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Subjective Global Nutritional Assessment for children^1,2,3

¹ From the Department of Clinical Dietetics and Division of Nephrology, The Hospital for Sick Children, Toronto, Canada (DJS), and the Division of Gastroenterology, St Michael's Hospital and the Institute of Medical Sciences, University of Toronto, Toronto, Canada (KNJ)

Background:Subjective Global Assessment (SGA), a method of nutritional assessment based on clinical judgment, has been widely used to assess the nutritional status of adults for both clinical and research purposes.

Objective:Foreseeing benefits of its use in children, we chose to adapt SGA and test its validity and reproducibility in the pediatric population.

Design:We prospectively evaluated the preoperative nutritional status of 175 children (aged 31 d to 17.9 y) having major thoracic or abdominal surgery with the use of Subjective Global Nutritional Assessment (SGNA) and commonly used objective measurements. Each child underwent nutritional assessment by 2 independent assessors, one performing measurements of anthropometrics and handgrip strength and one performing SGNA. To test interrater reproducibility, 78 children had SGNA performed by a third assessor. Occurrence of nutrition-associated complications was documented for 30 d postoperatively.

Results:SGNA successfully divided children into 3 groups (well nourished, moderately malnourished, severely malnourished) with different mean values for various anthropometric and biochemical measures (P < 0.05). Malnourished children had higher rates of infectious complications than did well-nourished children (P = 0.042). Postoperative length of stay was longer for malnourished children (8.2 ± 10 d) than for well-nourished children (5.3 ± 5.4 d) (P = 0.002). No objective nutritional measures showed association with outcomes, with the exception of serum albumin, which was not clinically predictive because mean concentrations were in the normal range irrespective of the presence or absence of complications.

Conclusion:SGNA is a valid tool for assessing nutritional status in children and identifying those at higher risk of nutrition-associated complications and prolonged hospitalizations.

Key Words: Malnutrition • children • surgery • nutritional assessment • Subjective Global Assessment • SGA • outcomes

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