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Vieira Maroun E, Argente Pla M, Pedraza Serrano MJ, Muresan BT, Ramos Prol A, Gascó Santana E, Martín Sanchis S, Durá De Miguel Á, Micó García A, Cebrián Vázquez A, Durbá Lacruz A, Merino-Torres JF. Phase Angle and Ultrasound Assessment of the Rectus Femoris for Predicting Malnutrition and Sarcopenia in Patients with Esophagogastric Cancer: A Cross-Sectional Pilot Study. Nutrients 2024; 17:91. [PMID: 39796524 PMCID: PMC11723315 DOI: 10.3390/nu17010091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 12/15/2024] [Accepted: 12/25/2024] [Indexed: 01/13/2025] Open
Abstract
BACKGROUND Disease-related malnutrition (DRM) and sarcopenia are prevalent conditions in gastrointestinal cancer patients, whose early diagnosis is essential to establish a nutritional treatment that contributes to optimizing adverse outcomes and improving prognosis. Phase angle (PhA) and rectus femoris ultrasound measurements are considered effort-independent markers of muscle wasting, which remains unrecognized in oncology patients. OBJECTIVE This study aimed to evaluate the potential utility of PhA, rectus femoris cross-sectional area (RFCSA), and rectus femoris thickness (RF-Y-axis) in predicting malnutrition and sarcopenia in patients with esophagogastric cancer (EGC). METHODS This was a cross-sectional study of patients diagnosed with EGC. PhA was obtained using bioelectrical impedance vector analysis (BIVA) along with ASMMI. The RFCSA and RF-Y-axis were measured using nutritional ultrasound (NU®). Muscle capacity was assessed using handgrip strength (HGS), and functionality by applying the Short Physical Performance Battery (SPPB). Malnutrition and sarcopenia were determined according to the GLIM and EWGSOP2 criteria, respectively. RESULTS Out of the 35 patients evaluated, 82.8% had malnutrition and 51.4% had sarcopenia. The RFCSA (r = 0.582) and RF-Y-axis (r = 0.602) showed significant, moderate correlations with ASMMI, unlike PhA (r = 0.439), which displayed a weak correlation with this parameter. However, PhA (OR = 0.167, CI 95%: 0.047-0.591, p = 0.006), RFCSA (OR = 0.212, CI 95%: 0.074-0.605, p = 0.004), and RF-Y-axis (OR = 0.002, CI 95%: 0.000-0.143, p = 0.004) all showed good predicting ability for sarcopenia in the crude models, but only the RF-Y-axis was able to explain malnutrition in the regression model (OR = 0.002, CI 95%: 0.000-0.418, p = 0.023). CONCLUSIONS The RF-Y-axis emerged as the only independent predictor of both malnutrition and sarcopenia in this study, likely due to its stronger correlation with ASMMI compared to PhA and RFCSA.
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Affiliation(s)
- Erika Vieira Maroun
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, Health Research Institute La Fe, 46026 Valencia, Spain; (E.V.M.); (J.F.M.-T.)
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
- Facultad Ciencias de la Salud, Universidad Europea de Valencia, 46010 Valencia, Spain;
| | - María Argente Pla
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, Health Research Institute La Fe, 46026 Valencia, Spain; (E.V.M.); (J.F.M.-T.)
- Endocrinology and Nutrition Department, La Fe University and Polytechnic Hospital in Valencia, 46026 Valencia, Spain; (A.R.P.); (E.G.S.); (S.M.S.); (Á.D.D.M.); (A.M.G.); (A.C.V.); (A.D.L.)
| | | | - Bianca Tabita Muresan
- Facultad Ciencias de la Salud, Universidad Europea de Valencia, 46010 Valencia, Spain;
| | - Agustín Ramos Prol
- Endocrinology and Nutrition Department, La Fe University and Polytechnic Hospital in Valencia, 46026 Valencia, Spain; (A.R.P.); (E.G.S.); (S.M.S.); (Á.D.D.M.); (A.M.G.); (A.C.V.); (A.D.L.)
| | - Eva Gascó Santana
- Endocrinology and Nutrition Department, La Fe University and Polytechnic Hospital in Valencia, 46026 Valencia, Spain; (A.R.P.); (E.G.S.); (S.M.S.); (Á.D.D.M.); (A.M.G.); (A.C.V.); (A.D.L.)
| | - Silvia Martín Sanchis
- Endocrinology and Nutrition Department, La Fe University and Polytechnic Hospital in Valencia, 46026 Valencia, Spain; (A.R.P.); (E.G.S.); (S.M.S.); (Á.D.D.M.); (A.M.G.); (A.C.V.); (A.D.L.)
| | - Ángela Durá De Miguel
- Endocrinology and Nutrition Department, La Fe University and Polytechnic Hospital in Valencia, 46026 Valencia, Spain; (A.R.P.); (E.G.S.); (S.M.S.); (Á.D.D.M.); (A.M.G.); (A.C.V.); (A.D.L.)
| | - Andrea Micó García
- Endocrinology and Nutrition Department, La Fe University and Polytechnic Hospital in Valencia, 46026 Valencia, Spain; (A.R.P.); (E.G.S.); (S.M.S.); (Á.D.D.M.); (A.M.G.); (A.C.V.); (A.D.L.)
| | - Anna Cebrián Vázquez
- Endocrinology and Nutrition Department, La Fe University and Polytechnic Hospital in Valencia, 46026 Valencia, Spain; (A.R.P.); (E.G.S.); (S.M.S.); (Á.D.D.M.); (A.M.G.); (A.C.V.); (A.D.L.)
| | - Alba Durbá Lacruz
- Endocrinology and Nutrition Department, La Fe University and Polytechnic Hospital in Valencia, 46026 Valencia, Spain; (A.R.P.); (E.G.S.); (S.M.S.); (Á.D.D.M.); (A.M.G.); (A.C.V.); (A.D.L.)
| | - Juan Francisco Merino-Torres
- Joint Research Unit on Endocrinology, Nutrition and Clinical Dietetics, Health Research Institute La Fe, 46026 Valencia, Spain; (E.V.M.); (J.F.M.-T.)
- Department of Medicine, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
- Endocrinology and Nutrition Department, La Fe University and Polytechnic Hospital in Valencia, 46026 Valencia, Spain; (A.R.P.); (E.G.S.); (S.M.S.); (Á.D.D.M.); (A.M.G.); (A.C.V.); (A.D.L.)
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Li XQ, Liang Y, Huang CF, Li SN, Cheng L, You C, Liu YX, Wang T. Advancements in nutritional diagnosis and support strategies during the perioperative period for patients with liver cancer. World J Gastrointest Surg 2024; 16:2409-2425. [PMID: 39220056 PMCID: PMC11362955 DOI: 10.4240/wjgs.v16.i8.2409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/27/2024] [Accepted: 06/24/2024] [Indexed: 08/16/2024] Open
Abstract
Liver cancer represents a grave hepatic condition and constitutes a significant global health concern. Surgical resection remains the principal therapeutic modality for liver cancer. Nevertheless, perioperative malnutrition exerts a notable impact on patients with liver cancer, emerging as an independent risk factor for disease mortality and adverse outcomes. Hence, precise nutritional diagnosis and timely nutritional support hold the potential to enhance therapeutic efficacy and quality of life for liver cancer patients. This study represents a meticulous foray into the literature, extracting data from PubMed, Web of Science, and EMBASE databases, with a focus on the past 5 years. It scrutinizes the impact of malnutrition on patients undergoing liver cancer surgery, the etiological underpinnings of malnutrition within this patient cohort, the critical assessment of perioperative nutritional status, and the strategic approaches to nutritional support. Utilizing rigorous inclusion and exclusion criteria, the amassed scholarly works are meticulously synthesized, methodically organized, and categorically elaborated upon. Ultimately, the authors propose the incorporation of a multidisciplinary nutrition management team during the perioperative period, comprising nutritionists, pharmacists, physicians, nurses, psychologists, and rehabilitation therapists, among other specialized professionals. Together, they collaborate to devise and implement personalized nutritional support plans, monitor patients' nutritional status, and make necessary adjustments as required. Through comprehensive management and intervention, improvements in the nutritional status of liver cancer patients can be achieved, thereby enhancing surgical success rates and facilitating postoperative recovery. It is believed that this manuscript will offer valuable insights to advance the nutritional management during the perioperative phase of liver cancer, aiding in ameliorating patients' nutritional status and treatment outcomes.
