Journal of Tropical Pediatrics, 2018, 0, 1–7

doi: 10.1093/tropej/fmy009
Original paper

Validation of the Subjective Global Nutrition

Assessment (SGNA) and Screening Tool for
the Assessment of Malnutrition in Paediatrics
(STAMP) to Identify Malnutrition in
Hospitalized Malaysian Children
Shu Hwa Ong,1 Winnie Siew Swee Chee,1
L. Mageswary Lapchmanan,2 Shan Ni Ong,1 Zhi Chin Lua,1 and
Jowynna Xia-Ni Yeo1
1
Department of Nutrition and Dietetics, School of Health Sciences, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
2
Department of Dietetics and Food Services, Hospital Selayang, Batu Caves, 68100, Malaysia
Correspondence: Shu Hwa Ong, Department of Nutrition and Dietetics, School of Health Sciences, International Medical University, 126,
Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia. E-mail <ongshuhwa@imu.edu.my>.

A BS TR A C T
Background: Early detection of malnutrition in hospitalized children helps reduce length of hos-
pital stay and morbidity. A validated nutrition tool is essential to correctly identify children at risk of
malnutrition or who are already malnourished. This study compared the use of the Subjective
Global Nutrition Assessment (SGNA, nutrition assessment tool) and Screening Tool for the
Assessment of Malnutrition in Paediatrics (STAMP, nutrition screening tool) with objective nutri-
tional parameters to identify malnutrition in hospitalized children.
Methods: A cross-sectional study was carried out in two general paediatric wards in a public hos-
pital. SGNA and STAMP were performed on 82 children (52 boys and 30 girls) of age 1–7 years.
The scores from both methods were compared against Academy of Nutrition and Dietetics/
American Society of Parental and Enteral Nutrition Consensus Statement for identification of
paediatric malnutrition. The objective measurements include anthropometry (weight, height
and mid-arm circumference), dietary intake and biochemical markers (C-reactive protein, total
lymphocytes and serum albumin). Kappa agreement between methods, sensitivity, specificity and
cross-classification were computed.
Results: SGNA and STAMP identified 45% and 79% of the children to be at risk of malnutrition,
respectively. Using a compendium of objective parameters, 46% of the children were confirmed to
be malnourished. The agreement between SGNA and objective measurements (k ¼ 0.337) was
stronger than between STAMP and objective measurements (k ¼ 0.052) in evaluating the
nutritional status of hospitalized children. SGNA also has a 4-fold higher specificity (70.45%) than
STAMP (18.18%) in detecting children who are malnourished.

C The Author(s) [2018]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com
V  1

Downloaded from https://academic.oup.com/tropej/advance-article-abstract/doi/10.1093/tropej/fmy009/4921194

by University of California, Santa Barbara user
on 11 March 2018
 2  Validation of SGNA and STAMP

Conclusion: SGNA is a valid nutrition assessment tool in diagnosing malnutrition status among
hospitalized children in Malaysia. The discrepancy in specificity values between the two methods ex-
plains the distinguished roles between SGNA and STAMP. The use of STAMP will have to be fol-
lowed up with a more valid tool such as SGNA to verify the actual nutrition status of the paediatric
population.

