Date post: | 22-Dec-2014 |
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Validation of Subjective Global Assessment (SGA) in assessing malnutrition among surgical patients upon
hospital admission at Hospital Tuanku Jaafar,
Seremban.
Chong Li Chin Dept of Nutrition & Dietetics, IMU Bukit Jalil, Kuala Lumpur
Malnutrition in Hospital
50 – 55% of patients have low calorie intake, low BMI and MAMC.
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Tai ML, Goh KL, Siti Hawa MT, Sanjay R, Sanjiv M. Anthropometric, biochemical and clinical assessment of malnutrition in Malaysian patients with advanced cirrhosis. Mal J Nutr 2010;9:27 Sakinah H, Suzana S, Noor Aini MY, et al. The magnitude of malnutrition among hospitalized elderly patients in University Malaya Medical Centre.Health and the Envitonmental Journal,2010;1(2): 64-72
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Malnutrition: Causes and consequences
Increased requirements
Loss of ability to eat
Poor nutrient absorption
Malnutrition
Deficiency in dietary intake
Nutrient losses
Loss of appetite
Weight loss
Low energy
Reduced independence
Infections
Confusion
Increased morbidity and mortality
Increased risk of hospital admissions
Muscle wasting
Nutrition Screening
Nutrition screening is important to identify patients at risk of malnutrition.
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Available tools:
NRS 2002
MST
MUST
SGA
Research objective
To validate the use of Subjective Global Assessment (SGA) (Detsky et al. 1987) in detecting malnutrition amongst surgical patients upon admission.
Validation by comparison with objective measurements of
anthropometric
biochemical
Data collection & analysis
INTERVIEW
MEDICAL RECORDS
ANTHROPOMETRIC MEASUREMENTS
i. SES Questionnaire ii. Assessment tool: SGA iii. Diet intake within a week prior to admission
i. Biochemical profile
i. Height and weight ii. Body mass index (BMI) iii. Triceps skinfold (TSF) iv. Mid arm circumference (MAC) v. Corrected mid arm muscle area (cAMA)
STATISTICAL ANAYLISIS i. Sensitivity, specificity and PPV, NPV of each
screening tool
PATIENTS WITHIN 72 HOURS OF
ADMISSION
Validation of SGA tools
Sensitivity % of malnourished patients correctly identified
% of healthy individuals correctly not identified as malnourished
Specificity
Probability of patients with positive test are correctly diagnosed as malnourished
PPV
Probability of patients with negative test are correctly diagnosed as non-malnourished
NPV
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RESULTS
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Male Female p value
n=43 n=62
Weight (kg) 65.1 ± 15.2 58.8 ± 14.3 0.033
Height (cm) 164.9 ± 8.0 156.9 ± 6.3 0.000
BMI (kg/m2) 24.0 ± 5.0 24.0 ± 5.5 0.992
MAC (cm) 29.1 ± 5.4 27.3 ± 5.2 0.087
TSF (mm) 14.6 ± 6.4 20.6 ± 9.7 0.001
cAMA (cm2) 37.1 ± 16.8 29.2 ± 11.9 0.006
Baseline Characteristics
n=11 n=19
Sr. Albumin (g/L) 28.6±6.6 28.3 ±6.9 0.899
SGA score
B and C (Malnourished)
BMI <18.5 kg/m2 (n=105)
Sensitivity (%) 100
Specificity (%) 49
Positive predictive value 0.3
Negative predictive value 1.0
Validation of SGA against BMI
SGA score
B and C (Malnourished)
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MAC ≤ 15th percentile (n=105)
Sensitivity (%) 100
Specificity (%) 47
Positive predictive value 0.2
Negative predictive value 1.0
TSF ≤ 15th percentile (n=105)
Sensitivity (%) 100
Specificity (%) 52
Positive predictive value 0.3
Negative predictive value 1.0
Validation of SGA against MAC and TSF
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SGA score
B and C (Malnourished)
cAMA ≤ 15th percentile (n=105)
Sensitivity (%) 65
Specificity (%) 48
Positive predictive value (%) 0.5
Negative predictive value (%) 0.6
Albumin <35 g/L (n=30)
Sensitivity (%) 64
Specificity (%) 100
Positive predictive value 1
Negative predictive value 0.2
C
Validation of SGA against cAMA and Serum Alb
C
0
10
20
30
40
50
60
70
All, n=105 Male, n=43 Female, n=62
41.9
51.2
35.5
58.1 48.8
64.5
Pe
rce
nta
ge (
%)
Patients
Well- nourished
Malnourished
Malnutrition Rate
Conclusion
SGA showed a high sensitivity when compared against objective anthropometry measurements. SGA showed good specificity compared against serum albumin.
SGA is a valid tool for malnutrition screening amongst surgical patients in Hospital Tuanku Jaafar
Acknowledgement
International Medical University for funding
Prof Winnie Chee, Thesis Supervisor, IMU
Pn Basmawati Bt Baharom, Hospital Tuanku Jaafar
Pn Amirozlin Bt. Amsar, Hospital Tuanku Jaafar
Ms. Chee Li Jiun, 4th year student, IMU
Ms. Lee Li Ting, 4th year student, IMU
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