Validation of a subjective global assessment questionnaire

Carniel, Maiara P.; Santetti, Daniele; Andrade, Juliana S.; Favero, Bianca P.; Moschen, Tábata; Campos, Paola A.; Goldani, Helena A.S.; Dornelles, Cristina T.L.

doi:10.1016/j.jped.2015.03.005

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• J. Pediatr. (Rio J.) 91 (6) • Nov-Dec 2015 • https://doi.org/10.1016/j.jped.2015.03.005 copy

Validation of a subjective global assessment questionnaire^☆ ☆ Please cite this article as: Carniel MP, Santetti D, Andrade JS, Favero BP, Moschen T, Campos PA, et al. Validation of a subjective global assessment questionnaire. J Pediatr (Rio J). 2015;91:596-602. ^☆☆ ☆☆ The study was conducted at Postgraduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To validate the Subjective Global Nutritional Assessment (SGNA) questionnaire for Brazilian children and adolescents.

Methods

A cross-sectional study with 242 patients, aged 30 days to 13 years, treated in pediatric units of a tertiary hospital with acute illness and minimum hospitalization of 24 h. After permission from the authors of the original study, the following criteria were observed to obtain the validation of SGNA instruments: translation and backtranslation, concurrent validity, predictive validity, and inter-observer reliability. The variables studied were age, sex, weight and length at birth, prematurity, and anthropometry (weight, height, body mass index, upper arm circumference, triceps skinfold, and subscapular skinfold). The primary outcome was considered as the need for admission/readmission within 30 days after hospital discharge. Statistical tests used included ANOVA, Kruskal-Wallis, Mann-Whitney, chi-square, and Kappa coefficient.

Results

According to SGNA score, 80% of patients were considered as well nourished, 14.5% moderately malnourished, and 5.4% severely malnourished. Concurrent validity showed a weak correlation between the SGNA and anthropometric measurements (p < 0.001). Regarding predictive power, the main outcome associated with SGNA was length of admission/readmission. Secondary outcomes associated included the following: length of stay at the unit after SGNA, weight and length at birth, and prematurity (p < 0.05). The interobserver reliability showed good agreement among examiners (Kappa = 0.74).

Conclusion

This study validated the SGNA in this group of hospitalized pediatric patients, ensuring its use in the clinical setting and for research purposes in the Brazilian population.

KEYWORDS
Nutritional assessment; Children; Adolescents; Anthropometry; Validation studies

Variables	n = 242
Age (months) – median (P25–P75)	10.4 (4.3–33.4)
Age range – n (%)
<2 years	164 (67.8)
≥2–<5 years	44 (18.2)
≥5–<10 years	25 (10.3)
≥10 years	9 (3.7)

Gender – n (%)
Male	149 (61.6)
Female	93 (38.4)

Patient referred from – n (%)
Pediatric emergency	153 (63.2)
Pediatric admission	89 (36.8)

Underlying disease – n (%)
Respiratory disorders	187 (77.3)
Gastrointestinal disorders	45 (18.6)
Surgical disorders	4 (1.7)
Systemic infectious diseases and others	6 (2.5)
Time remaining in the unit after SGNA (days) – median (P25–P75)	3 (2–5)
Need for hospital admission/readmission up to 30 days after discharge – n (%)	43 (17.8)

SGNA classification–n (%)
Well-nourished	194 (80.2)
Moderately malnourished	35 (14.5)
Severely malnourished	13 (5.4)

