© 2023 Canadian Malnutrition Task Force
Subjective Global Nutrition Assessment (SGNA)
Subjective Global Nutrition Assessment (SGNA) is an abbreviated nutritional assessment and considered a gold standard for diagnosing pediatric malnutrition in hospitals. Dietitians or other trained professionals assess growth and weight change, food intake, functional status, and body composition. SGNA is a bedside method and takes approximately 15 minutes to complete.
When using the SGNA, the infant/child is classified according to a global score:
a) Well nourished, when the child is growing normally, with adequate food consumption and without gastrointestinal symptoms;
b) Moderately malnourished, when the patient shows signs of weight loss or loss of food consumption, functional capacity, and reduced muscle mass, demonstrating nutritional status impairment, when it was previously normal; and
c) Severely malnourished, when the child has progressive malnutrition, with weight loss, reduction of muscle and fat mass, and loss of food consumption.
When should SGNA be used?
Dietitians or other trained professionals should conduct SGNA within 24 hours of screening a hospital patient as ‘at risk’. SGNA should also be used when nutrition risk screening is not possible or necessary for some patients (e.g. language difficulties or receiving enteral or parenteral nutrition or recently transferred from critical care). In these cases, SGNA should be automatically completed to rule out malnutrition, preferably on the first day of admission. When developing your screening and assessment process for triaging patients, make sure that staff knows the process (i.e., automatic referral) and what to do for these patients who cannot be screened.
How do I triage patients using SGNA?
The SGNA score triages patients into normal, moderately malnourished or severely malnourished. Within P-INPAC, the routes of care for each level are:
a) Well nourished: Despite screening at nutrition risk, these patients do not require further advanced or specialized care.
b) Moderately malnourished: Advanced care and a more comprehensive nutrition assessment is required to determine cause of malnutrition, potential micronutrient deficiency, or other investigations that could change the treatment plan.
c) Severely malnourished: Patients should receive a more comprehensive assessment and specialized care.
1. Secker DJ, Jeejeebhoy KN. Subjective global nutritional assessment for children. Am J Clin Nutr. 2007;85:1083-9
2. Secker DJ, Jeejeebhoy KN. How to Perform Subjective Global Nutritional Assessment in Children J Acad Nutr Diet. 2012;112:424-431.
3. Minocha, P., Sitaraman, S., Choudhary, A. et al. Subjective Global Nutritional Assessment: A Reliable Screening Tool for Nutritional Assessment in Cerebral Palsy Children. Indian J Pediatr 85, 15–19 (2018).
4.Matsuyama, Misa ; Bell, Kristie ; White, Melinda ; Lawson, Karen ; David, Michael ; Doolan, Annabel ; Todd, Alwyn ; Nutritional Assessment and Status of Hospitalized Infants Journal of Pediatric Gastroenterology and Nutrition, Volume 65, Number 3, September 2017, pp. 338-342(5)
5.Bell, Kristie L. et al. The Pediatric Subjective Global Nutrition Assessment Classifies More Children With Cerebral Palsy as Malnourished Compared With Anthropometry Journal of the Academy of Nutrition and Dietetics(2020) Volume 120, Issue 11, 1893 – 1901
6.Agarwal, D . (2012). Usefulness of Subjective Global Assessment Tool in Assessing the Nutritional Status of Critically Ill Pediatrics . Journal of Pediatric Sciences , 4 (3) Retrieved from https://dergipark.org.tr/en/pub/jps/issue/19087/202204
7.Carniel MP, Santetti D, Andrade JS, Favero BP, Moschen T, Campos PA, et al. Validation of a subjective global assessment questionnaire for children and adolescents for use in Brazil. J Pediatr (Rio J). 2015. http://dx.doi.org/10.1016/ j.jped.2015.03.005
8. Wanelia Afonso, Wilza Peres, Nivaldo Pinho, Renata Martucci, Juliana Braga, Carolina Soares, Patricia Padilha, Pediatric Subjective Global Nutritional Assessment of Children with Cancer in Brazil: Preliminary Results of the Brazilian Survey on Oncological Nutrition in Pediatrics (P12-022-19), Current Developments in Nutrition, Volume 3, Issue Supplement_1, June 2019, nzz035.P12–022–19, https://doi.org/10.1093/cdn/nzz035.P12-022-19