Subjective global assessment of nutrition a useful diagnostic tool for nurses?

Malnutrition in maintenance haemodialysis (HD) patients is closely related with morbidity and mortality in this population.

To evaluate feasibility, performance and information given by SGA (subjective global assessment), a semi-quantitative method of nutritional evaluation (based on a medical questionnaire and a simple clinical examination) carried out by a group of 12 nurses.

In March 1999, a feasibility study was organised to evaluate 9 patients during HD. Since July 1999, a nutritional evaluation of all the patients meeting the required parameters (e.g. duration of HD > 6 months, day sessions) has been set up every 4 months.

In March 1999, preliminary results demonstrated an average learning time per SGA of 15'. In July 1999, 32 patients were evaluated, albuminemia (micromol/l) and pre-albuminemia (g/l) were analysed according to the SGA classification (A = good nutrition, B= light to moderate malnutrition, C= severe malnutrition). The albuminemia and the prealbuminemia of patients A (respectively 541+/-45 and 0.37+/-0.10) were higher than those of patients B (482+/-41 and 0.31+/-0.01), and those of patients C (381+/-54 and 0.19+/-0.1), by variance analysis (p < 0.0001). The information drawn from the SGA reveal a severe malnutrition, a light to moderate malnutrition, and good nutrition in respectively 13%, 63% and 25% of the patients, and a noticeable muscular atrophy (moderate to severe) in 43% of cases. Anorexia and major gastro-intestinal symptom (nausea, vomiting, and diarrhoea) are found in 14% of cases.

Beside traditional methods of screening and evaluation of malnutrition in HD patients, the use of SGA by a nursing team uncovers useful information on nutritional status of patients, especially in areas lacking facilities such as a laboratory, dietetic department or permanent presence of doctors.