K E Y W O R D S : children, nutritional assessment, subjective, validation

INTRODUCTION nutrition screening tool widely used across paediatric

Existing malnutrition among hospitalized children in-
creases the burden and complication in their treatment
and costs. One major cause of childhood mortality is
protein–energy malnutrition, which leads to multiple
complexities related to their risk of infections, growth
and development [1]. Malnutrition has dire conse-
quences from the perspective of length of hospital
stay, recovery rate and growth retardation [2–3]. Early
detection of malnutrition in children has led to early
nutrition intervention and thwarted the escalating
morbidity and mortality rates of sick children [4].
Traditionally, the nutrition status of children is
indicated by their anthropometric parameters [5].
Recently, nutrition status is also classified as related
to illness or inflammation [6]. This subsequently
suggests the use of a single-parameter measure could
be insufficient in diagnosing the nutrition status of
children, especially those admitted to acute care hos-
pitals due to diseases [7]. This calls for the need for
a set of comprehensive, validated nutrition screening
tools against a collection of objective measurements
that define paediatric malnutrition.
In adults, the Subjective Global Assessment tool is
widely incorporated into routine hospital practice to
identify malnutrition in adult patients across a spec-
trum of disease conditions [8]. Secker and Jeejeebhoy
(2007) [9] then introduced the Subjective Global
Nutrition Assessment (SGNA) tool for assessing the
nutritional status of children. SGNA, similar to the
concept of Subjective Global Assessment, considers
nutrition-related findings and the severity of illness of
children, in the absence of biomarker data. SGNA
characterizes malnutrition status from disease state.
SGNA has been used across continents and disease
states [9–11] but has not been validated for use in
hospitalized children in Malaysia.
Screening Tool for the Assessment of Malnutrition
in Paediatrics (STAMP), on the other hand, is a
wards [12–14]. It considers the present state of the
medical condition, nutritional intake and history of
weight changes among hospitalized children of age
2–17 years. It was first published in 2012 after the pilot
study among hospitalized children in the UK [12]. It
has also been validated in developed and developing
countries.
Diversity in ethnicity of populations across con-
tinents [15] calls for the need to validate a set of
nutrition assessment tools that are applicable for our
local Malaysian children. Hence, this study aimed to
validate the use of SGNA and STAMP among hospi-
talized children in a Malaysian tertiary hospital.
METHODOLOGY
Study design and population
This cross-sectional study was carried out between
March and April 2016 at Hospital Selayang,
Malaysia. The parents of every child of age 1–7 years
admitted to the general medical paediatric wards
were approached to obtain consent to participate in
the study. Children who underwent surgery in the
past 30 days or were admitted in the emergency and
intensive care unit were excluded. The study was
approved by the Joint Research and Ethics
Committee of the International Medical University
(ID: BDN I-2016 [04]) and also the National
Medical Research Registry under the Ministry of
Health, Malaysia (ID: 29263). Written consent was
obtained from a parent or legal guardian. Children
gave assent to participate if they were able to
comprehend the study protocol.
Data collection
All children underwent nutrition assessment using
SGNA and STAMP and objective assessments,
including anthropometric measures, dietary intake

Downloaded from https://academic.oup.com/tropej/advance-article-abstract/doi/10.1093/tropej/fmy009/4921194

by University of California, Santa Barbara user
on 11 March 2018

and nutrition-related biochemical markers, including
inflammatory markers. A single trained assessor eval-
uated each child for all tools.
Subjective Global Nutrition Assessment
SGNA evaluates nutrition-focused medical history
(growth pattern, changes in body weight, adequacy
of dietary intake, persistent gastrointestinal symp-
toms, functional impairment and metabolic stress)
and nutrition-focused physical examination (muscle
wasting, fat loss and nutrition-related oedema)
for signs of inadequate energy and/or protein
intake. Considering the absence or presence of
the nutrition-focused findings, a global rating of
well-nourished, moderately malnourished or severely
malnourished was established according to guide-
lines provided on the SGNA rating form [16].
Children with a Grade B or C under SGNA were
classified as malnourished in the study.
Screening Tool for the Assessment of Malnutrition
Paediatrics
STAMP consists of three questions evaluating the
medical condition, nutritional intake and anthro-
pometry of a child that yield a sum total to calculate
the overall risk of malnutrition. Children with high
(score  4) or medium (score 2–3) risk of malnutri-
tion were classified as at risk of malnutrition [12].
Objective nutritional parameters
Anthropometric measurements (height in centimetres
using a stadiometer [SECA, Germany], weight in kilo-
grams using a digital weighing scale [TANITA,
Japan], and mid-upper arm circumference in centi-
metres using a measurement tape [SECA, Germany])
were taken for all the children. Classification of an-
thropometric status was determined by using the
World Health Organization (WHO) Child Growth
Standard 2006 [5]. Malnutrition (serum albu-
min < 30 g/l) [17] or inflammatory (total lympho-
cyte count > 33% [18] or C-reactive protein > 8 mg/
l) [19] markers and medical histories were obtained
from the children’s medical records. A 24-h diet recall
was performed to interview the parent/caregiver
about the child’s dietary intake over the past 24 h.
Energy intake was analysed using the Nutritionist
ProTM Diet Analysis software (Axxya Systems LLC,
Downloaded from https://academic.oup.com/tropej/advance-article-abstract/doi/10.1093/tropej/fmy009/4921194
by University of California, Santa Barbara user
on 11 March 2018
Validation of SGNA and STAMP  3
USA). Inadequate nutrient intake was considered
when a child consumed <75% of the estimated en-
ergy intake. The present study used the definition of
malnutrition according to the Academy of Nutrition
and Dietetics/American Society of Parental and
Enteral Nutrition (AND/ASPEN) [7]. Children are
identified as being malnourished if they experienced
abnormal anthropometric indicator supporting with
the presence of inadequate nutrient intake, inflamma-
tion or low albumin level [7].
Statistical analysis
Statistical analysis was performed using the SPSS
statistical software (Version 20.0, SPSS Inc., IBM
Corp). Data are presented as means 6 standard devi-
ations, with statistical significance set at the 5% level.
Cohen’s kappa and 95% confidence intervals were
calculated to test criterion and concurrent validity
between the methods (SGNA/STAMP versus ob-
jective assessment). Children belonging to the mod-
erately and severely malnourished groups were
consolidated in the presence of malnutrition risk cat-
egory when calculating the diagnostic values (sensi-
tivity, specificity and positive and negative predictive
values) of SGNA and STAMP.
Criterion validity
The classification of malnutrition for each child using
the SGNA and STAMP was compared with a refer-
ence standard—a complete objective nutritional as-
sessment (according to AND/ASPEN guidelines)
(n ¼ 82).
Concurrent validity
The child’s SGNA score was compared with the
STAMP score using the kappa statistic.
RESULTS
Participants
In total, 82 children (52 boys and 30 girls) partici-
pated in the study (Table 1). A majority of the par-
ticipants were of Malay ethnicity due to the normal
demographics of children in a public hospital
(Table 1) [20–21]. The length of hospital stay
ranged from 1 to 13 days. A majority of the patients
were admitted due to respiratory conditions (45%).
 4  Validation of SGNA and STAMP