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Affiliation(s)
- Xiao-Qin Li
- Department of Hepatobiliary Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Yun Liang
- Department of Paediatric Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Chen-Feng Huang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Sui-Ning Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Jinan University, Guangzhou 510632, Guangdong Province, China
| | - Lei Cheng
- Department of Hepatobiliary Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Chuan You
- Department of Hepatobiliary Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Yao-Xia Liu
- Department of Geriatric Endocrinology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan Province, China
| | - Tao Wang
- Department of Pediatric Cardiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
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Jost N, Erickson N, Bratu E, Nasseh D, Morasch V, Kraus-Pfeiffer G, Heinemann V, Fey T. Closing the cancer care gap with a patient-reported nutrition screening: A retrospective analysis of a quality improvement project on an oncology ward (CCC study). Clin Nutr ESPEN 2023; 57:246-252. [PMID: 37739664 DOI: 10.1016/j.clnesp.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/22/2023] [Accepted: 06/25/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Early identification of patients at risk for malnutrition followed by individualized nutrition interventions is a central step to the provision of appropriate nutrition care. However, a health care professional (HCP)-based nutrition screening is not always consistently integrated into routine care. Patient-reported (PR) nutrition screening could thus potentially alleviate the burden on the HCPs and contribute to a greater number of patients who are identified and treated for malnutrition. METHODS In 2021 a Quality Improvement Project (QIP) at our out-patient oncology clinic was undertaken to implement the change from a HCP-based nutrition screening to a PR-screening. This was followed by a retrospective analysis in which the primary outcome measure was the rate of nutrition consultations initiated for patients undergoing cancer therapy. RESULTS In total n = 1657 patient data sets derived from comparable time periods before and after the QIP were analyzed and compared. Both groups had a comparable mean age and gender distribution. The most common diagnosis in both groups was gastrointestinal tumors. The change in routine care from a HCP-based nutrition screening to a PR-screening led to a significant increase in nutrition consultation rates (RD = 19%; p < 0.001; 95% CI 14.4%-23.5%) and screening rates (RD = 30.5%; p < 0.001; 95% CI 26.2%-34.7%). CONCLUSIONS The change to PR-screening potentially facilitates an increase in nutrition screening rates. This in turn leads to an increased rate of patients identified at risk for malnutrition and thus referrals for nutrition consultations. Our findings indicate that a PR nutrition screening tool could play a role in closing the care gap and contribute to reducing rates of malnutrition among this population where screening is not consistently integrated into routine care.
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Affiliation(s)
- Nicole Jost
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany.
| | - Nicole Erickson
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany
| | - Elena Bratu
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany
| | - Daniel Nasseh
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany
| | - Vinzenz Morasch
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany
| | - Gabriele Kraus-Pfeiffer
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany
| | - Volker Heinemann
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany; Department of Oncology and Hematology, Ludwig Maximilians University (LMU) Hospital, Munich, Germany
| | - Theres Fey
- Comprehensive Cancer Center (CCC Munich LMU), Ludwig Maximilians University (LMU) University Hospital, Munich, Germany
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Meissner C, Tiegges S, Broehl M, Otto R, Ridwelski K. International study on the prevalence of malnutrition in centralized care for colorectal cancer patients. Innov Surg Sci 2023; 8:83-92. [PMID: 38058781 PMCID: PMC10696944 DOI: 10.1515/iss-2023-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/24/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Patients with different diseases may show signs of malnutrition both before and during the hospital stay. The presence of malnutrition may impact the recovery and length of stay and consequently the costs. Early identification of malnutrition is thus a critical factor. The objective of this multicenter study is to determine the prevalence of malnutrition in colorectal cancer centers. Another objective is to investigate possible consequences, such as complications or length of stay. In addition, the study aims to demonstrate the relevance of nutrition management in colorectal cancer centers. At the same time, relevant requirements clearly demanded by the Certification Commission for Certified Colorectal Cancer Centers are met through implementation of the study. Methods Between 2019 and 2021, patients in colorectal cancer centers were examined in the preoperative phase. In addition to questions about patients' state of health and nutrition, the validated screening forms-Subjective Global Assessment (SGA) and Nutritional Risk Screening Tool 2002 (NRS 2002)-were used to assess malnutrition. The data were processed by univariate analysis. Results In total, data records of 3,102 patients were evaluated. The mean age of the participants was 68.5 ± 11.9 years, and their average body mass index (BMI) was 26.8 ± 5.3 kg/m2. The SGA questionnaire indicated that 23 % of the participants suffered from malnutrition and 38 % were at risk of malnutrition (NRS≥3). Malnutrition was found more frequently in patients with colorectal carcinomas than in patients with rectal carcinomas (53.1 vs. 32.1 %). The length of stay in hospital and the rate of complications were significantly higher when malnutrition was identified. Conclusions Approximately one in three to four patients with a colorectal carcinoma has an increased risk of malnutrition. The two screening methods calculated a different prevalence (23 and 38 %). Any malnutrition that is present demonstrably has a significant impact both on the rate of complications and the length of stay and may therefore have a decisive influence on the costs. The results of this multicenter study underscore the need for systematic screening for malnutrition and at the same time should increase clinics awareness of the importance of establishing a nutrition management policy.
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Affiliation(s)
- Carl Meissner
- An-Institut für Qualitätssicherung in der operativen Medizin gGmbH an der Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
- Medizinischen Versorgungszentrum „Im Altstadtquartier“ GmbH, Haus- und Facharztzentrum, Ambulantes Operationszentrum, Magdeburg, Germany
| | | | | | - Ronny Otto
- An-Institut für Qualitätssicherung in der operativen Medizin gGmbH an der Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
| | - Karsten Ridwelski
- Klinikum Magdeburg gGmbH, Klinik für Allgemein- und Viszeralchirurgie, Magdeburg, Germany
- An-Institut für Qualitätssicherung in der operativen Medizin gGmbH an der Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
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Lee BJ, Park JS, Kim HS, Yoon DS, Lim JH. Effect of early oral nutrition supplement using Encover in patients undergoing hepato-biliary-pancreatic surgery. Ann Hepatobiliary Pancreat Surg 2022; 26:244-250. [PMID: 35272269 PMCID: PMC9428429 DOI: 10.14701/ahbps.21-152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 12/02/2022] Open
Abstract
Backgrounds/Aims Early recovery after surgery has become a popular trend. The aim of this study was to evaluate effect of nutritional intervention using Encover, an oral nutritional supplement, in patients undergoing hepato-biliary-pancreatic surgery. Methods This single center, prospective case-control study was conducted in Gangnam Severance Hospital from September 2018 to April 2019. Through randomization, patients were divided into an experimental group (30 patients) and a control group (30 patients). At postoperative seven days, the experimental group was instructed to take two packs of Encover (JW Pharmaceutical, Seoul, Korea) daily for seven days. Body cell mass index was measured at seven days after surgery and 14 days after discharge and Patient-Generated Subjective Global Assessment (PG-SGA) was performed at 14 days after discharge. Results Body cell mass index during outpatient follow-up was significantly decreased compared to that at discharge in both groups. However, the amount of body cell mass index showed no significant difference between postoperative seven days and outpatient follow- up in either group. During outpatient follow-up, the experimental group had a higher mean value of PG-SGA score than the control group (11.32 ± 3.46 vs. 9.48 ± 3.97; p = 0.037). Conclusions Short-term Encover doses after surgery may not produce significant results in weight gain or other body cell mass index. Encover did not significantly affect other dietary conditions based on PG-SGA.
