Validity and reliability testing of a subjective nutritional assessment tool for adult liver transplant candidates

Three transplant dietitians reviewed a "Subjective Global Assessment" (SGA) tool which was developed for use with adult liver transplant candidates. After "post-review" changes were made, two dietitians assessed 20 liver transplant candidates using 25 SGA parameters based on patient: history, physical appearance, nutrient deficiency symptoms, and existing clinical conditions. Fifteen percent of the patients were found to be well nourished, 70% were moderately malnourished, and 15% were severely malnourished. Raters agreed on the nutritional status 80% of the time, showing a positive correlation (r=0.91, p<0.01) between the raters and their overall SGA. Sixteen SGA parameters showed high interrater reliability (p<0.01), whereas nine showed high degrees of association to the final SGA rating (p~0.05). Muscle wasting, presence of ascites or edema, nausea, and weight change were determined to be the strongest predictors of SGA (r2=0.79, p~0.05). Because of low interrater reliability and difficulty in diagnosis of nutrient deficiencies, this section could be removed from the tool.