Skip to main content
SpringerLink
Log in

Subjective Global Assessment (SGA) of Malnutrition

  • Reference work entry
  • First Online:
Handbook of Famine, Starvation, and Nutrient Deprivation

Abstract

Malnutrition is a highly prevalent and well-recognized problem in hospitalized as well as in general population but often goes unrecognized. Nutrition assessment is a comprehensive approach to define nutritional status using various methods. Subjective Global Assessment (SGA) is one of the most commonly used methods to assess nutritional status. SGA is a semiquantitative tool to assess nutritional status based on the history and physical examination. Data are scored subjectively and determine nutritional status in three major SGA categories as well nourished (A), mild to moderately malnourished (B), or severely malnourished (C). It is simple, noninvasive, inexpensive, and quickly executable and can be performed bedside by any skilled and trained health-care professional after brief training. It also agreeably goes with the objective methods of evaluating nutritional status. Various modified versions of SGA have been proposed since its conception to improve its precision. It helps in identifying malnutrition, predicting outcomes, and making appropriate recommendations in hospitalized patients as well as in general population.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 869.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 549.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ASPEN:

American Society for Parenteral and Enteral Nutrition

BIA:

Bioimpedance analysis

BMI:

Body mass index

CANUSA:

Canada-USA

CKD:

Chronic kidney disease

DEXA:

Dual energy X-ray absorptiometry

DMS:

Dialysis malnutrition score

ESPEN:

European Society for Clinical Nutrition and Metabolism

ESRD:

End-stage renal disease

KDOQI:

Kidney Disease Outcomes Quality Initiative

MIS:

Malnutrition-Inflammation Score

NKF:

National Kidney Foundation

NRI:

Hemodialysis

NRI:

Nutritional Risk Index

PD:

Peritoneal dialysis

PG-SGA:

Patient-Generated-Subjective Global Assessment

SGA:

Subjective Global Assessment

TIBC:

Total iron-binding capacity

References

  • Afsar B, Sezer S, Ozdemir FN et al (2006) Malnutrition-inflammation score is a useful tool in peritoneal dialysis subjects. Perit Dial Int 26:705–711

    Google Scholar 

  • Amaral T, Matos L, Teixeira M et al (2010) Undernutrition and associated factors among hospitalized patients. Clin Nutr 29:580–585

    Article  Google Scholar 

  • American Dietetic Association (1994) Identifying patients at risk: ADA’s definitions for nutrition screening and assessment. J Am Diet Assoc 94:838–839

    Article  Google Scholar 

  • Asgarani F, Mazdeh MM, Lessan-Pezeshki M et al (2004) Correlation between modified subjective global assessment with anthropometric measurements and laboratory parameters. Acta Med Iran 42(5):331–337

    Google Scholar 

  • Baker JP, Detsky AS, Wesson DE et al (1982a) Nutritional assessment: a comparison of clinical judgement and objective measurements. N Engl J Med 306:969–972

    Article  CAS  Google Scholar 

  • Baker JP, Detsky AS, Whitwell J et al (1982b) A comparison of the predictive value of nutritional assessment techniques. Human Nut Clin Nutr 36c:233–241

    Google Scholar 

  • Baldwin C, Weekes CE (2012) Dietary counselling with or without oral nutritional supplements in the management of malnourished patients: a systematic review and meta-analysis of randomised controlled trials. J Hum Nutr Diet 25:411–426

    Article  CAS  Google Scholar 

  • Barbosa-Silva MC, Barros AJ (2006) Indications and limitations of the use of subjective global assessment in clinical practice: an update. Curr Opin Clin Nutr Metab Care 9(3):263–269

    Article  Google Scholar 

  • Bauer JD, Capra S, Ferguson M (2002) Use of the scored Patient- Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 56:779–785

    Article  CAS  Google Scholar 

  • Bistrian BR, Blackburn GL, Hallowell E et al (1974) Protein status of general surgical patients. JAMA 230:858–860

    Article  CAS  Google Scholar 

  • Braunschweig C, Gomez S, Sheean PM (2000) Impact of declines in nutritional status on outcomes in adult patients hospitalized for more than 7 days. J Am Diet Assoc 100(11):1316–1322

