Suboptimal Diet in PhilSPEN Modified SGA Form
In the PhilSPEN modified Subjective Global Assessment (SGA) form, "suboptimal diet" refers to inadequate food intake—either in quantity or quality—that fails to meet the patient's nutritional requirements, typically assessed through dietary history including recent changes in intake, appetite, and ability to consume adequate nutrients. 1, 2
Core Components of Suboptimal Diet Assessment
The SGA tool, including its PhilSPEN modification, evaluates dietary intake as a critical component of malnutrition risk through structured clinical parameters: 1, 2
Dietary History Elements
Reduced food intake duration: The assessment captures whether intake has been suboptimal for days to weeks, with particular attention to intake reductions lasting more than 7-10 days 1
Degree of intake reduction: This includes quantifying whether the patient is consuming less than their usual intake, often categorized as mild, moderate, or severe reduction 1, 2
Type of diet consumed: Assessment includes whether the patient can consume solid food, liquids only, or has minimal/no oral intake 1, 2
Appetite changes: Poor appetite or anorexia is a key indicator of suboptimal dietary intake 1
Clinical Context
The SGA framework—which the PhilSPEN modification is based on—combines dietary history with physical examination findings (muscle wasting, fat loss, edema) and functional capacity to arrive at an overall malnutrition grade (A = well-nourished, B = moderately malnourished, C = severely malnourished). 1, 2
Practical Application in PhilSPEN Context
In the Philippine setting, the modified SGA has been validated for identifying malnutrition in hospitalized patients, with studies showing 71.83% of COVID-19 patients were malnourished using this tool 3
The dietary component is patient-reported or family-reported, making it feasible even when patients cannot provide detailed nutritional history themselves 1
Suboptimal diet is not solely about caloric intake—it encompasses inadequate protein, micronutrients, and overall dietary diversity that fails to meet metabolic demands 1
Common Pitfalls to Avoid
Do not confuse suboptimal diet with low BMI alone: The SGA dietary assessment focuses on change in intake and recent patterns, not just current body weight 1
Recognize that "suboptimal" is context-dependent: A patient with cancer or critical illness may have suboptimal intake even if consuming what would be adequate for a healthy person, because their metabolic demands are elevated 1, 2
Document specific timeframes: Vague descriptions like "eating poorly" are insufficient—the assessment requires quantifying duration and degree of reduced intake 1, 2