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CLINICAL NUTRITION ASSESSMENT · DETSKY 1987 · KDOQI 2020

SGA Nutritional
Assessment.

Subjective Global Assessment: a validated, widely used bedside tool for assessing malnutrition. 7 structured components synthesise into Grade A (well-nourished), B (mild-moderate), or C (severe malnutrition).

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Detsky et al. 1987 · κ = 0.78
Recommended in KDOQI 2020 (dialysis)
ESPEN 2024 · GLIM Validated
7-Component Clinical Synthesis
SGA is a Clinical Synthesis Tool, Not Arithmetic Scoring. Rate each component below, then use your clinical judgment to synthesise the overall grade. Physical findings (fat/muscle loss) carry significant weight. This tool guides your assessment: the clinician always makes the final classification. Results are for trained clinicians only (dietitians, medical officers, trained nurses).

SGA Assessment Form

Rate all 7 components · Physical exam findings heavily weighted

PART A Medical History: 5 Components
Weight Change Most Heavily Weighted
Assess both 6-month overall loss AND recent 2-week trend
For personalised nutrition targets (kcal/day, g/day)
Auto-calculates % loss when both weights entered

6-month overall change:

Recent 2-week trend:

Dietary Intake Change
Current intake compared to usual; duration of change
Gastrointestinal Symptoms
Clinically significant only if present >2 weeks (except dysphagia: any duration)
Functional Capacity
How malnutrition affects daily activity and physical capacity
Disease & Metabolic Stress
Primary diagnosis and nutritional demand: affects energy/protein targets
PART B Physical Examination: 2 Components
Physical findings carry the greatest discriminatory weight in the final SGA grade. Severe wasting (3+) on physical exam can override the weight-loss criterion and yield SGA-C even with moderate weight loss (Detsky 1987).
Subcutaneous Fat Loss
Sites: triceps · chest (below clavicle) · orbital fat pads
Muscle Wasting
Sites: temporalis · deltoid · quadriceps · intercostals · scapula · calf
Oedema / Fluid Retention (modifier)
Can mask weight loss: documented but does NOT directly classify as SGA-C
Clinician Final Grade Override
Override the suggested grade if your clinical synthesis differs: SGA is always clinician-determined

Baker 1982 (NEJM) · Detsky 1987 (JPEN) · κ = 0.78 · KDOQI 2020

WHAT SGA ASSESSES

Weight Change6-month loss + 2-week trend
Dietary IntakeSolid food vs liquid vs starvation
GI Symptoms>2 weeks: nausea · vomiting · anorexia
Functional CapacityNormal → reduced → bedridden
Physical ExamFat loss + muscle wasting 0–3+
Evidence-based Care PlanESPEN 2024 · ASPEN targets

TRAINED DIETITIAN

Clinical Nutrition
Consultation

Our clinical dietitians will complete a comprehensive SGA with full anthropometry, biochemistry, and a personalised MNT plan for your patient.

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GUIDELINES THAT USE SGA

KDOQI 20207-point SGA recommended for adults on dialysis (1B)
ASPENListed among validated tools for diagnosing malnutrition
ESPENOne of several tools that may support assessment (2017)
GLIM 2019Most common comparison in GLIM validation studies
Indian evidenceCancer surgery, Tata Memorial (2005): SGA-C OR 5.27 for complications

VALIDATED POPULATIONS

General medicine & surgeryOriginal Detsky 1987 validation (n=202)
Chronic kidney diseaseModified 7-point SGA used in dialysis
Cirrhosis / hepatic diseaseStratifies mortality risk; SGA-C predicts decompensation
Chronic heart failureMalnutrition rate 38.8% by SGA
Indian cancer surgeryValidated 2004; SGA superior to BMI-only screening

Frequently Asked Questions: SGA Nutritional Assessment

What is the SGA (Subjective Global Assessment)?

The Subjective Global Assessment (SGA) is a validated bedside clinical nutrition screening and diagnostic tool developed by Detsky et al. (JPEN 1987). It synthesises 7 components (weight change, dietary intake, GI symptoms, functional capacity, metabolic stress, subcutaneous fat loss, and muscle wasting) into a final grade: SGA-A (well-nourished), SGA-B (mild-moderate malnutrition), or SGA-C (severe malnutrition). In the original study, two clinicians agreed on 91% of 109 patients (κ = 0.78).

Which guidelines recommend or use the SGA?
  • KDOQI 2020 (NKF and the Academy of Nutrition and Dietetics): recommends the 7-point SGA to assess nutritional status in adults on dialysis (grade 1B)
  • ASPEN: lists SGA among validated tools for diagnosing malnutrition in adults (2024 practice tool, alongside GLIM, MNA, PG-SGA and AAIM); this is not a graded recommendation
  • ESPEN: names SGA, PG-SGA and MNA as tools that may support nutritional assessment (definitions and terminology, 2017)
  • GLIM (2019, from ASPEN, ESPEN, FELANPE and PENSA): SGA is the comparison most often used in GLIM validation studies; agreement varies (κ about 0.2 to 0.8)
  • ICMR (India): the gastric cancer consensus (2014) lists SGA grade C as a sign of severe nutritional risk before surgery
  • Canada (INPAC): the Canadian Malnutrition Task Force care pathway completes SGA ideally within 24 hours of a positive nutrition screen
What does an SGA-C grade mean?

SGA-C indicates severe malnutrition. It requires same-day comprehensive dietitian assessment and urgent medical team notification. In Indian cancer surgery patients, SGA-C predicts an odds ratio of 5.27× higher postoperative adverse events (95% CI 1.35–20.51, p=0.016). Management includes 20–30 kcal/kg/day energy (20–25 for critical illness; 25–30 for general ward), 1.5–2.0 g protein/kg/day, NICE CG32 refeeding syndrome monitoring, and daily reassessment.

How is the final SGA grade determined?

SGA is a clinical synthesis, not an arithmetic score. Physical exam findings (subcutaneous fat loss and muscle wasting, graded 0–3+) carry the greatest discriminatory weight. Severe physical wasting (3+) can override the weight-loss criterion and yield SGA-C even with moderate weight loss (Detsky 1987). The final grade is always determined by the trained clinician.

How often should SGA be repeated?
  • SGA-A: every 7 days, or at any clinical change
  • SGA-B: every 3–5 days
  • SGA-C: daily until the patient is clinically stable
Who can use the SGA assessment tool?

SGA is a clinical diagnostic tool for use by trained clinicians only: registered dietitians, medical officers, and trained clinical nurses. It requires a 2-phase training programme (didactic + supervised practice with calibration) to achieve reliable interobserver agreement (κ = 0.78).

⚕️ Clinical Disclaimer: SGA is a diagnostic tool for trained clinicians (registered dietitians, medical officers, trained clinical nurses). This digital implementation guides structured assessment: the clinician always makes the final grade determination. SGA assesses protein-energy malnutrition only; supplement with micronutrient assessment, biochemical labs, and anthropometry for comprehensive MNT planning. Document SGA grade, date, assessor, contributing factors, and care plan initiated in the patient's medical record. Reassessment: SGA-A every 7 days; SGA-B every 3–5 days; SGA-C daily until stable. Interobserver kappa = 0.78 (Detsky 1987). For Indian patients, see ICMR/NIN guidelines; SGA-C is a stronger predictor than BMI in Indian populations with chronic energy deficiency.

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