    Article  CAS  Google Scholar 

  • Butterworth CE (1974) The skeleton in the hospital closet. Nutr Today 9:4–8

    Article  Google Scholar 

  • Campbell KL, Ash S, Bauer JD et al (2007a) Evaluation of nutrition assessment tools compared with body cell mass for the assessment of malnutrition in chronic kidney disease. J Ren Nutr 17:189–195

    Article  Google Scholar 

  • Campbell KL, Ash S, Bauer J et al (2007b) Critical review of nutrition assessment tools to measure malnutrition in chronic kidney disease. Nutr Diet 64(1):23–30

    Article  Google Scholar 

  • Christensson L, Unossons M, Ek AC (2003) Measurement of perceived health problems as a means of detecting elderly people at risk of malnutrition. J Nutr Health Aging 7:257–262

    CAS  Google Scholar 

  • Chung SH, Lindholm B, Lee HB (2000) Influence of initial nutritional status on continuous ambulatory peritoneal dialysis patient survival. Perit Dial Int 20:19–26

    CAS  Google Scholar 

  • Churchill DN, Taylor DW, Keshaviah PR (1996) Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 7:198–207

    Google Scholar 

  • Cooper BA, Bartlett LH, Aslani A et al (2002) Validity of subjective global assessment as a nutritional marker in end-stage renal disease. Am J Kidney Dis 40:126–132

    Article  Google Scholar 

  • Cupisti A, D’alessandro C, Morelli E et al (2004) Nutritional status and dietary manipulation in predialysis chronic renal failure patients. J Ren Nutr 14(3):127–133

    Article  Google Scholar 

  • Davis JP, Wong AA, Schluter PJ et al (2004) Impact of premorbid undernutrition on outcome in stroke patients. Stroke 35:1930–1935

    Article  Google Scholar 

  • de Mutsert R, Grootendorst DC, Boeschoten EW et al (2009) Subjective global assessment of nutritional status is strongly associated with mortality in chronic dialysis patients. Am J Clin Nutr 89:787–793

    Article  Google Scholar 

  • Detsky AS, Baker JP, Mendelson RA et al (1984) Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients: methodology and comparisons. JPEN J Parenter Enteral Nutr 8:153–159

    Article  CAS  Google Scholar 

  • Detsky AS, McLaughlin J, Baker JP et al (1987) What is subjective global assessment of nutritional status? J Parenter Enter Nutr 11(1):8–13

    Article  CAS  Google Scholar 

  • Elia M, Zellipour L, Stratton RJ (2005) To screen or not to screen for adult malnutrition? Clin Nutr 24(6):867–884

    Article  CAS  Google Scholar 

  • Enia G, Sicuso C, Alati G et al (1993) Subjective global assessment of nutrition in dialysis patients. Nephrol Dial Transplant 8:1094–1098

    CAS  Google Scholar 

  • Gibson R (1990) Principles of nutrition assessment, 2nd edn. Oxford University Press, New York

    Google Scholar 

  • Gupta D, Lammersfeld CA, Vashi PG et al (2005) Prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer. Eur J Clin Nutr 59(1):35–40

    Article  CAS  Google Scholar 

  • Heimburger O, Qureshi AR, Blaner WS et al (2000) Hand-grip muscle strength, lean body mass, and plasma proteins as markers of nutritional status in patients with chronic renal failure close to start of dialysis therapy. Am J Kidney Dis 36:1213–1225

    Article  CAS  Google Scholar 

  • Hirsch S, de Obaldia N, Petermann M et al (1991) Subjective global assessment of nutritional status: further validation. Nutrition 7:35–37

    CAS  Google Scholar 

  • Isenring E, Bauer J, Capra S (2003) The scored patient-generated subjective global assessment (PG-SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. Eur J Clin Nutr 57:305–309

    Article  CAS  Google Scholar 

  • Jeejeebhoy KN (2000) Nutritional assessment. Nutrition 16:585–590

    Article  CAS  Google Scholar 

  • Jensen GL, Bistrian B, Roubenoff R et al (2009) Malnutrition syndromes: a conundrum vs continuum. J Parenter Enter Nutr 33:710–716

    Article  Google Scholar 

  • K/DOQI, National Kidney Foundation (2000) Clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 35(6 Suppl 2):S1–S140

    Google Scholar 

  • Kalantar-Zadeh K, Kleiner M, Dunne E et al (1998) Total iron-binding capacity–estimated transferrin correlates with the nutritional subjective global assessment in hemodialysis patients. Am J Kidney Dis 31:263–267