Table 1. Baseline characteristics of participants of the hospitalized children were malnourished,

which was similar to that identified using SGNA
Characteristics of children Number of
(n ¼ 82) children (%)
(45%). SGNA showed a moderate-to-fair agreement
(k ¼ 0.337, p ¼ 0.002) with objective assessment
Gender methods in evaluating the nutritional status of hospi-
Boy 52 (63.4) talized children.
Girl 30 (36.6) On the other hand, STAMP identified 79%
Age (mean 6 SD) in years 3.05 6 1.60 (n ¼ 65) of the children as at risk of malnutrition,
Ethnicity which is 1.7 times higher than the figures reported
Malay 61 (74.4) using SGNA and AND/ASPEN objective criteria. The
Chinese 12 (14.6) agreement between STAMP and AND/ASPEN object-
Indian 7 (8.5) ive measurements is very poor (k ¼ 0.052, p ¼ 0.026).
Other 2 (2.4) Table 3 shows that the sensitivity and specificity
Reason of admission of SGNA is 63.16% and 70.45%, respectively. It re-
Respiratory 37 (45) sulted a false-positive error rate and a false-negative
Gastroenterology 13 (16) error rate of 29.55% and 36.84%, respectively.
Infectious/fever 12 (15) Positive predictive value of SGNA indicates that 65%
Neurology 10 (12) of the children who were classified as being at risk of
Others 10 (12) malnutrition were truly malnourished.
Length of hospital stay 3.96 6 2.00 STAMP instead has a sensitivity of 76.32% and
(mean 6 SD) in days specificity of 18.18% with a much higher false-positive
HFA < 2 SD (stunting) 12 (14.6) error rate of 81.82% compared with objective meas-
WFA < 2 SD (wasted) 16 (19.5) ures. Positive predictive value of STAMP indicates
BMI < 2 SD (underweight) 19 (23.2) that 45% of the children who were classified as being
MUAC 159 6 1.6 at risk of malnutrition were truly malnourished.
(mean 6 SD in mm)
Caloric intake 75.66 6 56.75 Concurrent validity
(mean 6 SD in %) A weak agreement (k ¼ 0.061, p ¼ 0.467) between
Albumin level 41.27 6 5.58 SGNA and STAMP in identifying those children
(mean 6 SD in g/l) who are malnourished was achieved. Both genders
C-reactive protein level 2.84 6 4.35 shared a similar kappa agreement (k ¼ 0.085 for
(mean 6 SD in mg/l) boys, k ¼ 0.098 for girls, p > 0.05) between SGNA
Total lymphocyte count 36.49 6 18.03 and STAMP evaluation tools. STAMP had a sensitiv-
(mean 6 SD in %) ity of 75.68% and a specificity of 17.78%, when com-
pared to SGNA as a reference method.
SD ¼ standard deviation; HFA ¼ height-for-age; WFA ¼ weight-for-age;
BMI ¼ body mass index; MUAC ¼ mid-upper arm circumference.
Effect size
The other admission reasons comprised medical The study obtained a large effect size of 0.71
conditions related to cardiology (1%), nephrology (Cohen’s d), with a sample size of 82 children and
(1%), eye disorder (2%), endocrinology (1%), acci- chi-square value of 9.30 between SGNA and object-
dents/injuries (1%) and elective admissions (5%). ive nutritional assessment.

