Jornal Vascular Brasileiro
Jornal Vascular Brasileiro
Review Article

Evidências para o uso da avaliação nutricional subjetiva global nos pacientes com doença arterial periférica

Evidence for use of subjective global assessment of the nutritional status of patients with peripheral arterial disease

Leandro de Oliveira Costa; Débora Úrsula Fernandes Souza; Walter Moreira Fonseca; Bárbara Couto Cifuentes Gonçalves; Gabriela Bhering Gomes; Lucas Amorim Ribeiro da Cruz; Nilder Nister Alves Reis Júnior; José Oyama Moura Leite

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Resumo A desnutrição é uma doença extremamente prevalente em pacientes internados, chegando a acometer 50% deles, 47% dos pacientes cirúrgicos e entre 39 e 73% dos portadores de doença arterial periférica, com grande impacto na morbimortalidade desses pacientes. A desnutrição possui grande relevância no desfecho clínico desses pacientes durante a internação, estando associada a maior incidência de infecções, demora na cicatrização das feridas, diminuição do status de deambulação, maior tempo de internação e mortalidade. Entretanto, o diagnóstico de desnutrição ou risco nutricional desses pacientes tem sido um desafio. A avaliação nutricional subjetiva global revelou-se, até o momento, o padrão ouro como método de triagem de pacientes cirúrgicos internados devido à sua praticidade e acurácia. O objetivo deste trabalho é revisar métodos utilizados na avaliação do estado nutricional e da triagem nutricional de pacientes internados e caracterizar a importância dessa avaliação nos desfechos clínicos dos pacientes com arteriopatias.


doença arterial periférica, morbidade, mortalidade, estado nutricional, avaliação nutricional subjetiva global, desnutrição


Abstract Malnutrition is an extremely common disease among hospitalized patients, with prevalence rates as high as 50% overall, 47% among surgical patients and from 39 to 73% among patients with peripheral arterial disease. It has a major impact on morbidity and mortality among these patients. Malnutrition is very relevant to these patients’ clinical outcomes and is associated with a higher incidence of infections, slower wound healing, lower rates of mobility, longer hospital stays and greater mortality. However, diagnosing malnutrition or nutritional risk in these patients has proven to be a challenge. To date, subjective global nutritional assessment remains the gold standard screening method for use with hospitalized surgical patients because of its practicality and accuracy. The objective of this study is to review methods used for assessment of nutritional status and for nutritional screening of hospitalized patients and determine the importance of these assessments to the clinical outcomes of patients with arteriopathies.


peripheral arterial disease, morbidity, mortality, nutritional status, subjective global nutritional assessment, malnutrition


Durkin MT, Mercer KG, McNulty MF. Vascular surgical society of great britain and ireland: contribution of malnutrition to postoperative morbidity in vascular surgical patients. Br J Surg. 1999;86(5):702.

Harris CL, Fraser C. Malnutrition in the institutionalized elderly: the effects on wound healing. Ostomy Wound Manage. 2004;50(10):54-63.

Li HJ, Cheng HS, Liang J, Wu CC, Shyu YI. Functional recovery of older people with hip fracture: does malnutrition make a difference?. J Adv Nurs. 2013;69(8):1691-703.

McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ. 1994;308(6934):945-8.

Pérez de la Cruz A, Lobo Támer G, Orduña Espinosa R, Mellado Pastor C, Aguayo de Hoyos E, Ruiz López MD. Malnutrition in hospitalized patients: prevalence and economic impact. Med Clin (Barc). 2004;123(6):201-6.

Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999;134(1):36-42.

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(1^sSupl):S5-67.

Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation. 2004;110(6):738-43.

Makdisse M, Pereira AC, Brasil DP. Prevalence and risk factors associated with peripheral arterial disease in the Hearts of Brazil Project. Arq Bras Cardiol. 2008;91(6):370-82.

Landry GJ. Functional outcome of critical limb ischemia. J Vasc Surg. 2007;45(^sSupl A):A141-8.

Taylor SM, Cull DL, Kalbaugh CA. Critical analysis of clinical success after surgical bypass for lower-extremity ischemic tissue loss using a standardized definition combining multiple parameters: a new paradigm of outcomes assessment. J Am Coll Surg. 2007;204(5):831-8.