    Article  CAS  Google Scholar 

  • Kalantar-Zadeh K, Kleiner M, Dunne E et al (1999) A modified quantitative subjective global assessment of nutrition for dialysis patients. Nephrol Dial Transplant 14:1732–1738

    Article  CAS  Google Scholar 

  • Kalantar-Zadeh K, Kopple JD, Block G et al (2001a) A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis 38:1251–1263

    Article  CAS  Google Scholar 

  • Kalantar-Zadeh K, Kopple JD, Block G et al (2001b) Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis. J Am Soc Nephrol 12:2797–2806

    CAS  Google Scholar 

  • Kalantar-Zadeh K, Kopple JD, Humphreys MH et al (2004a) Comparing outcome predictability of markers of malnutrition- inflammation complex syndrome in haemodialysis patients. Nephrol Dial Transplant 19:1507–1519

    Article  CAS  Google Scholar 

  • Kalantar-Zadeh K, Rodriguez RA, Humphreys MH (2004b) Association between serum ferritin and measures of inflammation, nutrition and iron in haemodialysis patients. Nephrol Dial Transplant 19:141–149

    Article  CAS  Google Scholar 

  • Kirkland LL, Kashiwagi DT, Brantley S et al (2013) Nutrition in the hospitalized patient. J Hosp Med 8(1):52–58

    Article  Google Scholar 

  • Kondrup J, Allison SP, Elia M et al (2003) Educational and Clinical Practice Committee, European Society for Clinical Nutrition and Metabolism (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr 22(4):415–421

    Article  CAS  Google Scholar 

  • Kyle UG, Pirlich M, Schuetz T et al (2003) Prevalence of malnutrition in 1760 patients at hospital admission: a controlled population study of body composition. Clin Nutr 22:473–481

    Article  CAS  Google Scholar 

  • Laky B, Janda M, Cleghorn G et al (2008) Comparison of different nutritional assessments and body-composition measurements in detecting malnutrition among gynecologic cancer patients. Am J Clin Nutr 87:1678–1685

    Article  CAS  Google Scholar 

  • Lim SL, Ong KC, Chan YH et al (2012) Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr 31(3):345–350

    Article  Google Scholar 

  • Lim SL, Lin XH et al (2016) Seven-point subjective global assessment is more time sensitive than conventional subjective global assessment in detecting nutrition changes. J Parenter Enter Nutr 40(7):966–972

    Article  Google Scholar 

  • McCann L (1996) Subjective global assessment as it pertains to the nutritional status of dialysis patients. Dial Transplant 25:190–202

    Google Scholar 

  • McCusker FX, Teehan BP, Thorpe KE et al (1996) How much peritoneal dialysis is required for the maintenance of a good nutritional state? Canada-USA (CANUSA) Peritoneal Dialysis Study Group. Kidney Int Suppl 56:S56–S61

    CAS  Google Scholar 

  • Mowe M, Bosaeus I, Rasmussen HH et al (2006) Nutritional routines and attitudes among doctors and nurses in Scandinavia: a questionnaire based survey. Clin Nutr 25(3):524–532

    Article  Google Scholar 

  • Ottery FD (1994) Rethinking nutritional support of the cancer patient: the new field of nutritional oncology. Semin Oncol 21:770–778

    CAS  Google Scholar 

  • Pifer TB, McCullough KP, Port FK et al (2002) Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS. Kidney Int 62:2238–2245

    Article  Google Scholar 

  • Prasad N, Gupta A, Sinha A et al (2007) Impact of nutritional status on peritonitis in CAPD patients. Perit Dial Int 27(1):42–47

    CAS  Google Scholar 

  • Prasad N, Gupta A, Sinha A et al (2008) Changes in nutritional status on follow-up of an incident cohort of continuous ambulatory peritoneal dialysis patients. J Ren Nutr 18:195–201

    Article  Google Scholar 

  • Prasad N, Gupta A, Sinha A et al (2010) Confounding effect of comorbidities and malnutrition on survival of peritoneal dialysis patients. J Ren Nutr 20:384–391

    Article  Google Scholar 

  • Raslan M, Gonzalez MC, Dias MCG et al (2010) Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients. Nutrition 26:721–726