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Affiliation(s)
- Byeong Jun Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Seong Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Sun Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Sup Yoon
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Hong Lim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Crestani MS, Grassi T, Steemburgo T. Methods of nutritional assessment and functional capacity in the identification of unfavorable clinical outcomes in hospitalized patients with cancer: a systematic review. Nutr Rev 2021; 80:786-811. [PMID: 34850196 DOI: 10.1093/nutrit/nuab090] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Malnutrition has a negative impact on patients with cancer. Identifying risk, nutritional status, and functional capacity can contribute to adequate and early nutritional therapy, which can reduce unfavorable clinical outcomes. OBJECTIVE To evaluate and summarize the main instruments of nutritional assessment and functional capacity and associate their results with clinical outcomes in hospitalized patients with cancer. DATA SOURCES A systematic search was performed in the PubMed/MEDLINE, Embase, SciELO, and LILACS databases. Studies in which researchers evaluated and compared screening, nutritional assessment, and functional capacity instruments and their associations with clinical outcomes were included. DATA EXTRACTION The data were extracted by 2 independent reviewers. RESULTS A total of 29 studies met the inclusion criteria (n = 20 441 individuals). The Nutritional Risk Screening-2002 (NRS-2002) and Patient-Generated Subjective Global Assessment (PG-SGA) were the most common tools used for nutritional assessment. High nutritional risk according to the NRS-2202 and worse nutritional status according to the PG-SGA and Subjective Global Assessment were positively associated with a longer hospital stay and mortality. Low functional capacity, according to handgrip strength, was associated with longer hospital stay and nutrition impact symptoms. CONCLUSIONS Tools such as the NRS-2002, PG-SGA, Subjective Global Assessment, and handgrip strength assessment are efficacious for assessing unfavorable clinical outcomes in hospitalized patients with cancer.
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Affiliation(s)
- Mariana S Crestani
- M.S. Crestani, T. Grassi, and T. Steemburgo are with the Postgraduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. M.S. Crestani and T. Steemburgo are with Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. T. Steemburgo is with Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Thaiciane Grassi
- M.S. Crestani, T. Grassi, and T. Steemburgo are with the Postgraduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. M.S. Crestani and T. Steemburgo are with Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. T. Steemburgo is with Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Thais Steemburgo
- M.S. Crestani, T. Grassi, and T. Steemburgo are with the Postgraduate Program in Food, Nutrition, and Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. M.S. Crestani and T. Steemburgo are with Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. T. Steemburgo is with Department of Nutrition, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Huong LT, Phuong DT, Anh DK, Toi PL, Anh NLT, Huy TL, Linh NT. Nutritional Intervention Improves Nutrition Outcomes in Stomach and Colon Cancer Patients Receiving Chemotherapy: Finding from a Quasi-Experiment in Vietnam. Healthcare (Basel) 2021; 9:healthcare9070843. [PMID: 34356221 PMCID: PMC8304715 DOI: 10.3390/healthcare9070843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/17/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Evidence on the effects of nutritional interventions on gastrointestinal cancer patients receiving chemotherapy is not well documented. This study aims to assess the effects of nutritional intervention in patients diagnosed with stomach and colon cancer receiving chemotherapy in Vietnam. Methods: A quasi-experiment with intervention and control groups for pre- and post-intervention was carried out in cancer patients receiving chemotherapy in a university hospital in Vietnam. Patients in the intervention group were provided nutritional counseling, personalized specific dietary advice, and received oral nutrition supplements (ONSs) while patients in the control group only received nutrition counseling. Results: The weight in the intervention and control group after 2 months increased significantly by 1.4 ± 2.6 kg and 0.4 ± 2.3 kg, respectively. Muscle mass increased by 1.2 ± 4.1 cm in the intervention group, while those in the control group decreased by 0.55 ± 2.77 cm. There was no statistical significance between two groups after intervention in terms of Mid–Upper Arm Circumference (MUAC) and percentage of fat. The percentage of malnutrition based on the Scored Patient-Generated Subjective Global Assessment (PG-SGA) and Body Mass Index (BMI) declined after the intervention in both groups. According to the average treatment effect on the treated (ATT) using the propensity score matching and DiD method, participants receiving the intervention were more likely to have a higher score of weight (Coef = 0.84; 95%CI = 0.47; 2.16) and muscle mass (Coef = 1.08; 95%CI = 0.09; 2.06) between pre- and post-intervention. By contrast, the PG-SGA scores on treated participants were more likely to decrease after the intervention (Coef = −1.28; 95%CI = −4.39; −0.84). After matching, being female, living in rural areas, or having stomach cancer were still positively related to being moderately/severely malnourished by the PG-SGA, and these findings were statistically significant (p < 0.05). Conclusion: The nutritional interventions had a positive effect on weight gain, muscle mass, and reduced malnutrition. Further studies with a longer follow-up duration are needed to confirm the effects of the intervention.
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Affiliation(s)
- Le Thi Huong
- Nutrition and Dietetics Department, Hanoi Medical University Hospital, Hanoi 10000, Vietnam; (L.T.H.); (N.T.L.)
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 10000, Vietnam; (D.K.A.); (N.L.T.A.)
| | - Duong Thi Phuong
- Nutrition and Dietetics Department, Hanoi Medical University Hospital, Hanoi 10000, Vietnam; (L.T.H.); (N.T.L.)
- Correspondence:
| | - Dang Kim Anh
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 10000, Vietnam; (D.K.A.); (N.L.T.A.)
| | - Phung Lam Toi
- Health Strategy and Policy Institute, Ministry of Health, Hanoi 10000, Vietnam;
| | - Nguyen Le Tuan Anh
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 10000, Vietnam; (D.K.A.); (N.L.T.A.)
| | - Trinh Le Huy
- Oncology Department, Hanoi Medical University, Hanoi 10000, Vietnam;
| | - Nguyen Thuy Linh
- Nutrition and Dietetics Department, Hanoi Medical University Hospital, Hanoi 10000, Vietnam; (L.T.H.); (N.T.L.)
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 10000, Vietnam; (D.K.A.); (N.L.T.A.)
