1987
ADA Manual of Clinical Dietetics (2000)

9. What is Subjective Global
Assessment?
A.History
1.Weight Change
2.Dietary Intake Change
3.Gastrointestinal Symptoms
4.Functional Capacity
5.Disease Stress

10. What is Subjective Global
Assessment?
B.Physical Examination
1.Loss of subcutaneous fats
2.Muscle wasting
3.Ankle Edema
4.Sacral Edema
5.Ascites

11. What is Subjective Global
Assessment?
C.SGA Rating
______A=Well nourished
______B=Moderately Malnourished
______C=Severely Malnourished

12. SGA Strengths
 Reproducibility
 Sensitivity
 Specificity
 Validity
 Reliability
 Predictivity
 Flexibility

13. How to do SGA Rating?
Well-nourished
No wt Loss
Good Intake
No GI Symptoms
No edema,ascites

14. How to do SGA Rating?
Moderately(Grade B) or suspected to be
malnourished

15. How to do SGA Rating?
Pt who exhibited more of the features
I.e. Wt loss,
Low intake,
significant GI sysmptoms,
poor functional capacity,
loss of muscles,
loss of fats,edema,ascites etc.

16. How to do SGA Rating?
5%wt loss in few weeks prior to
admission without stabilization or
weight gain
Definite reduction in dietary intake
Mild subcutaneous tissue loss

17. How to do SGA Rating?
 Grade-C;In order to receive a C rank,the
patient had to demonstrate obvious physical
signs of malnutrition(severe loss of
subcutaneous tissue,muscle wasting,and
often some edema) in presence of a clear and
convincing pattern of ongoing weight loss.
 Net loss of at least 10% of the normal wt.

18. Thank you