Agreement between PG-SGA Short Form, MUST and SNAQ in hospital patients

Rationale: The Patient-Generated Subjective Global Assessment (PG-SGA) is a validated instrument to assess malnutrition and its risk factors in clinical populations. Its patient component, PG-SGA Short Form (SF), can be used as screening instrument. In this cross-sectional study we aimed to assess agreement between the PG-SGA SF, Malnutrition Universal Screening Tool (MUST), and Short Nutritional Assessment Questionnaire (SNAQ) in patients at the University Medical Center Groningen, The Netherlands.

Methods: Malnutrition risk was assessed by PG-SGA SF, MUST, and SNAQ in 81 patients from the Departments Ear Nose Throat (ENT), Oral and Maxillofacial Surgery (OMS) and Orthopedics. Point scores of PG-SGA SF=4-8, MUST=1, and SNAQ=2 were classified as ‘medium malnutrition risk’, and PG-SGA SF≥9, MUST ≥2, and SNAQ ≥3 as ‘high malnutrition risk’. Agreement in classification for malnutrition risk was assessed by weighted kappa (κ) and intra-class correlation coefficient (ICC). A p-value of <0.05 was considered statistically significant.

Results: According to the PG-SGA SF, MUST and SNAQ, respectively 65%, 81%, and 80% of all patients were classified as ‘low malnutrition risk’; 24%, 8% and 6% as ‘medium malnutrition risk’; 11%, 10% and 14% as ‘high malnutrition risk’.Agreement between PG-SGA SF and MUST (κ=0.452, ICC=0.448; p<0.001), and between PG-SGA SF and SNAQ (κ=0.395, ICC=0.395; p<0.001) were both fair. In patients from the Departments ENT and OMS, PG-SGA SF classified more patients at medium/high malnutrition risk (n=26) as compared to the MUST (n=12) or SNAQ (n=14).

Conclusion: We found only fair agreement between the PG-SGA SF and MUST and SNAQ, respectively. The PG-SGA SF classified three and four times more patients at medium malnutrition risk, compared to MUST and SNAQ respectively, due to its scoring on symptoms and activities/functioning. Hence, the PG-SGA SF may help facilitate proactive prevention of malnutrition.