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Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study). Support Care Cancer 2021; 29:7715-7724. [PMID: 34159428 PMCID: PMC8549920 DOI: 10.1007/s00520-021-06351-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/08/2021] [Indexed: 01/04/2023]
Abstract
Abstract Patient-reported outcome measures obtained via E-Health tools ease the assessment burden and encourage patient participation in cancer care (PaCC Study) Background E-health based patient-reported outcome measures (PROMs) have the potential to automate early identification of both nutrition status and distress status in cancer patients while facilitating treatment and encouraging patient participation. This cross-sectional study assessed the acceptability, accuracy, and clinical utility of PROMs collected via E-Health tools among patients undergoing treatment for stomach, colorectal, and pancreatic tumors. Results Eight-nine percent mostly, or completely, agreed that PROMs via tablets should be integrated in routine clinical care. Men were significantly more likely to require help completing the questionnaires than women (inv.OR= 0.51, 95% CI=(0.27, 0.95), p = 0.035). The level of help needed increased by 3% with each 1-year increase in age (inv. OR=1.03, 95% CI=(1.01, 1.06), p = 0.013). On average, a patient tended to declare weight which was 0.84 kg inferior to their true weight (Bland and Altman 95 % CI=(-3.9, 5.6); SD: 2.41) and a height which was 0.95 cm superior to their true height (Bland and Altman 95 % CI=(−5, 3.1); SD 2.08). Patient-reported nutrition status was significantly associated with the professionally generated assessment (95% CI=(2.27, 4.15), p < 0.001). As nutrition status declined, the distress score increased (95%CI=(0.88, 1.68), p < 0.001). Of the patients, 48.8% who were both distressed and malnourished requested supportive care to address their problems. Conclusion Patient-reported assessments utilizing E-health tools are an accurate and efficient method to encourage patient participation in cancer care while simultaneously ensuring that regular assessment of psycho-social and nutritional aspects of care are efficiently integrated in the daily clinical routine.
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Nutritional Status in Patients with Medication-Related Osteonecrosis of the Jaw (MRONJ). Nutrients 2021; 13:nu13051585. [PMID: 34068498 PMCID: PMC8151518 DOI: 10.3390/nu13051585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 12/20/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe side effect of mostly antiresorptive drugs. The aim of this prospective clinical study was to evaluate the nutritional status in MRONJ patients scheduled for surgical treatment (intraoral soft tissue closure). The following parameters were evaluated: body weight, body height, BMI, nutritional risk index (NRI), bioelectric impedance analysis (BIA), vitamins A, B12, D3, E, K1, folic acid, iron, total protein, transferrin, ferritin, prealbumin, albumin, and zinc. All subjects were admitted to hospital four to five days before surgery and sip-fed with Nutritia Fortimel Compact Protein in addition to regular oral food intake. During surgery, a nasogastric tube was inserted and only removed on hospital discharge five days postoperatively. A total of 58 patients could be included. Half of the MRONJ patients were identified to be at risk for malnutrition. Deficiencies regarding protein levels were revealed, whereas hardly any relevant deficits of micronutrients were noted. The intraoral wound healing four weeks post-surgery was highly satisfactory with a low dehiscence rate of intraoral mucosal sites. Of all parameters analyzed, the dehiscence rate at the last follow-up four weeks post-surgery was significantly influenced by vitamin K, transferrin, and ferritin levels (p = 0.030, p = 0.004, and p = 0.023, respectively). In conclusion, perioperative dietary counselling and appropriate nutritional therapy are important supportive measures in MRONJ patients scheduled for intraoral soft tissue closure.
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10
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Chen Y, Xiang Q, Li C, Zeng Y, Dong J, Zhang P, Li Y, Wang Y, Wang K. Nutritional Risk and Assessment for Patients with Cancer Pain. Nutr Cancer 2021; 74:168-174. [PMID: 33570437 DOI: 10.1080/01635581.2021.1882510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The incidence of nutritional risk and malnutrition are high in patients with cancer pain. It is very important to choose an effective tool to identify these patients promptly. However, few studies have discussed this issue. The primary objective of this study is to clarify the similarities and differences between the two nutritional screening and assessment tools, and to estimate the anthropometry and biochemical indicators of the patients with cancer pain, with a view to provide help for treatment of these patients. METHOD Data of 146 patients with cancer pain were collected from August 2018 to May 2019 in the Pain Therapy Department of Tianjin Cancer Hospital. The information of numerical rating scale (NRS), nutritional risk screening-2002 (NRS-2002), patient-generated subjective global assessment (PG-SGA), anthropometry and biochemical indicators were collected for pain assessment, nutritional risk screening, and nutritional status assessment. RESULTS NRS scores had a positive correlation with NRS-2002 (R = 0.273, P = 0.001) and PG-SGA (R = 0.341, P = 0.000) separately. NRS-2002 and PG-SGA had a significant positive correlation with each other (R = 0.468, P = 0.000). NRS-2002 was finished in a shorter time period (4.2 ± 0.8 min vs. 12.8 ± 0.8 min, P = 0.001), while PG-SGA had a higher detection rate of malnutrition (86.3% vs. 65.8%). In the stepwise multiple regression analysis, NRS (0.258, P = 0.001), PA (-0.297, P = 0.000), TP (0.178, P = 0.030) are the indicators of NRS-2002; and NRS (0.317, P = 0.000), PA (β = 0.288, P = 0.000) and BMI (-0.281, P = 0.000) are the related variables of PG-SGA. The kappa coefficient was lower than 0.4 (kappa value = 0.396) when choosing the score of NRS-2002 ≥ 3 and PG-SGA ≥ 9 as the diagnostic criteria. If choosing the score of NRS-2002 ≥ 2 and PG-SGA ≥ 9, both the correlation coefficient (R = 0.699, P = 0.000) and the kappa coefficient (kappa value = 0.698, P = 0.000) became more coefficient. CONCLUSIONS Both NRS-2002 and PG-SGA could identify patients with nutritional risk and malnutrition accurately. NRS-2002 is simpler and takes less time to finish, while PG-SGA is more cumbersome with a higher detection rate of malnutrition. NRS, PA, TP and BMI are the most important reference indicators predicting on nutritional risk index and malnutrition status. We recommend NRS-2002 ≥ 2 as the diagnostic criteria in order to avoid missing the patients with nutritional risk.
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Affiliation(s)
- Yajun Chen
- Department of Nutrition, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Qi Xiang
- Department of Nutrition, Tianjin Nankai Hospital, Tianjin, China
| | - Chunlei Li
- Department of Nutrition, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yaqi Zeng
- Department of Nutrition, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jie Dong
- Department of Nutrition, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Ping Zhang
- Department of Nutrition, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yueying Li
- Department of Nutrition, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yujie Wang
- Department of Nutrition, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Kun Wang
- Department of Nutrition, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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11
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Sonneborn-Papakostopoulos M, Dubois C, Mathies V, Heß M, Erickson N, Ernst T, Huebner J. Quality of life, symptoms and dietary habits in oncology outpatients with malnutrition: A cross-sectional study. Med Oncol 2021; 38:20. [PMID: 33543336 PMCID: PMC7862192 DOI: 10.1007/s12032-021-01460-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/01/2021] [Indexed: 01/06/2023]
Abstract
Cancer-related malnutrition has a high prevalence, reduces survival and increases side effects. The aim of this study was to assess oncology outpatients and risk of malnutrition. Reported symptoms and quality of life (QoL) in patients found to be at risk of malnutrition or malnourished were compared to patients without malnutrition. Using a standardized questionnaire, the European Organization for Research and Treatment of Cancer Questionnaire for Quality of Life and the Mini Nutritional Assessment (MNA), patients in an outpatient cancer clinic undergoing chemotherapy treatment at a German University Hospital were assessed for nutrition, risk of malnutrition and quality of life. Based on the MNA, 39 (45.9%) patients were categorized as malnourished or at risk for malnutrition. Loss of appetite (n = 37.6%, p < 0.001) and altered taste sensation (n = 30,3%, p < 0.001) were the symptoms most frequently associated with reduced food intake. Patients with risk of malnutrition scored lower on the global health status (n = 48.15%, p = 0.001). Side effects of cancer treatments lead to a higher risk of malnutrition and as a consequence lower QoL. These side effects should be addressed more efficiently in cancer care.
