Subjective global assessment, physical function and anthropometrics: What should we be measuring in maintenance dialysis patients?

Abstract

Purpose - Malnutrition is common in maintenance dialysis patients; subjective global assessment is a recommended tool to identify nutritional status. The aim of the study was to establish whether a 7 point SGA tool would provide an adequate degree of accuracy in identifying malnutrition when compared to other validated subjective and objective measures of nutritional status. Previous studies have only looked at the total SGA score, this study looked at the total SGA score and also the separate sections of the SGA scoring. Methods - The study population consisted of 67 maintenance dialysis patients receiving either peritoneal dialysis (PD) or Haemodialysis (HD). Patients were assessed using a 7 point SGA tool; anthropometric measures - height, weight, triceps skin-fold, sub-scapular skin-fold, mid arm circumference, mid"arm muscle circumference, calf circumference, mid thigh circumference; dietary measures - 24 hour diet recall and Functional measures - handgrip strength and International physical activity questionnaire (IPAQ) Results Correlations were assessed using Spearman's Rank or Pearson's correlation; and conducted between the total SGA score and separate sections of the SGA tool. Only 3 results indicated a high correlation co-efficient: mid thigh Circumference (cm) with muscle mass section of the SGA score r = 0.778 (p=0.0005), mid calf circumference (cm) with muscle mass section of the SGA score r = 0.727 (p=0.0005) and mid thigh circumference (cm) with the total SGA score r = 0.707 (p= 0.0005) Conclusions - The results suggest that the 7 point SGA tool although it addresses a number of areas to consider when addressing nutrition status does not appear to have a high correlation with a number of validated measures of nutritional status, suggesting that the SGA tool needs further adaptation to prove its worth as a standalone measure.