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1. Nutritional Assessment
Surgical Nutrition Workshop
IKABDI – KALBE FARMA
Surabaya, Dec. 17.2016
Materi TNT Course

2. Nutritional Assessment
• Collect and evaluate clinical conditions,
diet, body composition and biochemical
data, among others
• Classify patients by nutritional state :
well-nourished or malnourished

3. Nutritional Assessment
Common Objectives
Identify at-risk patients to reduce :
• Complications
• Treatment failures
• Physiological problems
• Health care costs

4. Nutritional Assessment
• Subjective Global Assessment
- Clinical Assessment
• Anthropometric Measurement
- BW - BMI
- TSF - MAC
• Biochemical data

5. Nutritional Assessment :
Body Composition Parameter
• Weight and Height
• BMI = Weight / Height2
• Triceps or subcapsular thickness of skin
fold
• Mid-arm muscle circumference and mid-
arm muscle area

6. Nutritional Assessment :
Biochemical Parameters
At Risk Level
• Serum Albumin < 3.5 g/dL
• Total lymphocyte count < 1500 cell/mm3
• Serum transferrin < 140 mg/dL
• Serum pre-albumin < 17 mg/dL
• Total iron-binding
capacity
< 250 mcg/dL
• Serum cholesterol < 150 mg/dL

7. Subjective Global Assessment
1. Weight changes
2. Changes in dietary intake
3. Gastrointestinal symptoms
4. Functional capacity
5. Link between disease and nutritional
requirements
6. Physical exam focused on nutritional aspects

8. SGA :
1. Weight Changes
• Over the last six months
• During the past two weeks

9. SGA :
2. Dietary intake
• No change
• Change
- Duration
- Type :
* Inadequate conventional diet
* Total liquid diet
* Clear liquid diet (hypocaloric)
* Fasting

10. SGA :
3. Gastrointestinal symptoms
• Nausea
• Vomiting
• Diarrhea
• Anorexia

11. SGA :
4. Functional capacity
• Dysfuction
–Duration
–Type :
• Ambulatory
• Bedridden

12. SGA :
6. Physical Exam
• chewing / swallowing
problems
• muscle wasting • angular stomatitis
• ankle edema • fractures or bone pain
• sacral edema • glossitis
• ascites • skin alteration
• loss of subcutaneous fat

13. Subjective Global Assessment :
Diagnosis
• Well nourished
• Moderately malnourished or suspected manutrition
• Severely malnourished

14. NUTRITIONAL
STATUS
WEIGHT
LOSS
DIETARY
INTAKE
PHYSICAL
PHYSIOLOGIC
FUNCTION
FAT LOSS
MUSCLE
WASTING
A < 5 % N ± ± NORMAL
B 5-10 %  + + NORMAL
C > 10 % 
+++
EDEMA
+++ ABNORMAL
SUBJECTIVE GLOBAL ASSESSMENT

16. Nutritional Assessment
Body Mass Index
• BMI = BW (kg)
H2 (m2)
• BW = Body weight
• H = Height

17. Nutritional Assessment
Body Mass Index ( WHO 1997)
• < 18,5 : Underweight
• 18.5 – 24,9 : Normal weight
• 25.0 – 29,9 : Obesity
• 30 – 34,9 : Class I Obesity
• 35.0 – 39,9 : Class II Obesity
• > 40,0 : Class III Obesity

18. Nutritional Assessment
Weight Loss :
• ≤ 10 % : Mild
• 10 – 20 % : Moderate
• ≥ 20 % : Severe
Chest, 1999, 115 ; 5:

19. Nutritional Assessment
Severely Malnourished :
• > 10 % Weight Loss
• Albumin Level < 2.5 g/dL
Chest, 1999, 115 ; 5:

20. ESPEN Working Groups
Risk of Severe Undernutrition
One of the following criteria :
• Weight loss > 10 – 15 % within 6 months
• BMI < 18 Kg/m2
• SGA , Grade C
• Serum Albumin < 30 g/L (with no hepatic/renal
dysfunction)
Braga et al, Clin. Nutr. 2009, 28, 378 -86

21. Summary
• Defined nutritional assessment
• Described techniques for assessing nutritional status
• Explanation of the Subjective Global Assessment