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Affiliation(s)
| | - Clara Dubois
- Klinik für Innere Medizin II, University Hospital Jena, Jena, Germany
| | - Viktoria Mathies
- UniversitätsTumorCentrum Jena, University Hospital Jena, Bachstraße 18, 07743, Jena, Germany.
| | - Mara Heß
- Klinik für Innere Medizin II, University Hospital Jena, Jena, Germany
| | - Nicole Erickson
- Comprehensive Cancer Center CCCLMU, Ludwig-Maximilian University Clinic, Munich, Germany
| | - Thomas Ernst
- Klinik für Innere Medizin II, University Hospital Jena, Jena, Germany
| | - Jutta Huebner
- Klinik für Innere Medizin II, University Hospital Jena, Jena, Germany
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12
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Tsai YT, Lai CH, Huang TH, Hsieh CC, Huang EI, Lee YC, Yeh HK, Tsai MS, Chang GH, Hsu CM. Association of malnutrition with postoperative complication risk after curative surgery for oral cancer: Observational study. Medicine (Baltimore) 2020; 99:e23860. [PMID: 33350779 PMCID: PMC7769301 DOI: 10.1097/md.0000000000023860] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 11/21/2020] [Indexed: 02/02/2023] Open
Abstract
Malnutrition is common among patients who have oral cavity squamous cell carcinoma (OSCC), but its effect on the incidence of postoperative complications remains uncertain. Validated nutrition and complication assessment tools were used to evaluate the effects of nutrition on the likelihood of postoperative complications after curative surgery for OSCC.A retrospective study that spanned January 2014 to December 2018 enrolled 70 patients who received curative surgery for OSCC. Nutritional status before surgery was evaluated with the scored Patient-Generated Subjective Global Assessment (PG-SGA), and patients were classified as either well-nourished (rating A) or malnourished (ratings B and C). Complications 30 days after the operation were graded using Clavien-Dindo classification. The perioperative clinicopathological characteristics of the groups were compared, and risk factors for postoperative complications were identified through logistic regression.A total of 44 (62.8%) patients formed the malnourished group, and they tended to be older (P = .03), weigh less (P = .001), have lower Body Mass Index (P = .003), higher PG-SGA scores (P < .001), higher neutrophil-to-lymphocyte ratio (P = .034), more postoperative complications (P < .001), and longer hospital stays (P = .021). Major complications (Clavien-Dindo classification ≥ IIIa) were experienced by 18.5% (n = 13) of patients and were more common in the malnourished group (P = .007). Multivariate logistic regression demonstrated that PG-SGA score ≥4 was an independent risk factor for postoperative complications (hazard ratio = 4.929, P = .008).Malnutrition defined using the PG-SGA is an independent risk factor for postoperative complications of curative surgery in patients with OSCC. More prospective studies are warranted to confirm our findings.
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Affiliation(s)
- Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery
| | | | - Tzu-Hao Huang
- Department of Surgery, Chang Gung Memorial Hospital, Chiayi
| | | | | | - Yi-Chan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung
| | - Hsuan-Keng Yeh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | | | - Geng-He Chang
- Department of Otorhinolaryngology-Head and Neck Surgery
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13
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Impact of Artificial Nutrition on Postoperative Complications. Healthcare (Basel) 2020; 8:healthcare8040559. [PMID: 33327483 PMCID: PMC7764968 DOI: 10.3390/healthcare8040559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 12/26/2022] Open
Abstract
Malnutrition is common in surgical cancer patients and it is widely accepted that it can adversely affect their postoperative outcome. Assessing the nutritional status of every patient, in particular care of elderly and cancer patients, is a crucial feature of the therapeutic pathway in order to optimize every strategy. Evidence exists that the advantages of perioperative nutrition are more significant in malnourished patients submitted to major surgery. For patients recognized as malnourished, preoperative nutrition therapies are indicated; the choice between parenteral and enteral nutrition is still controversial in perioperative malnourished surgical cancer patients, although enteral nutrition seems to have the best risk–benefit ratio. Early oral nutrition after surgery is advisable, when feasible, and should be administered in all the patients undergoing elective major surgery, if compliant. In patients with high risk for postoperative infections, perioperative immunonutrition has been proved in some ways to be effective, even if operations including those for cancer have to be delayed.
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14
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Santos IM, Mendes L, Carolino E, Santos CA. Nutritional Status, Functional Status, and Quality of Life - What is the Impact and Relationship on Cancer Patients? Nutr Cancer 2020; 73:2554-2567. [PMID: 33121266 DOI: 10.1080/01635581.2020.1839520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
RATIONALE AND AIMS Malnutrition is common and multifactorial in cancer patients (CP), combining the systemic inflammatory process with decreased food intake, loss of muscle and bone mass, and decreased functional status (FS). We aimed to track and evaluate the nutritional status (NS) of CP; associate results between hospitalized patients (HP) and day hospital patients (DHP); associate NS with tumor, symptoms, and FS. METHODS Cross-sectional observational study in HP or DHP from Garcia de Orta Hospital, over 18 years old. NS was monitored and evaluated using Nutritional Risk Screening (NRS-2002), Patient-Generated Subjective Global Assessment (PG-SGA), and anthropometric and biochemical parameters. To assess FS we used the Eastern Cooperative Oncology Group (ECOG), Karnofsky Performance Scale Index (KPSI), and handgrip dynamometer (HGD). RESULTS The 265 CP (114-HP, 151-DHP), of which 34.2%-HP and 17.2%-DHP had low BMI. From NRS-2002, 86.0% and 35.8% were respectively at nutritional risk. Using PG-SGA, 93.0% and 39.7% were respectively malnourished. PG-SGA were positively correlated with ECOG (p < 0.01) and negatively correlated with KPSI (p < 0.01), BMI (p < 0.01), and handgrip strength-HGS (p < 0.01-DHP and p < 0.05-HP). CONCLUSIONS PG-SGA and FS scales are appropriate and validated tools for early identification of malnutrition and FS in CP. HGD can be a useful tool for assessing FS and NS.
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Affiliation(s)
- Inês Miranda Santos
- Dietetics and Nutrition, Lisbon School of Health Technology, Lisbon, Portugal
| | - Lino Mendes
- Dietetics and Nutrition, Lisbon School of Health Technology, Lisbon, Portugal.,H&TRC (Health and Technology Research Center), Lisbon, Portugal
| | - Elisabete Carolino
- Department of Natural and Exact Sciences - Mathematical Science Area, Lisbon School of Health Technology, Lisbon, Portugal
| | - Carla Adriana Santos
- H&TRC (Health and Technology Research Center), Lisbon, Portugal.,Nutrition Department & GENE (Enteral Feeding Team), Garcia de Orta Hospital, Lisbon, Portugal
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15
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Nutritional screening tools for adult cancer patients: A hierarchical Bayesian latent-class meta-analysis. Clin Nutr 2020; 40:1733-1743. [PMID: 33041089 DOI: 10.1016/j.clnu.2020.09.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/20/2020] [Accepted: 09/24/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Cancer treatment requires attentiveness to its broader effect on the body. Cancer's effect on appetite, strength, and body composition is contained in the summary term malnutrition. The tools used to detect malnutrition are a critical part of effective cancer care. In clinical care, selection of any specific tool is random. The relative validity of these tools have not been systematically compared. Using hierarchical Bayesian latent-class meta-analysis methods, this report compares three tools used for adult cancer patients - the Mini Nutritional Assessment (MNA), the Nutritional Risk Screening 2002 (NRS-2002) and the Patient Generated Subjective Global Assessment (PG-SGA). METHOD Drawing from English and Chinese language databases, a broad pool of eligible studies were identified for further selection and assessment. Using the hierarchical summary receiver operating characteristic (HSROC) model, pooled sensitivity, specificity, and other measurements the accuracy of the three tools were compared. RESULT A total of 37 eligible studies involving the MNA, NRS-2002 and PG-SGA were included in this meta-analysis. The pooled sensitivity was 0.910 (95% CI: 0.763 to 0.970) for MNA, 0.747 (95% CI: 0.680 to 0.804) for NRS-2002, and 0.964 (95% CI: 0.913 to 0.986) for PG-SGA. The pooled specificity was 0.720 (95% CI: 0.623 to 0.800) for MNA, 0.854 (95% CI: 0.808 to 0.891) for NRS-2002, 0.905 (95% CI: 0.807 to 0.956) for PG-SGA, respectively. The back-calculated likelihood ratio (LR) showed that MNA had a low negative likelihood ratio (LR-), NRS-2002 corresponded to a high positive likelihood ratio (LR+) and PG-SGA represented the best LR+ and LR-. CONCLUSIONS While there is no standard approach to assessment of malnutrition, the PG-SGA has the best diagnostic performance with cancer patients. Further work is needed to refine the utility of these tools in larger clinical samples.