Variables	N	SGNA			p	r Kendall
		Well-nourished	Moderately malnourished	Severely malnourished
		Mean ± SD	Mean ± SD	Mean ± SD
W/H – z score	208	0.72 ± 1.40^b a,b Equal letters do not differ by Tukey test at the 5% significance level	−0.82 ± 0.97^a a,b Equal letters do not differ by Tukey test at the 5% significance level	−1.04 ± 2.66^a a,b Equal letters do not differ by Tukey test at the 5% significance level	<0.001	−0.36
W/A – z score	233	0.31 ± 1.13^b a,b Equal letters do not differ by Tukey test at the 5% significance level	−1.57 ± 0.51^a a,b Equal letters do not differ by Tukey test at the 5% significance level	−2.23 ± 0.76^a a,b Equal letters do not differ by Tukey test at the 5% significance level	<0.001	−0.53
H/A – z score	242	−0.16 ± 1.23^c a,b Equal letters do not differ by Tukey test at the 5% significance level	−1.49 ± 0.98^b a,b Equal letters do not differ by Tukey test at the 5% significance level	−2.43 ± 2.04^a a,b Equal letters do not differ by Tukey test at the 5% significance level	<0.001	−0.37
BMI/A – z score	242	0.57 ± 1.43^b a,b Equal letters do not differ by Tukey test at the 5% significance level	−0.98 ± 1.14^a a,b Equal letters do not differ by Tukey test at the 5% significance level	−0.77 ± 2.87^a a,b Equal letters do not differ by Tukey test at the 5% significance level	<0.001	−0.34
AC/A – z score	198	0.45 ± 1.12^b a,b Equal letters do not differ by Tukey test at the 5% significance level	−0.65 ± 1.06^a a,b Equal letters do not differ by Tukey test at the 5% significance level	−0.83 ± 1.76^a a,b Equal letters do not differ by Tukey test at the 5% significance level	<0.001	−0.32
TSF/A – z score	198	0.63 ± 1.25^b a,b Equal letters do not differ by Tukey test at the 5% significance level	−0.23 ± 1.06^a a,b Equal letters do not differ by Tukey test at the 5% significance level ^b a,b Equal letters do not differ by Tukey test at the 5% significance level	−0.52 ± 1.24^a a,b Equal letters do not differ by Tukey test at the 5% significance level	<0.001	−0.23
SSF/A – z score	198	0.82 ± 1.38^b a,b Equal letters do not differ by Tukey test at the 5% significance level	−0.25 ± 1.20^a a,b Equal letters do not differ by Tukey test at the 5% significance level	−0.29 ± 1.34^a a,b Equal letters do not differ by Tukey test at the 5% significance level	<0.001	−0.25

Variables	Well-nourished (n = 194)	Moderately malnourished (n = 35)	Severely malnourished (n = 13)	p
Length of stay in the unit after SGNA (days) – median (P25–P75)	1 (1–3)^a a,b Equal letters do not differ by Tukey test at 5% significance level.	2 (1–5)^b a,b Equal letters do not differ by Tukey test at 5% significance level.	2 (16)^a a,b Equal letters do not differ by Tukey test at 5% significance level. ^,^b a,b Equal letters do not differ by Tukey test at 5% significance level.	0.021
Need for admission/readmission within 30 days of discharge, n (%)	21 (10.8)	15 (42.9)	7 (53.8)	<0.001
Birth weight (kg) – mean ± SD	3.22 ± 0.59^b a,b Equal letters do not differ by Tukey test at 5% significance level.	2.82 ± 0.72^a a,b Equal letters do not differ by Tukey test at 5% significance level. ^,^b a,b Equal letters do not differ by Tukey test at 5% significance level.	2.68 ± 0.95^a a,b Equal letters do not differ by Tukey test at 5% significance level.	<0.001
Birth length (cm) – mean ± SD	48.4 ± 3.0^b a,b Equal letters do not differ by Tukey test at 5% significance level.	46.3 ± 3.5^a a,b Equal letters do not differ by Tukey test at 5% significance level. ^,^b a,b Equal letters do not differ by Tukey test at 5% significance level.	45.3 ± 7.5^a a,b Equal letters do not differ by Tukey test at 5% significance level.	<0.001
Prematurity, n (%)	11 (5.7)	4 (11.4)	3 (23.1)	<0.001

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[1] * Corresponding author. E-mail: maiara carniel@yahoo.com.br (M.P. Carniel).