Criterion validity DISCUSSION

Table 2 shows the classification of malnutrition for SGNA is a comprehensive nutrition assessment tool
children determined by SGNA, STAMP and objective that has been validated in paediatric populations
nutrition assessments. According to a compendium of from various countries and settings [9–11]. Prevalence
AND/ASPEN objective measurements, 46% (n ¼ 38) of malnutrition in hospitalized children between

Downloaded from https://academic.oup.com/tropej/advance-article-abstract/doi/10.1093/tropej/fmy009/4921194

by University of California, Santa Barbara user
on 11 March 2018
 Validation of SGNA and STAMP  5

Table 2. Cross-classification of nutritional status SGNA demonstrated its ability in identifying mal-
on SGNA, STAMP and objective assessment nourished children with good sensitivity (63.15%),
and it could correctly predict 64.86% of the children
No. of children (%)
who were truly malnourished. The performance of
Malnourished Well-nourished Total SGNA in this study differed from that reported by
Mahdavi et al., [10] which was 88.24% sensitivity,
Objective assessment
45.83% specificity and 60.61%positive predictive value
SGNA
among hospitalized Iranian children. In our study, to
Malnourished 24 (TP) 13 (FP) 37
diagnose a child with malnutrition, a child not only
Well-nourished 14 (FN) 31 (TN) 45
experienced subnormal anthropometric parameters
Total 38 44 82
but also an additional subnormal parameter, including
STAMP
inflammation markers, serum albumin or dietary in-
At risk of 29 (TP) 36 (FP) 65
take, according to AND/ASPEN consensus statement
malnutrition
[7]. Based on the study by Mahdavi et al., [10] chil-
Low risk of 9 (FN) 8 (TN) 17
dren were classified as malnourished when at least
malnutrition
two parameters (including weight-for-age, height-for-
Total 38 44 82
age, weight-for-height, triceps skinfold thickness and
SGNA
serum transferrin) were subnormal. The latter study
STAMP
might limit the diagnostic criteria to merely include
At risk of 28 (TP) 37 (FP) 65
the anthropometric variables for classifying those with
malnutrition
non-illness-related malnutrition. Thus, this discrep-
Low risk of 9 (FN) 8 (TN) 17
ancy might explain a higher false-positive error rate
malnutrition
(54.17%) observed in the other study when compared
Total 37 45 82
with this study (29.55%). Indeed, lack of a clear defin-
TP ¼ true positive; FP ¼ false positive; FN ¼ false negative; TN ¼ true
ition for paediatric malnutrition at present is a study
negative. limitation when comparing findings across countries.
Consistent with other studies, [12, 13, 23]
countries can be different due to the diversity in social STAMP offers high sensitivity as compared with
demographics, medical care services and food culture AND/ASPEN objective measures in detecting risk
[11, 22]. of malnutrition among children. Its high sensitivity
When comparing the agreement between SGNA produced high false-positive results (81.82%); there-
and objective methods, this study reported a moder- fore, well-nourished children experienced increased
ate-to-fair agreement that was consistent with other likelihood to be identified as being at high risk
studies [9–11] in identifying malnutrition status of of malnutrition using STAMP. On a side note, the
hospitalized children. The malnutrition evaluation cri- Consensus Statement of AND/ASPEN not purposes
teria in both SGNA and AND/ASPEN consensus to identify criteria for nutrition screening. McCarthy
statement include the assessment of anthropometry, et al. [12] introduced STAMP as a nutrition screen-
fluid accumulation, functional status and dietary ad- ing tool requiring no training and minimal time
equacy measures. Conversely, children are identified for identifying the likelihood of hospitalized children
as being malnourished by SGNA based on the clinical developing malnutrition. Although false-positive
judgement of healthcare professionals; thus, training results may call for detailed nutrition assessment on
on nutrition-focused physical examination in children the well-nourished children, it serves the purpose of
is required. In clinical settings, it might be impractical preventing nutritional status deterioration upon hos-
to include all variables in objective nutritional assess- pital admission. Thus, high sensitivity is ideal for a
ments; this study recommends that SGNA is a valid nutrition screening tool in identifying those children
yet comprehensive nutritional assessment tool to be at high risk of malnutrition during a prolonged
implemented in the local hospital settings. length of hospital stay.

