SGA Scoring Guidelines

The clinician rates each medical history and physical examination parameter as A, B, or C on the SGA scoring sheet. On the basis of all of these parameter ratings, the clinical observer assigns an overall SGA classihcation, which corresponds to his or her subjective opinion of the patient’s nutritional status. SGA is not a numerical scoring system. Therefore, it is inappropriate just to add the number of A, B, and C ratings to arrive at the overall SGA classihcation.

The clinician should examine the form to obtain a general feel for the patient’s status. If there seem to be more checks on the right-hand side of the form (more B and C ratings), the patient is more likely to be malnourished. If the ratings seem to be on the left-hand side, the patient is likely to be nourished. The severely malnourished (C) rating is given whenever a patient has physical signs of malnutrition, such as severe loss of subcutaneous fat, severe muscle wasting, or edema, in the presence of a medical history suggestive of risk, such as continuing weight loss with a net loss of 10% or more, or a decline in dietary intake. GI symptoms and functional impairments usually exist in these patients. Severely malnourished patients will rank in the moderate to severe category in most sections of the SGA form.

When weight loss is 5%-10% with no subsequent gain, in conjunction with mild subcutaneous fat or muscle loss and a reduction in dietary intake, the patient is assigned the mildly/moderately malnourished (B) rating. These patients may or may not exhibit functional impairments or GI symptoms. The B rating is expected to be the most ambiguous of all the SGA classihcations. These patients may have a ranking in all three categories. In general, if the severely malnourished (C) or well-nourished (A) rating is not clearly indicated, assign the patient to the moderately malnourished classihcation.

If there is no physical signs of malnutrition, no signihcant weight loss, no dietary difficulties, no nutritionally related functional impairments, or no GI symptoms that might predispose to malnutrition, the patient should be assigned to the well-nourished (A) category.

If the patient has recently gained weight, and other indicators, such as appetite, show improvement, the patient may be assigned the A rating, despite previous loss of fat and muscle, which may still be physically apparent. On the other hand, obese patients can be moderately or severely malnourished based upon their poor medical history and signs of muscle loss. Even patients with a normal appearance could be classihed as mildly or moderately malnourished because of a poor medical history.⁷