Taylor SM, Kalbaugh CA, Blackhurst DW, Kellicut DC, Langan 3rd EM, Youkey JR. A comparison of percutaneous transluminal angioplasty versus amputation for critical limb ischemia in patients unsuitable for open surgery. J Vasc Surg. 2007;45(2):304-10, discussion 310-1.

Joosten MM, Pai JK, Bertoia ML. Associations between conventional cardiovascular risk factors and risk of peripheral artery disease in men. JAMA. 2012;308(16):1660-7.

Pecci R, De La Fuente Aguado J, Sanjurjo Rivo AB, Sanchez Conde P, Corbacho Abelaira M. Peripheral arterial disease in patients with chronic obstructive pulmonary disease. Int Angiol. 2012;31(5):444-53.

Inglis SC, Hermis A, Shehab S, Newton PJ, Lal S, Davidson PM. Peripheral arterial disease and chronic heart failure: a dangerous mix. Heart Fail Rev. 2013;18(4):457-64.

Tranche-Iparraguirre S, Marín-Iranzo R, Fernández-de Sanmamed R, Riesgo-García A, Hevia-Rodríguez E, García-Casas JB. Peripheral arterial disease and kidney failure: a frequent association. Nefrologia. 2012;32(3):313-20.

Carter SA. Indirect systolic pressures and pulse waves in arterial occlusive diseases of the lower extremities. Circulation. 1968;37(4):624-37.

Carter SA. Clinical measurement of systolic pressures in limbs with arterial occlusive disease. JAMA. 1969;207(10):1869-74.

Belch JJ, Topol EJ, Agnelli G. Critical issues in peripheral arterial disease detection and management: a call to action. Arch Intern Med. 2003;163(8):884-92.

Lijmer JG, Hunink MG, van den Dungen JJ, Loonstra J, Smit AJ. ROC analysis of noninvasive tests for peripheral arterial disease. Ultrasound Med Biol. 1996;22(4):391-8.

Ouriel K, Zarins CK. Doppler ankle pressure: an evaluation of three methods of expression. Arch Surg. 1982;117(10):1297-300.

Yao ST, Hobbs JT, Irivne WT. Ankle systolic pressure measurements in arterial disease affecting the lower extremities. Br J Surg. 1969;56(9):676-9.

Diehm C, Allenberg JR, Pittrow D. Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease. Circulation. 2009;120(21):2053-61.

Jelnes R, Gaardsting O, Hougaard Jensen K, Baekgaard N, Tønnesen KH, Schroeder T. Fate in intermittent claudication: outcome and risk factors. Br Med J (Clin Res Ed). 1986;293(6555):1137-40.

Dormandy J, Heeck L, Vig S. The natural history of claudication: risk to life and limb. Semin Vasc Surg. 1999;12(2):123-37.

Hooi JD, Kester AD, Stoffers HE, Rinkens PE, Knottnerus JA, van Ree JW. Asymptomatic peripheral arterial occlusive disease predicted cardiovascular morbidity and mortality in a 7-year follow-up study. J Clin Epidemiol. 2004;57(3):294-300.

Twine CP, Coulston J, Shandall A, McLain AD. Angioplasty versus stenting for superficial femoral artery lesions. Cochrane Database Syst Rev. 2009:CD006767.

Rooke TW, Hirsch AT, Misra S. 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2011;58(19):2020-45.

Dormandy JA, Rutherford RB. Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg. 2000;31(1 Pt 2):S1-296.

Leng GC, Lee AJ, Fowkers FG. Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral arterial disease in the general population. Int J Epidemiol. 1996;25(6):1172-81.

Golomb BA, Dang TT, Criqui MH. Peripheral arterial disease: morbidity and mortality implications. Circulation. 2006;114(7):688-99.

Dhaliwal G, Mukherjee D. Peripheral arterial disease: epidemiology, natural history, diagnosis and treatment. Int J Angiol. 2007;16(2):36-44.