Downloaded from https://academic.oup.com/tropej/advance-article-abstract/doi/10.1093/tropej/fmy009/4921194

by University of California, Santa Barbara user
on 11 March 2018
 6  Validation of SGNA and STAMP

Table 3. Statistical indicators between nutritional screening/assessment tools and objective assess-
ment in identifying children with malnutrition
Statistic indicators Formula SGNA STAMP
TP
Sensitivity (%) TPþFN 63.15 76.32
TN
Specificity (%) TNþFP 70.45 18.18
TP
Positive predictive value (%) TPþFP 64.86 44.62
TN
Negative predictive value (%) TNþFN 68.89 47.06
FP
False-positive error rate FPþTN 29.55 81.82
FN
False-negative error rate FNþTP 36.84 23.68
TPþTN
Accuracy (%) TPþFPþFNþTN 67.07 45.12
þ sensitivity
Likelihood ratio positive (LR ) 1specificity 2.14 0.93
 1sensitivity
Likelihood ratio negative (LR ) specificty 0.52 1.33
LRþ
Odd ratio LR 4.12 0.70

TP ¼ true positive; FP ¼ false positive; FN ¼ false negative; TN ¼ true negative; LR ¼ likelihood ratio.

SGNA offers higher specificity (70.45%) than
STAMP (18.18%) when compared with malnutrition
identification based on objective measurements
as recommended by ASPEN/AND criteria. On
comparison with SGNA as the reference method
(concurrent validity determination), STAMP obtains
17.78% specificity. The discrepancy in specificity
values between the two methods explains their
respective distinguished roles: SGNA as a nutrition
assessment tool requires more time and technical
skills to evaluate the nutritional status of children,
resulting in a higher accuracy (67.07%) in detect-
ing malnourished children, whereas STAMP as a
nutrition screening tool aims to screen in a quick
and easy manner children who are at high risk of
developing malnutrition. Hence, SGNA performs
better than STAMP in identifying well-nourished
children among the hospitalized children, which
is reflected in its higher odds ratio (3.77)
compared with STAMP (odds ratio ¼ 0.70). This
study also suggests that SGNA and STAMP should
not be used interchangeably in the clinical practice
settings.
A higher number of boys and Malays participated
this study. The higher proportion of Malays in this
study adequately represents the ethnic distribution
in Malaysia (which comprises 50% Malays, 23%
Chinese and 7% Indians] [15]. However, the
unequal gender distribution may be due to boys
being more likely to be admitted to hospitals than
girls, as reported in other local studies [20–21]. Our
study findings indicate that the boys experienced no
significant difference in age, dietary intake and bio-
markers, when compared with the girls. Thus, we
consolidated the participants to validate the applica-
tion of SGNA in our local setting.
CONCLUSION
SGNA can be validly recommended for evaluating
the malnutrition status of hospitalized children in
Malaysian tertiary hospital settings. However, the
study found that STAMP cannot be recommended
for use as a routine nutrition screening tool in local
Malaysian children due to high chances of misclassi-
fication of their nutritional status. The use of
STAMP will have to be followed up with a more
valid tool such as SGNA to verify the actual nutrition
status of the paediatric population.
ACKNOWLEDGEMENTS
The authors thank dieticians and nursing staffs from Hospital
Selayang for supporting the conduct of research at its
premise.

Downloaded from https://academic.oup.com/tropej/advance-article-abstract/doi/10.1093/tropej/fmy009/4921194

by University of California, Santa Barbara user
on 11 March 2018
 Validation of SGNA and STAMP  7

