Q1: How should Subjective Global Assessment be interpreted when a patient has lost weight but subsequently gains weight?

A: Weight gain after weight loss is a positive predictor – it allows us to interpret that there has been reduction in risk related to malnutrition and obviates the concern about the previous weight loss


Q2: How is weight gain in hospitalized patients interpreted?

A: It is important to look at the volume status of patients and to assess them for evidence of edema, heart failure and ascites – weight gain in hospitals often relates to increases in total body volume without increases in lean tissue or fat stores


Q3: If a patient has had nausea or been vomiting for 4-5 days but it has resolved, is this an indicator for nutrition risk?

A: No – symptoms that may limit oral intake need to be present for more than 2 weeks to be considered a contributor to nutrition risk


Q4: Should I be worried about a patient who has reported a weight loss of 5 lbs?

A: Not necessarily – weight loss of over 5% is potentially significant, Therefore, in an individual who weighs 90 lbs, this may be significant but in an individual who weighs 180 lbs, this is not significant.


Q5: How does Subjective Global Assessment differ from other nutritional assessment techniques such as the NRS and Mini nutritional Assessment?

A:Assessing patient nutritional status is difficult and many techniques have been used with varying degrees of success. Clinical methods such as Nutritional Risk Screening, or NRS, and the Mini nutritional assessment depend upon Body Mass Index, which has not been shown to correlate with outcome. Subjective Global Assessment has been shown to correlate strongly with outcome measures.


Q6: How do I interpret weight loss in a well-trained athlete  who, because of illness or trauma, is losing weight in spite of an appropriate caloric intake based on height and weight?

A: Well-developed muscular athletes lose muscle mass rapidly when placed in an inactive state (bed rest, skeletal traction, etc). For example, mid thigh circumference may change visibly on a day-to-day basis.  This is why measurements of lower extremity muscle circumference are not recommended for general serial nutrition assessment.  Therefore, this type of weight loss in a trained athlete would not have the same significance as that in an otherwise normally-built individual with recent onset Crohns disease.


Q7: What do I do when I can’t obtain a weight history?

A:  Work on the basis of change in diet, amount of intake, stool frequency, water intake,  looseness of clothing, belt notches, etc.


Q8: Is Subjective Global Assessment appropriate for the frail elderly?

A: Yes. Points of the physical examination emphasized in the video are selected on the basis of their having application for the widest age range and body habitus.  An accurate history, especially  related to rate-of-change,  is very important.