    Article  Google Scholar 

  • Sacks GS, Dearman K, Replogle WH et al (2000) Use of subjective global assessment to identify nutrition-associated complications and death in geriatric long-term care facility residents. J Am Coll Nutr 19:570–577

    Article  CAS  Google Scholar 

  • Shirodkar M, Mohandas KM (2005) Subjective global assessment: a simple and reliable screening tool for malnutrition among Indians. Indian J Gastroenterol 24:246–250

    CAS  Google Scholar 

  • Sobotka L (ed) (2012) Basics in clinical nutrition, 4th edn. Galen, Prague

    Google Scholar 

  • Steiber A, Leon JB, Secker D et al (2007) Multicenter study of the validity and reliability of subjective global assessment in the hemodialysis population. J Ren Nutr 17:336–342

    Article  Google Scholar 

  • Stenvinkel P, Heimburger O, Paultre F et al (1999) Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int 55:1899–1911

    Article  CAS  Google Scholar 

  • Stephenson GR, Moretti EW, El Moalem H et al (2001) Malnutrition in liver transplant patients: preoperative subjective global assessment is predictive of outcome after liver transplantation. Transplantation 72:666–670

    Article  CAS  Google Scholar 

  • Sungurtekin H, Sungurtekin U, Balci C et al (2004) The influence of nutritional status on complications after major intraabdominal surgery. J Am Coll Nutr 23(3):227–232

    Article  Google Scholar 

  • Tappenden KA, Quatrara B, Parkhurst ML et al (2013) Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. J Parenter Enter Nutr 37:482–497

    Article  Google Scholar 

  • The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group (1991) Perioperative nutrition in surgical patients. N Engl J Med 325:525–532

    Article  Google Scholar 

  • Thoresen L, Fjeldstad I, Krogstad K et al (2002) Nutritional status of patients with advanced cancer: the value of using the subjective global assessment of nutritional status as a screening tool. Palliat Med 16:33–42

    Article  Google Scholar 

  • Ukleja A, Freeman KL, Gilbert K et al (2010) Standards for nutrition support: adult hospitalized patients. Nutr Clin Pract 25(4):403–414

    Article  Google Scholar 

  • Ulijaszeki S, Kerr D (1999) Anthropometric measurement error and the assessment of nutritional status. Br J Nutr 82:165–177

    Article  Google Scholar 

  • Visser R, Dekker FW, Boeschoten EW et al (1999) Reliability of the 7-point subjective global assessment scale in assessing nutritional status of dialysis patients. Adv Perit Dial 15:222–225

    CAS  Google Scholar 

  • Waitzberg DL, Caiffia WT, Correia MTD (2001) Hospital malnutrition: the Brazilian national survey (IBRANUTR): a study of 4000 patients. Nutrition 17:575–580

    Article  Google Scholar 

  • Weinsier RL, Hunker EM, Krumdieck CL et al (1979) Hospital malnutrition. A prospective evaluation of general medical patients during the course of hospitalization. Am J Clin Nutr 32:418–426

    Article  CAS  Google Scholar 

  • Wysynski DF, Perman M, Crivelli A (2003) Prevalence of hospital malnutrition in Argentina: preliminary results of a population-based study. Nutrition 19:115–119

    Article  Google Scholar 

  • Yang FL, Lee RP, Wang CH et al (2007) A cohort study of subjective global assessment and mortality in Taiwanese hemodialysis patients. Ren Fail 29(8):997–1001

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

    Narayan Prasad

  2. Department of Dietetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

    Archana Sinha

Authors
  1. Narayan Prasad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Archana Sinha
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Narayan Prasad .

Editor information

Editors and Affiliations

  1. Diabetes and Nutritional Sciences Research Division, Faculty of Life Science and Medicine, King’s College London, London, UK

    Victor R. Preedy

  2. School of Life Sciences, University of Westminster, London, UK

    Vinood B. Patel

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Prasad, N., Sinha, A. (2019). Subjective Global Assessment (SGA) of Malnutrition. In: Preedy, V., Patel, V. (eds) Handbook of Famine, Starvation, and Nutrient Deprivation. Springer, Cham. https://doi.org/10.1007/978-3-319-55387-0_116

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-55387-0_116

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-55386-3

  • Online ISBN: 978-3-319-55387-0

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation