Update to the pediatric Subjective Global Nutritional Assessment (SGNA)

Abstract

Lack of a standardized method of identifying and defining pediatric malnutrition has led to an inability to fully understand the prevalence of and impact that malnutrition has on pediatric patients and the healthcare system. The Subjective Global Nutritional Assessment (SGNA) is an assessment tool meant to determine presence and severity of malnutrition in pediatric populations. However, the anthropometric section of the tool contains some out-dated parameters. This has limited its clinical practicality. The aim of this paper is to propose updates to the anthropometrics section of the SGNA. A retrospective analysis of 153 SGNA's performed on children aged 1 month to 16 years was completed, comparing the original SGNA results to SGNA results incorporating updated anthropometric parameters for percentiles and ideal body weight. The category of length/height for age was updated to include z score cutoffs rather than percentiles, and ideal body weight was updated to z scores for weight for length or body mass index (BMI). Two serial growth questions were updated in wording only, to reflect z score trends. The results of the analysis showed these updates would have changed the rankings of eight patients (5%) for length/height for age, and 20 patients (13%) for ideal body weight to weight for length or BMI.Adjustments to these questions did not impact the overall SGNA rating. This study shows updates to the SGNA are not expected to have a significant impact on the validity of the tool and has the potential to improve its applicability to current day practice.

Completion of a Nutrition‐Focused Physical Exam with hospitalized adults and pediatric patients: Secondary analysis of a prospective cohort study

“…3 An NFPE to evaluate a patient for malnutrition includes assessment of subcutaneous fat and muscle, fluid status, functional status, and altered micronutrient status, along with mid-upper arm circumference (MUAC) in children. 1,2 Evaluation of subcutaneous fat and muscle loss, functional status, and edema is currently included as part of the malnutrition tools often used in the hospital setting, such as the pediatric STRONGkids tool, 5 the Pediatric Subjective Global Nutritional Assessment, 6,7 the adult Subjective Global Assessment (SGA), 8 Patient-Generated SGA, 9 and the Academy of Nutrition and Dietetics (Academy) and American Society for Parenteral and Enteral Nutrition Indicators to diagnose Malnutrition (AAIM). 10 In recognition of its utility in patient care, NFPE competency has been highlighted in the Standards of Practice/Standards of Professional Performance for registered dietitian nutritionists (RDNs) since 2012 [11][12][13] and in US dietetic education and training standards since 2017.…”