1. Malnutrition in Peds None of the criteria stand on their own – the entire picture has to be taken into account.

2. http://www.merck.com/mmpe/sec01/ch002/ch002b.html Values Commonly Used to Grade the Severity of Protein-Energy Malnutrition (Adult) MeasurementNormalMild Malnutrition Moderate Malnutrition Severe Malnutrition Normal weight (%) 90 – 11085 – 9075 – 85 < 75 Body mass index 19 – 24*18 – 18.916 – 17.9 < 16 Serum albumin (g/dL) 3.5 – 5.03.1 – 3.42.4 – 3.0 < 2.4 Transthyretin (prealbumin) (mg/dL) 17-4011-167-10<7 Serum transferrin (mg/dL) 220 – 400201 – 219150 – 200 < 150 Total lymphocyte count (per mm3) 2000 – 35001501 – 1999800 – 1500 < 800 Delayed hypersensitivity index † 2210 *In the elderly, BMI < 21 may increase mortality risk. † Delayed hypersensitivity index quantitates the amount of induration elicited by skin testing using a common antigen, such as those derived from Candida sp or Trichophyton sp. Induration grade 0 = < 0.5 cm, 1 = 0.5 – 0.9 cm, 2 = ≥ 1.0 cm.

6. SGA Subjective Global Assessment Scoring Sheet Patient Name:_________________________Patient ID:_____________Date:_______________ Part 1: Medical History S GA Score 1. Weight Change A B C A. Overall change in past 6 months: kgs. B. Percent change: ______ gain - < 5% loss _____ 5-10% loss _____ > 10% loss C. Change in past 2 weeks: ______ increase ______ no change ______ decrease 2. Dietary Intake A. Overall change: _______no change _______change B. Duration: ______weeks C. Type of change: ______suboptimal solid diet ________ full liquid diet _______hypocaloric liquid ________ starvation 3. Gastrointestinal Symptoms (persisting for >2 weeks) ____none _______nausea _____vomiting____ diarrhea ________ anorexia 4. Functional Impairment (nutritionally related) A. Overall impairment: none moderate severe B. Change in past 2 weeks: improved no change regressed Part 2: Physical Examination S GA Score Normal Mild Moderate Severe 5. Evidence of: Loss of subcutaneous fat Muscle wasting Edema Ascites (hemo only) Part 3: SGA Rating (check one) A. Well-Nourished B. Mildly-Moderately Malnourished C. Severely Malnourished