Pediatric nutritional assessment: A comparison of clinical judgment and objective measures.
Published: 2006
Language: eng
Number of pages: 224
ISBN-13: 9780494219799
Description: Subjective Global Assessment (SGA), a method of nutritional assessment using clinical judgment, has been widely used to assess nutritional status of adults, for both clinical and research purposes. Foreseeing benefits of its use in children, we chose to adapt SGA and test its validity and reproducibility in the pediatric population. We compared its ability to identify malnourished children and predict their risk of developing nutrition-associated complications with that of currently used objective measures of nutritional status.Nutritional status of 175 children (31 days--17.9 years old) having major thoracic or abdominal surgery was assessed pre-operatively by 2 assessors, independently performing subjective global nutritional assessment (SGNA) or objective measurements. Occurrence of nutrition-associated morbidities was documented for 30 days post-operatively. SGNA successfully divided children into 3 groups (well nourished, moderately malnourished, severely malnourished) with different mean values for serum albumin and various anthropometric measures (p&lt;0.05). SGNA showed moderate to fair correlation with all anthropometric and 2 of 4 biochemical measurements. Malnourished children had higher rates of infectious and minor complications compared to their well-nourished counterparts (p&lt;0.05) and longer post-operative lengths of stay (p=0.002), undesirable consequences for children and families that also increase hospital costs. Objective nutritional measures showed no association with these outcomes, with the exception of serum albumin, which we believe to be a marker of inflammation and illness rather than nutritional status. In 78 children having a second SGNA performed independently by a 3rd assessor, inter-rater agreement (56%, kappa=0.28) was lower than in adult SGA studies, possibly due to variability in the development and body composition of growing children or the need for continuous training of assessors. Physical signs of fat and muscle wasting, weight loss, and gastrointestinal symptoms were components of SGNA that most influenced assessors' overall ratings.Subjective Global Nutrition Assessment is a valid tool for assessing nutritional status in hospitalized children and identifying children at higher risk of post-operative nutrition-associated complications and lengthier hospitalizations. In contrast to objective measures of nutritional status, SGNA identified the potential cause(s) and future direction of malnutrition and provided guidance on where to target intervention. Further study to improve reliability is needed.
Notes: Source: Dissertation Abstracts International, Volume: 68-01, Section: B, page: 0219.

Thesis (Ph.D.)--University of Toronto, 2006.

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