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16
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Pan X, Wang C, Li R, Su L, Zhang M, Cai C, Liu S, Zhang W, Song J, Hong J. Applicability of the Nutrition Risk Screening 2002 Combined with a Patient-Generated Subjective Global Assessment in Patients with Nasopharyngeal Carcinoma. Cancer Manag Res 2020; 12:8221-8227. [PMID: 32982418 PMCID: PMC7489935 DOI: 10.2147/cmar.s261945] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/02/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose This study aims to explore the applicability of the Nutrition Risk Screening 2002 (NRS2002) tool in screening nutritional risk and the Patient-Generated Subjective Global Assessment (PG-SGA) in determining nutrition status in nasopharyngeal carcinoma (NPC) patients. Materials and Methods NRS2002 and PG-SGA were simultaneously applied to evaluate the nutritional status of NPC patients before induction chemotherapy, as well as before and after radiotherapy. The PG-SGA results were considered golden standard in evaluating nutrition status, and the ROC curve value and Youden index were applied to analyze NRS2002 effectiveness in screening nutritional risk. Results A total of 102 NPC patients were included in this study. Patients with an NRS2002 score <3 and PG-SGA score ≥4 accounted for 5.3% (5/95), 19.6% (18/92) and 94.8% (36/38) at the time before induction chemotherapy, before radiotherapy and at the end of radiotherapy, respectively. The cut-off values of NRS2002 scores all <2 corresponded to the maximum Youden index at the three procedural times. And the area under curve (AUC) were 0.598 (P = 0.390), 0.665 (P = 0.015) and 0.940 (P = 0.034), respectively. At the end of radiotherapy, NRS2002 scores of <3 and <2 were used as cut-off values for nutritional risk screening, respectively. Additionally, the malnutrition-missed detection rates were 36.0% and 12.0% (χ2 = 15.789; P <0.001). Discussion NRS2002 nutritional risk screening combined with the PG-SGA nutritional assessment has certain applicability in NPC. NRS2002 score ≥2 can be considered as a new cut-off point for nutritional assessment.
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Affiliation(s)
- Xiaoxian Pan
- Department of Radiotherapy, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Caihong Wang
- Department of Radiotherapy, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Rong Li
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Li Su
- Department of Radiotherapy, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Key Laboratory of Radiation Biology (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, People's Republic of China.,Fujian Provincial Key Laboratory of Precision Medicine for Cancer, Fuzhou, Fujian, People's Republic of China
| | - Mingwei Zhang
- Department of Radiotherapy, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Key Laboratory of Radiation Biology (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, People's Republic of China.,Fujian Provincial Key Laboratory of Precision Medicine for Cancer, Fuzhou, Fujian, People's Republic of China
| | - Chuanshu Cai
- Department of Radiotherapy, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Key Laboratory of Radiation Biology (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, People's Republic of China.,Fujian Provincial Key Laboratory of Precision Medicine for Cancer, Fuzhou, Fujian, People's Republic of China
| | - Shiping Liu
- Department of Radiotherapy, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Weijian Zhang
- Department of Radiotherapy, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Key Laboratory of Radiation Biology (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, People's Republic of China.,Fujian Provincial Key Laboratory of Precision Medicine for Cancer, Fuzhou, Fujian, People's Republic of China
| | - Jihong Song
- The School of Nursing, Fujian Medical University, Fuzhou, Fujian, People's Republic of China
| | - Jinsheng Hong
- Department of Radiotherapy, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, People's Republic of China.,Key Laboratory of Radiation Biology (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, People's Republic of China.,Fujian Provincial Key Laboratory of Precision Medicine for Cancer, Fuzhou, Fujian, People's Republic of China
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17
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Von Geldern P, Salas C, Alvayay P, Silva C, de la Maza MP. Nutritional assessment by subjective methods versus computed tomography to predict survival in oncology patients. Nutrition 2020; 84:111006. [PMID: 33051113 DOI: 10.1016/j.nut.2020.111006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the association between survival and two validated methods of nutritional assessment: body composition through computed tomography (CT) scans and Patient-Generated Subjective Global Assessment (PG-SGA). METHODS Cancer-bearing patients (n = 103) hospitalized in the Oncology Ward of Clínica Alemana in Santiago, Chile, for palliative or curative treatment were assessed by both methods. Images from abdominal CT scans at the L3 level were analyzed by SliceOmatic (version 5.0), to measure muscle and fat areas and densities. Skeletal muscle mass index (MMI) was calculated using total abdominal mass area (psoas + rest of muscles)/ height2. These were compared with those obtained for assessment of trauma of 130 healthy young adults (18-40 y of age), as reference control values. Sarcopenia was established as MMI<1 SD compared with control participants. RESULTS Patients with cancer had less muscle and higher abdominal fat areas compared with controls (P < 0.05). According to the PG-SGA, ~50% were classified as malnourished. Patients were followed for 38 mo, when 53% had died. Survival time was significantly and negatively correlated with PG-SGA score, cancer stage, and sarcopenia, independent of age and sex. Multivariate analysis included both cancer stage and nutritional assessment variables. CONCLUSIONS Together with cancer stage, both CT measurements and subjective assessment of nutritional status through PG-SGA can adequately identify cancer patients with a higher mortality risk, independent of age and sex. However, the latter is less costly and simple to use; it should be included as a valuable tool during management of patients with cancer.
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Affiliation(s)
- Paula Von Geldern
- School of Nutrition and Dietetics, Mayor University, Santiago, Chile; Institute of Nutrition & Food Technology Dr. Fernando Monckeberg Barros (INTA), University of Chile, Santiago, Chile
| | - Claudio Salas
- Clínica Alemana of Santiago, Faculty of Medicine, Del Desarrollo University (UDD), Santiago, Chile
| | - Pablo Alvayay
- Clínica Alemana of Santiago, Faculty of Medicine, Del Desarrollo University (UDD), Santiago, Chile
| | - Claudio Silva
- Clínica Alemana of Santiago, Faculty of Medicine, Del Desarrollo University (UDD), Santiago, Chile
| | - Maria Pía de la Maza
- Institute of Nutrition & Food Technology Dr. Fernando Monckeberg Barros (INTA), University of Chile, Santiago, Chile; Clínica Alemana of Santiago, Faculty of Medicine, Del Desarrollo University (UDD), Santiago, Chile.
