Detecting loss of subcutaneous fat, loss of muscle, and shift of intravenous fluid. These are recorded as normal (0), mild (1+), moderate (2+), or severe (3+). The best locations for assessing subcutaneous fat are
the triceps regions of the arms, the midaxillary line at the costal margin, the interosseous and palmar areas
of the hand, and the deltoids of the shoulder. Loss of subcutaneous fat appears as lack of fullness, withskin loosely fitting over the deeper tissues.
Muscle wasting is best assessed by palpation (although inspection may also help). Best locations
for doing so are the quadriceps femoris and deltoids. Shoulders of malnourished patients appear “squared
off” as a result of both muscle wasting and subcutaneous fat loss.
Loss of fluid from the intravascular to extravascular space refers primarily to ankle/sacral edema and
ascites. Edema is best assessed by palpation—that is, by pressing over the ankles or sacral area. Fluid
displaced from subcutaneous tissues as a result of compression is its hallmark. Such displacement is
clinically manifested by a persistent depression of the compressed area (pitting), which lasts for more than 5
seconds.
Once gathered, these physical findings should be quantified (as normal, mild, moderate, or severe),
combined subjectively with other clinical findings, and an SGA finally generated. There is no clear-cut
weighting recommendation for combining these features, even though the following variables are
usually important:
Weight loss >10%
Poor dietary intake
Loss of subcutaneous tissue
Muscle wasting
For example, patients with all three physical signs of malnutrition plus a weight loss >10% are usually
classified as severely malnourished (class C). Note that the SGA technique is not highly sensitive for
diagnosing malnutrition, but it is quite specific.
the triceps regions of the arms, the midaxillary line at the costal margin, the interosseous and palmar areas
of the hand, and the deltoids of the shoulder. Loss of subcutaneous fat appears as lack of fullness, withskin loosely fitting over the deeper tissues.
Muscle wasting is best assessed by palpation (although inspection may also help). Best locations
for doing so are the quadriceps femoris and deltoids. Shoulders of malnourished patients appear “squared
off” as a result of both muscle wasting and subcutaneous fat loss.
Loss of fluid from the intravascular to extravascular space refers primarily to ankle/sacral edema and
ascites. Edema is best assessed by palpation—that is, by pressing over the ankles or sacral area. Fluid
displaced from subcutaneous tissues as a result of compression is its hallmark. Such displacement is
clinically manifested by a persistent depression of the compressed area (pitting), which lasts for more than 5
seconds.
Once gathered, these physical findings should be quantified (as normal, mild, moderate, or severe),
combined subjectively with other clinical findings, and an SGA finally generated. There is no clear-cut
weighting recommendation for combining these features, even though the following variables are
usually important:
Weight loss >10%
Poor dietary intake
Loss of subcutaneous tissue
Muscle wasting
For example, patients with all three physical signs of malnutrition plus a weight loss >10% are usually
classified as severely malnourished (class C). Note that the SGA technique is not highly sensitive for
diagnosing malnutrition, but it is quite specific.