Conducting a Nutritional Assessment
The Importance of Early Diagnosis in Effective Nutrition Management
To counteract malnutrition and its consequences in patients, timely identification of impaired nutritional status and rapid initiation of effective treatment are crucial. Once nutritional risk screening has indicated the patient is at risk, a more in-depth evaluation of the causes of disease-related malnutrition and the risk factors for nutrition and fluid deficiency should be conducted.
Nutritional assessment is critical to fully understand the patient’s condition, thus allowing for the development of a specific nutrition care plan. Nutritional assessment has been defined as “a comprehensive approach to determining nutritional status using medical, nutritional, and medication histories; physical examination, anthropometric measurements and laboratory data.”1,2,3
Relevant assessment parameters, which should be evaluated in detail, include disease and treatment-related risk factors such as nausea, dehydration, diarrhea, acute infections; social and psycho-social risk factors such as depression and social isolation; and nutrition-related risk factors such as allergies and restrictive diets. Biochemical parameters are also useful, objective, and readily available to assess nutritional status and nutritional risk.4
Subjective Global Assessment
Subjective Global Assessment (SGA) is a nutritional assessment tool to identify patients with malnutrition, or who are at risk of malnutrition. SGA considers not only alterations in body composition, but also changes in physiological function. The non-invasive assessment is suitable to be used in a wide variety of health care settings. Screening procedures are easy to learn, and it is highly efficient and cost effective as it requires no blood draws or laboratory tests.5
SGA criteria take into account the following patient factors:6
- Weight loss
- Dietary intake
- GI symptoms
- Functional capacity
- Disease-related effects
- Physical signs of malnutrition (loss of subcutaneous fat or muscle mass, edema, ascites)
If a patient receives an SGA “A” rating, he is considered well nourished. An SGA “B” rating indicates a moderately malnourished patient. And an SGA “C” rating indicates a severely malnourished patient.
Finally, nutritional intake should be assessed and, in the event intake is low/not sufficient, nutritional therapy should be offered.
- 1. No authors listed. Identifying patients at risk: ADA's definitions for nutrition screening and nutrition assessment. Council on Practice (COP) Quality Management Committee. J Am Diet Assoc 1994;94:838-839.
- 2. Thomas B, Bishop J (Eds). Manual of Dietetic Practice 4th ed. Oxford: Wiley Blackwell 2007.
- 3. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health 2011;8(2):514-527.
- 4. Schutz Y. Assessment of Nutritional Status. In: Biesalski HK, Fürst P, Kasper H et al., editors. Nutritional Medicine. Stuttgart: Thieme 2004:19-27.
- 5. Keith JN. Bedside nutrition assessment past, present, and future: a review of the Subjective Global Assessment. Nutr Clin Pract 2008;23(4):410-416.
- 6. Detsky AS, McLaughlin JR, Baker JP et al. What is subjective global assessment of nutritional status? JPEN 1987;11(1):8-13.