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How to Perform Subjective Global Nutritional Assessment in Children - 07/03/12

Doi : 10.1016/j.jada.2011.08.039 
Donna J. Secker, PhD, RD, FDC , Khursheed N. Jeejeebhoy, PhD, MBBS, FRCPC

Address correspondence to: Donna J. Secker, PhD, RD, FDC

Abstract

Subjective Global Assessment (SGA) is a method for evaluating nutritional status based on a practitioner's clinical judgment rather than objective, quantitative measurements. Encompassing historical, symptomatic, and physical parameters, SGA aims to identify an individual's initial nutrition state and consider the interplay of factors influencing the progression or regression of nutrition abnormalities. SGA has been widely used for more than 25 years to assess the nutritional status of adults in both clinical and research settings. Perceiving multiple benefits of its use in children, we recently adapted and validated the SGA tool for use in a pediatric population, demonstrating its ability to identify the nutritional status of children undergoing surgery and their risk of developing nutrition-associated complications postoperatively. Objective measures of nutritional status, on the other hand, showed no association with outcomes. The purpose of this article is to describe in detail the methods used in conducting nutrition-focused physical examinations and the medical history components of a pediatric Subjective Global Nutritional Assessment tool. Guidelines are given for performing and interpreting physical examinations that look for evidence of loss of subcutaneous fat, muscle wasting, and/or edema in children of different ages. Age-related questionnaires are offered to guide history taking and the rating of growth, weight changes, dietary intake, gastrointestinal symptoms, functional capacity, and any metabolic stress. Finally, the associated rating form is provided, along with direction for how to consider all components of a physical exam and history in the context of each other, to assign an overall rating of normal/well nourished, moderate malnutrition, or severe malnutrition. With this information, interested health professionals will be able to perform Subjective Global Nutritional Assessment to determine a global rating of nutritional status for infants, children, and adolescents, and use this rating to guide decision making about what nutrition-related attention is necessary. Dietetics practitioners and other clinicians are encouraged to incorporate physical examination for signs of protein-energy depletion when assessing the nutritional status of children.

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Keywords : Malnutrition, Pediatric nutritional assessment, Subjective Global Assessment (SGA), Physical examination


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 Statement of Potential Conflict of Interest: No potential conflict of interest was reported by the authors.
 Funding/Support: Funding for this research was provided by The Canadian Foundation for Dietetic Research. Doctoral fellowships for Dr Secker were provided by the Canadian Institutes of Health Research Doctoral Research Award, the Canadian Institutes of Health Research Clinician Scientist Training Program in Clinical Nutrition, and The Hospital for Sick Children Research Institute Research Training Centre (Restracomp).


© 2012  Academy of Nutrition and Dietetics. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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