Heald CL, Fowkes FG, Murray GD, Price JF. Risk of mortality and cardiovascular disease associated with the ankle-brachial index: systematic review. Atherosclerosis. 2006;189(1):61-9.

Newman AB, Shemanski L, Manolio TA. Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. The CARDIOVASCULAR Health Study Group. Arterioscler Thromb Vasc Biol. 1999;19(3):538-45.

Newman AB, Sutton-Tyrrell K, Vogt MT, Kuller LH. Morbidity and mortality in hypertensive adults with a low ankle/arm blood pressure index. JAMA. 1993;270(4):487-9.

Källerö KS. Mortality and morbidity in patients with intermittent claudication as defined by venous occlusion plethysmography. A ten-year follow-up study. J Chronic Dis. 1981;34(9-10):455-62.

Sungurtekin H, Sungurtekin U, Balci C, Zencir M, Erdem E. The influence of nutritional status on complications after major intraabdominal surgery. J Am Coll Nutr. 2004;23(3):227-32.

Weinsier RL, Hunker EM, Krumdieck CL, Butterworth Jr CE. Hospital malnutrition. A prospective evaluation of general medical patients during the course of hospitalization. Am J Clin Nutr. 1979;32(2):418-26.

Bistrian BR, Blackburn GL, Vitale J, Cochran D, Naylor J. Prevalence of malnutrition in general medical patients. JAMA. 1976;235(15):1567-70.

Duerksen DR, Keller HH, Vesnaver E. Physicians’ Perceptions regarding the detection and management of malnutrition in Canadian Hospitals: results of a Canadian Malnutrition Task Force Survey. JPEN J Parenter Enteral Nutr. 2015;39(4):410-7.

Anthony PS. Nutrition screening tools for hospitalized patients. Nutr Clin Pract. 2008;23(4):373-82.

Tsaousi G, Panidis S, Stavrou G, Tsouskas J, Panagiotou D, Kotzampassi K. Prognostic indices of poor nutritional status and their impact on prolonged hospital stay in a Greek university hospital. BioMed Res Int. 2014;2014:924270-8.

Thompson JS, Burrough CA, Green JL, Brown GL. Nutritional screening in surgical patients. J Am Diet Assoc. 1984;84(3):337-8.

Christensen KS, Gstundtner KM. Hospital-wide screening improves basis for nutrition intervention. J Am Diet Assoc. 1985;85(6):704-6.

Hannaman KN, Penner SF. A nutrition assessment tool that includes diagnosis. J Am Diet Assoc. 1985;85(5):607-8.

Identifying patients at risk: ADA’s definitions for nutrition screening and nutrition assessment. Council on Practice (COP) Quality Management Committee. J Am Diet Assoc. 1994;94(8):838-9.

Weekes CE, Elia M, Emery PW. The development, validation and reliability of a nutrition screening tool based on the recommendations of the British Association for Parenteral and Enteral Nutrition (BAPEN). Clin Nutr. 2004;23(5):1104-12.

de Jong PC, Wesdorp RI, Volovics A, Roufflart M, Greep JM, Soeters PB. The value of objective measurements to select patients who are malnourished. Clin Nutr. 1985;4(2):61-6.

Dempsey DT, Buzby GP, Mullen JL. Nutritional assessment in the seriously ill patient. J Am Coll Nutr. 1983;2(1):15-22.

Chang RW. Nutritional assessment using a microcomputer. 1. Programme design. Clin Nutr. 1984;3(2):67-73.

Chang RW, Richardson R. Nutritional assessment using a microcomputer. 2. Programme evaluation. Clin Nutr. 1984;3(2):75-82.

Detsky AS, McLaughlin JR, Baker JP. What is subjective global assessment of nutritional status?. JPEN J Parenter Enteral Nutr. 1987;11(1):8-13.

Faintuch J, Cohen RV, Machado MC, Pinotti HW. Subjective nutritional assessment of surgical patients with cancer. Preliminary results. Rev Paul Med. 1988;106(3):155-60.

Coppini LZ, Waitzberg DL, Ferrini MT, Silva ML, Gama-Rodrigues J, Ciosak SL. Comparison of the subjective global nutrition assessment x objective nutrition evaluation. Rev Assoc Med Bras. 1995;41(1):6-10.