FUNDING 12. McCarthy H, Dixon M, Crabtree I, et al. The development

This work is supported by the International Medical University and evaluation of the Screening Tool for the Assessment
Undergraduate Research Fund (BDN I-2016 [04]), Malaysia. of Malnutrition in Paediatrics (STAMP) for use by health-
care staff. J Hum Nutr Diet 2012;25:311–18.
13. Wong S, Graham A, Harini SP, et al. Validation of
REFERENCES
the Screening Tool for the Assessment of Malnutrition
1. World Health Organization (WHO). World Health
in Paediatrics (STAMP) in patients with spinal cord
Statistics: Monitoring health for the sustainable develop-
injuries (SCIs). Spinal Cord 2013;51:424–9.
ment goals. World Health Organization, 2016. http://
14. Lama More RA, Morais Lopez A, Herrero Alvarez M, et al.
www.who.int/gho/publications/world_health_statistics/
Validation of a nutritional screening tool for hospitalized
en/ (30 December 2016, date last accessed).
pediatric patients [in Spanish]. Nutr Hosp 2012;27:
2. Costa CA, Tonial CT, Garcia PC. Association between nu-
1429–36.
tritional status and outcomes in critically-ill paediatric pa-
15. CIA World Factbook. Malaysia demographics profile. CIA.
tients—a systematic review. J Pediatr 2016;92:223–9.
http://www.indexmundi.com/malaysia/demographics_
3. Hecht C, Weber M, Grote V, et al. Disease associated mal-
profile.html (10 December 2016, date last accessed).
nutrition correlates with length of hospital stay in children.
16. Secker DJ, Jeejeebhoy KN. How to perform subjective
Clin Nutr 2015;34:53–9.
global nutritional assessment in children. J Acad Nutr Diet
4. Groleau V, Thibault M, Doyon M, et al. Malnutrition in
2012;112:424–31.e6.
hospitalized children: prevalence, impact, and manage-
17. Gandy J. Manual of Dietetic Practice. 5th edn. Chichester:
ment. Can J Diet Pract Res 2014;75:29–34.
John Wiley & Sons, Ltd, 2014.
5. WHO Multicentre Growth Reference Study Group. WHO
18. Hockenberry M, Wilson D, Wong D. Wong’s Essentials of
Child growth standards based on length/height, weight
Pediatric Nursing. St. Louis, MO: Elsevier/Mosby, 2013.
and age. Acta Paediatr Suppl 2006;450:76–85.
19. Velasquez C, Navarro C, Munoz C, et al. Inflammatory re-
6. Mehta NM, Corkins MR, Lyman B, et al. Defining pediat-
sponse in Colombian children with severe protein-energy
ric malnutrition: a paradigm shift toward etiology-related
malnutrition before and after nutritional intervention.
definitions. JPEN J Parenter Enteral Nutr 2013;37:460–81.
Colomb Med 2010;41:121–8.
7. Becker P, Carney LN, Corkins MR, et al. Consensus state-
20. Koh MT, Eg KP, Loh SS. Hospitalised Malaysian children
ment of the Academy of Nutrition and Dietetics/American
with pandemic (H1N1) 2009 influenza: clinical character-
Society for parenteral and enteral nutrition: indicators
istics, risk factors for severe disease and comparison with
recommended for the identification and documentation of
the 2002-2007 seasonal influenza. Singapore Med J 2016;
pediatric malnutrition (undernutrition). J Acad of Nutr
57:81–6.
Diet 2014;114:1988–2000.
21. Pillai CP, Yoshida Y, Lawrence PJ, et al. Pediatric car-
8. Fink J, Mello P, Mello E. Subjective global assessment of
diothoracic program in Malaysia: a study based on the
nutritional status—a systematic review of the literature.
outcome of the program. Nagoya J Med Sci 2016;78:
Clin Nutr 2015;34:785–92.
9–17.
9. Secker DJ, Jeejeebhoy KN. Subjective global nutritional
22. Mahdavi A, Safaiyan A, Ostadrahimi A. Subjective vs ob-
assessment for children. Am J Clin Nutr 2007;85:1083–9.
jective nutritional assessment study in children: a cross-
10. Mahdavi A, Ostadrahimi A, Safaiyan A. Subjective global
sectional study in the northwest of Iran. Nutr Res 2009;29:
assessment of nutritional status in children. Matern Child
269–74.
Nutr 2010;6:374–81.
23. Wonoputri N, Djais J, Rosalina I. Validity of nutri-
11. Carniel MP, Santetti D, Andrade JS, et al. Validation of a
tional screening tools for hospitalized children. J Nutr and
subjective global assessment questionnaire. J Pediatr 2015;
Metab 2014;2014:143649. doi: 10.1155/2014/143649.
91:596–602.

Downloaded from https://academic.oup.com/tropej/advance-article-abstract/doi/10.1093/tropej/fmy009/4921194

by University of California, Santa Barbara user
on 11 March 2018