title: Subjective global assessment for the diagnosis of protein-energy wasting in nondialysis-dependent chronic kidney disease patients.
abstract: OBJECTIVE
  Subjective global assessment (SGA) has been demonstrated to be a reliable method for protein-energy wasting (PEW) evaluation in chronic kidney disease (CKD) patients on dialysis. Few data are available on PEW evaluation in nondialysis stages of CKD, and the validity of SGA has been scarcely investigated in this population. Herein, we aimed to evaluate in nondialysis-dependent CKD patients (NDD-CKD): (1) the prevalence of PEW by SGA; (2) the most common abnormalities of the SGA components; and (3) the agreement of SGA with the traditional anthropometric parameters.
  
  
  METHODS
  This is a retrospective cross-sectional study including 922 NDD-CKD patients referred to the renal dietitians in the period of 2001 to 2012. Nutritional status was assessed by 7-point SGA. Body mass index (BMI), midarm circumference, midarm muscle circumference, and triceps skinfold thickness were available from 494 patients.
  
  
  RESULTS
  From the 922 patients, 58.6% were men, mean age was 63.8 ± 13.6 years, BMI was 27.7 ± 5.3 kg/m(2). The majority of the patients were in CKD Stages 3 (48.9%) or 4 (40.3%). PEW (SGA ≤5) was present in 11% of the patients and 32% had signs of PEW (SGA 6). In the logistic regression analysis, the presence of comorbidities and worse renal function were independently associated with PEW. Among the SGA components, the most frequent abnormality in patients with PEW was muscle and fat wasting (88.6%). BMI, midarm circumference, midarm muscle circumference, and triceps skinfold thickness were lower across the worse SGA scores, and a moderate to good level of agreement was found between the anthropometric parameters and presence of PEW evaluated by SGA.
  
  
  CONCLUSIONS
  The prevalence of PEW was 11% in our unselected cohort of NDD-CKD patients. The physical examination component (muscle/fat wasting) was the most frequent alteration found in those patients. When compared with anthropometric parameters, 7-point SGA has shown to be a valid tool to assess PEW in NDD-CKD population.
authors.affiliation: Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil; Graduation Program on Nutrition, Federal University of São Paulo, São Paulo, Brazil. Electronic address: lcuppari@uol.com.br.
authors.forename: Lilian
authors.initials: L
authors.lastname: Cuppari
authors.affiliation: Graduation Program on Nutrition, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Marion Schneider
authors.initials: MS
authors.lastname: Meireles
authors.affiliation: Graduation Program on Nutrition, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Christiane Ishikawa
authors.initials: CI
authors.lastname: Ramos
authors.affiliation: Graduation Program on Nutrition, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Maria Ayako
authors.initials: MA
authors.lastname: Kamimura
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002100:Cachexia / Q000453:epidemiology* / Q000473:pathology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D015995:Prevalence; D011502:Protein-Energy Malnutrition / Q000175:diagnosis* / Q000453:epidemiology*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000473:pathology*; D012189:Retrospective Studies; D012885:Skinfold Thickness; D011795:Surveys and Questionnaires