Table 1.

Features of the Subjective Global Assessment¹

Height:_______	Admit weight:_______	Body mass index:_______
A. History
1. Weight (wt) change:
In the past 2 weeks, weight has: Increased/Decreased/Not changed
Overall weight loss in the past 6 months: _________ kg: _________%.
2. Change in dietary intake (relative to normal intake): circle
No change	Borderline/poor	Unable to eat
If intake has decreased, for how long:____________weeks.
3. Gastrointestinal Symptoms (>2 weeks): circle all that apply
None	Nausea Vomiting	Diarrhea	Anorexia
4. Functional capacity: circle
No change	Decreased activities of daily living	Bed ridden
5. Metabolic stress: circle
No stress	Low/moderate stress	High stress
B. Physical Examination: check all that apply
_____ Triceps and chest subcutaneous fat loss
_____ Quadriceps and deltoid muscle wasting
_____ Ankle edema
_____ Sacral edema
_____ Ascites
C. SGA rating: check one
_________ A = well nourished
_________ B = moderately malnourished
_________ C = severely malnourished

¹Adapted from Detsky et al. (1987).