Chakravarty C, Hazarika B, Goswami L, Ramasubban S. Prevalence of malnutrition in a tertiary care hospital in India. Indian J Crit Care Med. 2013;17(3):170-3.

Thieme RD, Cutchma G, Chieferdecker ME, Campos AC. Nutritional risk index is predictor of postoperative complications in operations of digestive system or abdominal wall?. Arq Bras Cir Dig. 2013;26(4):286-92.

Martineau J, Bauer JD, Isenring E, Cohen S. Malnutrition determined by the patient-generated subjective global assessment is associated with poor outcomes in acute stroke patients. Clin Nutr. 2005;24(6):1073-7.

Baccaro F, Moreno JB, Borlenghi C. Subjective global assessment in the clinical setting. JPEN J Parenter Enteral Nutr. 2007;31(5):406-9.

Secker DJ, Jeejeebhoy KN. Subjective global nutritional assessment for children. Am J Clin Nutr. 2007;85(4):1083-9.

Yamauti AK, Ochiai ME, Bifulco PS. Subjective global assessment of nutritional status in cardiac patients. Arq Bras Cardiol. 2006;87(6):772-7.

Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002;56(8):779-85.

Hasse J, Strong S, Gorman MA, Liepa G. Subjective global assessment: alternative nutrition-assessment technique for liver-transplant candidates. Nutrition. 1993;9(4):339-43.

Giryes S, Leibovitz E, Matas Z. Measuring Nutrition risk in hospitalized patients: MENU, a hospital-based prevalence survey. Isr Med Assoc J. 2012;14(7):405-9.

Moriana M, Civera M, Artero A. Validity of subjective global assessment as a screening method for hospital malnutrition. Prevalence of malnutrition in a tertiary hospital. Endocrinol Nutr. 2014;61(4):184-9.

Westvik TS, Krause LK, Pradhan S. Malnutrition after vascular surgery: are patients with chronic renal failure at increased risk?. Am J Surg. 2006;192(5):e22-7.

Eneroth M, Apelqvist J, Larsson J, Persson BM. Improved wound healing in transtibial amputees receiving supplementary nutrition. Int Orthop. 1997;21(2):104-8.

de Ulíbarri Pérez JI, González-Madroño Giménez A, González Pérez P. New procedure for the early detection and control of hospital malnutrition. Nutr Hosp. 2002;17(4):179-88.

Ferguson M, Capra S, Bauer J, Banks M. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition. 1999;15(6):458-64.

Reilly Jr JJ, Hull SF, Albert N, Waller A, Bringardener S. Economic impact of malnutrition: a model system for hospitalized patients. JPEN J Parenter Enteral Nutr. 1988;12(4):371-6.

Neumayer LA, Smout RJ, Horn HG, Horn SD. Early and sufficient feeding reduces length of stay and charges in surgical patients. J Surg Res. 2001;95(1):73-7.

Chandra RK, Kumari S. Nutrition and immunity: an overview. J Nutr. 1994;124(8^sSupl):1433S-5S.

Edington J, Boorman J, Durrant ER. Prevalence of malnutrition on admission to four hospitals in England. The Malnutrition Prevalence Group. Clin Nutr. 2000;19(3):191-5.

Herrmann FR, Safran C, Levkoff SE, Minaker KL. Serum albumin level on admission as a predictor of death, length of stay, and readmission.. Arch Intern Med. 1992;152(1):125-30.

Hill GL, Blackett RL, Pickford I. Malnutrition in surgical patients. An unrecognised problem. Lancet. 1977;1(8013):689-92.

Cederholm T, Jägrén C, Hellström K. Outcome of protein-energy malnutrition in elderly medical patients. Am J Med. 1995;98(1):67-74.

Sullivan DH, Walls RC. The risk of life-threatening complications in a select population of geriatric patients: the impact of nutritional status. J Am Coll Nutr. 1995;14(1):29-36.

Wells JL, Dumbrell AC. Nutrition and aging: assessment and treatment of compromised nutritional status in frail elderly patients. Clin Interv Aging. 2006;1(1):67-79.

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