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18
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Ni J, Zhang L. Cancer Cachexia: Definition, Staging, and Emerging Treatments. Cancer Manag Res 2020; 12:5597-5605. [PMID: 32753972 PMCID: PMC7358070 DOI: 10.2147/cmar.s261585] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/26/2020] [Indexed: 12/26/2022] Open
Abstract
Cachexia is a multifactorial disease characterized by weight loss via skeletal muscle and adipose tissue loss, an imbalance in metabolic regulation, and reduced food intake. It is caused by factors of catabolism produced by tumors in the systemic circulation as well as physiological factors such as the imbalanced inflammatory activation, proteolysis, autophagy, and lipolysis that may occur with gastric, pancreatic, esophageal, lung cancer, liver, and bowel cancer. Cancer cachexia not only negatively affects the quality of life of patients with cancer but also reduces the effectiveness of anti-cancer chemotherapy and increases its toxicity, leading to increased cancer-related mortality and expenditure of medical resources. Currently, there are no effective medical interventions to completely reverse cachexia and no approved drugs. Adequate nutritional support is the main method of cachexia treatment, while drugs that target the inhibition of catabolism, cell damage, and excessive activation of inflammation are under study. This article reviews recent advances in the diagnosis, staging, and evaluation of cancer cachexia.
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Affiliation(s)
- Jun Ni
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, People's Republic of China
| | - Li Zhang
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, People's Republic of China
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Abstract
Cancer occurs most frequently in patients aged 65 and older. With the increasing age of the world's population, there will be a significant increase in cancer diagnoses in older adults. Aging imposes a wide variety of physiological responses, comorbidities, and ailments, but older patients are less represented in clinical studies. Specific needs of older patients with cancer often go under-recognized and consequently unmet. In this review, common diagnoses that can affect the outcomes of this population, including frailty, malnutrition, and delirium, are discussed. Areas that need further research to improve the care of geriatric cancer patients, particularly in the hospital settings, are also identified.
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Affiliation(s)
- Anne M Meehan
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Lena Kassab
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Haixia Qin
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
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20
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Yang D, Zheng Z, Zhao Y, Zhang T, Liu Y, Xu X. Patient-generated subjective global assessment versus nutritional risk screening 2002 for gastric cancer in Chinese patients. Future Oncol 2019; 16:4475-4483. [PMID: 31793364 DOI: 10.2217/fon-2019-0539] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Aim: Patient-Generated Subjective Global Assessment (PG-SGA) and Nutritional Risk Screening 2002 (NRS2002) are used to evaluate patients' nutritional status. Materials & methods: The data of 114 gastric cancer patients with pyloric obstruction treated between July 2016 and July 2017 were assessed retrospectively. Results: Based on clinical evaluation, 70.1% had malnutrition, with 61.4% at nutritional risk by NRS2002 and 66.7% by PG-SGA. The area under the receiver operating characteristic curve was 0.858 for PG-SGA and 0.706 for NRS2002. Sensitivity and specificity were 89 and 85% for PG-SGA and 78 and 76% for NRS2002. In both assessments, patients at risk showed more postoperative complications. Conclusion: PG-SGA was more suitable for evaluating the preoperative nutritional status of gastric cancer patients with pyloric obstruction, with higher diagnostic efficacy.
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Affiliation(s)
- Dong Yang
- Department of Gastrosurgery, Liaoning Cancer Hospital & Institute, Shenyang, PR China
| | - Zhichao Zheng
- Department of Gastrosurgery, Liaoning Cancer Hospital & Institute, Shenyang, PR China
| | - Yan Zhao
- Department of Gastrosurgery, Liaoning Cancer Hospital & Institute, Shenyang, PR China
| | - Tao Zhang
- Department of Gastrosurgery, Liaoning Cancer Hospital & Institute, Shenyang, PR China
| | - Yong Liu
- Department of Gastrosurgery, Liaoning Cancer Hospital & Institute, Shenyang, PR China
| | - Xing Xu
- Department of Gastrosurgery, Liaoning Cancer Hospital & Institute, Shenyang, PR China
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21
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Muscaritoli M, Arends J, Aapro M. From guidelines to clinical practice: a roadmap for oncologists for nutrition therapy for cancer patients. Ther Adv Med Oncol 2019; 11:1758835919880084. [PMID: 31762796 PMCID: PMC6854759 DOI: 10.1177/1758835919880084] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 08/30/2019] [Indexed: 02/06/2023] Open
Abstract
Tackling malnutrition in cancer patients remains one of the most challenging tasks in clinical practice. Even though robust evidence exists stressing the role of nutritional status in relation to treatment outcome, its appropriate consideration in clinical practice is often lacking. In this review, we discuss the significance of nutritional status and of malnutrition for the cancer patient. Drawn from experience and from current recommendations of the European Society for Clinical Nutrition and Metabolism (ESPEN), we propose concrete and manageable steps to routinely incorporate nutritional aspects in today’s oncological clinical practice.
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Affiliation(s)
- Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell'Università, 37, Rome 00185, Italy
| | - Jann Arends
- Department of Medicine I, University of Freiburg, Freiburg, Germany
| | - Matti Aapro
- Cancer Center, Clinique de Genolier, Genolier, Switzerland
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22
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Nutritional assessment of Oraons of West Bengal: a comparison between biochemical and anthropometric methods. ANTHROPOLOGICAL REVIEW 2019. [DOI: 10.2478/anre-2019-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Comprehensive nutritional assessment is the basis of nutritional diagnosis and necessary to identify the individual or the population at a risk of dietary deficiencies. However, there is no specific and confirmatory method to measure nutritional status. Present study tried to find out the efficacy of two nutritional assessment method (1) biochemical test like Total serum protein (TSP) and (2) anthropological measurements like body mass index (BMI) and mid-upper-arm-circumference (MUAC). Later, three methods were tested and compared for the strength of assessing the nutritional status. Study was conducted among 198 adult Oraon, 84 male, 114 female individuals of Madarihat and Falakata police station area, Alipurduar district, West Bengal. Selected blood parameters such as total serum protein (TSP), serum albumin and haemoglobin and anthropometric measurements (height, weight, mid-upper arm circumference, waist circumference, hip circumference, calf circumference, biceps skinfold, triceps skinfold, and calf skinfold) were obtained following standard instruments and protocols. Nutritional status of all individuals was assessed by TSP, BMI and MUAC classification methods. Comparison between/among three classification methods (TSP, BMI and MUAC) was done and discriminant function analysis was adopted to find out the percentage of correct classification by each methods. It was found that prevalence of undernutrition using TSP classification was 38.1% male and 43.0% female; using BMI was 34.5% male and 53.5% female; using MUAC was 45.2% male and 64.9% female. Discriminant function analysis showed that BMI (97.0%) had the highest capability of correct classification followed by MUAC (84.80%) and TSP (63.60%). Results indicate that however, TSP is an objective way of nutritional assessment, but BMI had the highest capability of correct classification of nutritional status. It may be pointed out that the evaluation with TSP was expensive and invasive whereas BMI is non-expensive and completely a non-invasive way of evaluation. Therefore, BMI may widely be used for nutritional assessment.
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23
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Clement DSVM, Tesselaar MET, van Leerdam ME, Srirajaskanthan R, Ramage JK. Nutritional and vitamin status in patients with neuroendocrine neoplasms. World J Gastroenterol 2019; 25:1171-1184. [PMID: 30886501 PMCID: PMC6421241 DOI: 10.3748/wjg.v25.i10.1171] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/13/2019] [Accepted: 02/22/2019] [Indexed: 02/06/2023] Open
Abstract
Symptoms of gastroenteropancreatic located neuroendocrine neoplasms (GEP-NENs) are often related to food intake and manifest as abdominal pain or diarrhoea which can influence patients nutritional status. Malnutrition is common in cancer patients and influences quality of life, treatment options and survival but is also present in up to 40% of patients with GEP-NENs. As part of malnutrition there are often deficiencies in fat-soluble vitamins, mainly vitamin D. Little knowledge exists on trace elements. Several factors influence the development of malnutrition such as size and localisation of the primary tumour as well as metastases, side effects from treatment but also hormone production of the tumour itself. One of the main influencing factors leading to malnutrition is diarrhoea which leads to dehydration and electrolyte disturbances. Treatment of diarrhoea should be guided by its cause. Screening for malnutrition should be part of routine care in every GEP-NEN patient. Multidisciplinary treatment including dietician support is necessary for all malnourished patients with GEP-NENs.
