Assessment of Nutritional Status by Subjective Global Assessment, Malnutrition Inflammation Score, and a Comprehensive Nutrition Assessment: A Prospective Study

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$66(660(172)1875,7,21$/67$786%<68%-(&7,9( */2%$/$66(660(170$/1875,7,21,1)/$00$7,21 6&25($1'$&2035(+(16,9(1875,7,21 $66(660(17$35263(&7,9(678'< Melissa Prest1, 3, Laura Byham-Gray1, J. Scott Parrott1, Alison Steiber2, Terrie Rydzon3, and Paula Staab4. University of Medicine and Dentistry of New Jersey, Newark and Stratford, New Jersey1; Case Western Reserve University, Cleveland, Ohio2; Fresenius Medical Care of North America Chicago, IL3 and Portland, Oregon4. Nutritional status of maintenance hemodialysis (MHD) patients is often compromised due to protein-energy wasting leading to poorer overall treatment outcomes. The purpose of this prospective, nonrandomized study was to determine the level of agreement of nutritional status between Subjective Global Assessment (SGA) and two methods of categorizing the Malnutrition Inflammation Score (MIS) as described by Ho et al and Chan et al to the gold standard Comprehensive Nutrition Assessment (CNA) performed by a registered dietitian (RD). Two blinded RD reviewers assessed the unscored CNAs to establish the CNA as the comparative measure. Ho et al and Chan et al used cut-off scores (5 and 8, respectively) to distinguish between well-nourished and malnourished patients. Fifty-seven participants were included from one urban MHD center and were assessed simultaneously using all three assessment tools with scoring done one month from assessment to prevent investigator bias. Sixtyeight percent (n = 39) of participants were black; 66% (n = 38) were male; mean age was 54.26 r 14.72 years; mean dialysis vintage was 7.68 r 5.37 years; and 90.4% (n = 55) of the participants had one to two comorbidities. SGA (K = .685), MIS-Ho (K = .653), and MISChan (K = .722) were identified as having a good level of agreement with the CNA. SGA and MIS-Chan were able to identify 97% and 100% of well-nourished patients, respectively, but were only able to identify 67% of the malnourished patients. MIS-Ho identified 100% of the malnourished patients and 70% of the well-nourished patients. In conclusion, these findings indicate that all three assessments have a good level of agreement to the CNA but the MIS as described by Ho et al was superior to the SGA in the identification of malnourished patients.

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