The Academy of Nutrition and Dietetics (AND) and the American Society for Parenteral and Enteral Nutrition (ASPEN) proposed characteristics for malnutrition. Patients meeting two or more criteria (change in oral intake and weight, muscle/fat wasting, fluid accumulation, and decreased handgrip strength) are deemed malnourished; however, these characteristics have not yet been validated. Subjective Global Assessment (SGA), a validated tool, identifies malnutrition using similar criteria (change in intake, weight, and functional status, presence of gastrointestinal symptoms, muscle/fat wasting and presence of edema); however, clinicians may diagnose malnutrition regardless of number of criteria met. The purpose of this quality improvement project was to compare characteristics of malnourished patients using the AND/ASPEN guidelines and SGA. Subjects admitted over two 2-month time periods (n=1009) were assessed using SGA and the AND/ASPEN guidelines. Descriptive statistics (counts and percentages) were used to describe the sample. In patients deemed malnourished by SGA but not by AND/ASPEN guidelines (n=32), GI symptoms were the most frequently present criteria (50% of patients). Ninety-five percent of patients found to be malnourished using AND/ASPEN guidelines but not by SGA (n=176), had inadequate handgrip strength as determined by AND standards while only 23% of these patients had decreased functional status according to SGA. Current AND/ASPEN handgrip guidelines may not accurately assess functional status of hospitalized patients. An ideal tool to determine malnutrition would use measures of functional status with high specificity and include presence of GI symptoms. Further research is needed to determine the most sensitive and specific tool to identify malnutrition.