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Affiliation(s)
- Dominique SVM Clement
- Neuroendocrine Tumour Unit, King’s College Hospital ENETS Centre of Excellence, London SE5 9RS, United Kingdom
| | - Margot ET Tesselaar
- Department of Medical Oncology, Netherlands Cancer Institute ENETS Centre of Excellence, Amsterdam 1066 CX, Netherlands
| | - Monique E van Leerdam
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam 1066 CX, Netherlands
| | - Rajaventhan Srirajaskanthan
- Neuroendocrine Tumour Unit, King’s College Hospital ENETS Centre of Excellence, London SE5 9RS, United Kingdom
- Department of Gastroenterology, King’s College Hospital, London SE5 9RS, United Kingdom
| | - John K Ramage
- Neuroendocrine Tumour Unit, King’s College Hospital ENETS Centre of Excellence, London SE5 9RS, United Kingdom
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24
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Wu M, Lian XJ, Jia JM, Cao WT, Yan N, Xin YM, Liu ZR, Li HY, Fan ZF, Sun P. The role of the Patient-Generated Subjective Global Assessment (PG-SGA) and biochemical markers in predicting anemia patients with cancer. Support Care Cancer 2018; 27:1443-1448. [PMID: 30206725 DOI: 10.1007/s00520-018-4462-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 09/05/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE The causes of anemia and the common side effects of cancer are multifactorial. Malnutrition is one of the alleged components of the aforementioned complications. This study planned to investigate the relationship among biochemical markers, Patient-Generated Subjective Global Assessment (PG-SGA), and anemia in cancer patients. METHODS This analysis consisted of 234 patients who were enlisted in the Department of Oncology of the First Hospital of Shanxi Medical University between December 2016 and October 2017. The groups were divided into anemic and non-anemic patients. The gathered data primarily discussed the patients' basic information, specifically the age, gender, smoking, alcohol consumption, and nutritional status based on levels of serum biochemical markers and PG-SGA scores. RESULTS Among the participants, 31.2% of the cancer patients were diagnosed with anemia whereas, according to the scores of PG.SGA, 65.0% of patients experienced malnourishment. The anemia was significantly associated with biochemical markers, expecting a transferrin in univariable analyses. Binary logistic regression analysis between anemic cancer patients and non-anemic cancer patients suggested that high PG-SGA score (odds ratio 1.082; 95% CI 1.027-1.141) implied the risk factor for anemia, and high PG-SGA scores could potentially increase the risk of anemia. The multiple regression analysis showed that hemoglobin concentration (OR 0.575; 95% CI 0.450-0.736) and PG-SGA score (OR 1.231; 95% CI 1.013-1.496) were linked to anemia. However, total protein, albumin, prealbumin, serum iron, transferrin, and transferrin saturation lacked a strong relationship with anemia. CONCLUSION Anemia prevailed in cancer patients, as nutritionally assessed by PG-SGA, while hemoglobin established a linkage with anemia as they could provide extra predictive information about anemia in patients diagnosed with cancer.
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Affiliation(s)
- Meng Wu
- Department of Nutrition and Food Hygiene, School of Public Health, Shanxi Medical University, 56 Xinjiannanlu Street, Taiyuan, 030001, China
| | - Xiao-Jiao Lian
- Department of Nutrition and Food Hygiene, School of Public Health, Shanxi Medical University, 56 Xinjiannanlu Street, Taiyuan, 030001, China
| | - Jun-Mei Jia
- Department of Oncology, the First Clinical Medical School of Shanxi Medical University, 85 Jiefangnanlu Street, Taiyuan, 030001, China
| | - Wen-Ting Cao
- Department of Nutrition, the First Clinical Medical School of Shanxi Medical University, 85 Jiefangnanlu Street, Taiyuan, 030001, China
| | - Na Yan
- Department of Nutrition, the First Clinical Medical School of Shanxi Medical University, 85 Jiefangnanlu Street, Taiyuan, 030001, China
| | - Yan-Mei Xin
- Department of Nutrition, the First Clinical Medical School of Shanxi Medical University, 85 Jiefangnanlu Street, Taiyuan, 030001, China
| | - Zeng-Rong Liu
- Department of Nutrition, the First Clinical Medical School of Shanxi Medical University, 85 Jiefangnanlu Street, Taiyuan, 030001, China
| | - Hua-Yan Li
- Department of Nutrition, the First Clinical Medical School of Shanxi Medical University, 85 Jiefangnanlu Street, Taiyuan, 030001, China
| | - Zhi-Fang Fan
- Department of Nutrition, the First Clinical Medical School of Shanxi Medical University, 85 Jiefangnanlu Street, Taiyuan, 030001, China
| | - Ping Sun
- Department of Nutrition, the First Clinical Medical School of Shanxi Medical University, 85 Jiefangnanlu Street, Taiyuan, 030001, China.
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25
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Byrnes A, Mudge A, Young A, Banks M, Bauer J. Use of hand grip strength in nutrition risk screening of older patients admitted to general surgical wards. Nutr Diet 2018; 75:520-526. [PMID: 29663632 DOI: 10.1111/1747-0080.12422] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/25/2018] [Accepted: 02/25/2018] [Indexed: 02/06/2023]
Abstract
AIM Hand grip strength (HGS) has been proposed as an indicator of nutritional status that is objective, requires minimal assessor training and is quick to administer, making it attractive for use in the acute setting. This study aimed to determine the discriminatory ability of impaired HGS to screen for malnutrition in an older hospital population and assess the added value of combining this with existing screening tools. METHODS Measures were undertaken during acute admission in patients ≥65 years admitted to general surgical wards. Impaired HGS was defined as a mean value below the lower limit of the 95% CI of population norms and observed HGS standardised as a percentage of this value. Nutritional risk was assessed using the Malnutrition Screening Tool (MST) and malnutrition defined as Patient-Generated Subjective Global Assessment (PG-SGA) rating B or C. Discriminatory ability of impaired HGS to identify malnourished patients was tested using the area under the receiver operating characteristic curve (AUC). RESULTS Seventy-five patients (mean age: 74.0 (SD 6.7) years, 60% male) were recruited. Impaired HGS did not accurately identify malnutrition (AUC (95% CI): 0.41 (0.25-0.58), P < 0.001), nor did it improve discriminatory ability of the MST (AUC (95% CI), MST: 0.83 (0.71-0.95), P = 0.32; MST/HGS combined: 0.68 (0.51-0.86), P = 0.035). CONCLUSIONS HGS was not found to be suitable in screening older inpatients for malnutrition during admission to surgical wards. As such, screening for nutrition risk using an existing validated tool to identify patients for further in-depth nutritional assessment by an appropriately trained clinician remains the preferred method.
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Affiliation(s)
- Angela Byrnes
- Centre for Dietetics Research, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Alison Mudge
- Internal Medicine and Aged Care Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Adrienne Young
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Merrilyn Banks
- Nutrition and Dietetics Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Judy Bauer
- Centre for Dietetics Research, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
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