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Wu T, Zhou M, Xu K, Zou Y, Zhang S, Cheng H, Guo P, Song C. GLIM Achieves Best Diagnostic Performance in Non-Cancer Patients with Low BMI: A Hierarchical Bayesian Latent-Class Meta-Analysis. Nutr Rev 2024:nuae096. [PMID: 39013202 DOI: 10.1093/nutrit/nuae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
CONTEXT Global Leadership Initiative on Malnutrition (GLIM) and Patient-Generated Subjective Global Assessment (PG-SGA) are commonly used nutrition assessment tools, whose performance does not reach a consensus due to different and imperfect reference standards. OBJECTIVE This study aimed to evaluate and compare the diagnostic accuracy of GLIM and PG-SGA, using a hierarchical Bayesian latent class model, in the absence of a gold standard. DATA SOURCES A systematic search was undertaken in PubMed, Embase, and Web of Science from inception to October 2022. Diagnostic test studies comparing (1) the GLIM and/or (2) PG-SGA with "semi-gold" standard assessment tools for malnutrition were included. DATA EXTRACTION Two authors independently extracted data on sensitivity, specificity, and other key characteristics. The methodological quality of each included study was appraised according to the criteria in the Quality Assessment of Diagnostic Accuracy Studies-2. DATA ANALYSIS A total of 45 studies, comprising 20 876 individuals evaluated for GLIM and 11 575 for PG-SGA, were included. The pooled sensitivity was 0.833 (95% CI 0.744 to 0.896) for GLIM and 0.874 (0.797 to 0.925) for PG-SGA, while the pooled specificity was 0.837 (0.780 to 0.882) for GLIM and 0.778 (0.707 to 0.836) for PG-SGA. GLIM showed slightly better performance than PG-SGA, with a higher diagnostic odds ratio (25.791 vs 24.396). The diagnostic performance of GLIM was most effective in non-cancer patients with an average body mass index (BMI) of <24 kg/m2, followed by non-cancer patients with an average age of ≥60 years. PG-SGA was most powerful in cancer patients with an average age of <60 years, followed by cancer patients with an average BMI of <24 kg/m2. CONCLUSION Both GLIM and PG-SGA had moderately high diagnostic capabilities. GLIM was most effective in non-cancer patients with a low BMI, while PG-SGA was more applicable in cancer patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration No. CRD42022380409.
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Affiliation(s)
- Tiantian Wu
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Mingming Zhou
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Kedi Xu
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Yuanlin Zou
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Shaobo Zhang
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Haoqing Cheng
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Pengxia Guo
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Chunhua Song
- Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China
- Henan Key Laboratory of Tumor Epidemiology, Zhengzhou University, Zhengzhou, Henan 450052, China
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou, Henan 450052, China
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Song J, Yang X, Wu J, Wu Z, Zhuo L, Hong J, Su L, Lyu W, Ye J, Fang Y, Zhan Z, Zhang H, Li X. Could nutrition status predict fatigue one week before in patients with nasopharynx cancer undergoing radiotherapy? Cancer Med 2024; 13:e7191. [PMID: 38659395 PMCID: PMC11043677 DOI: 10.1002/cam4.7191] [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: 11/28/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Patients with nasopharyngeal carcinoma (NPC) undergoing radiotherapy experience significant fatigue, which is frequently underestimated due to the lack of objective indicators for its evaluation. This study aimed to explore the longitudinal association between fatigue and nutrition status 1 week in advance. METHODS From January 2021 to June 2022, a total of 105 NPC patients who received intensity-modulated radiation therapy were enrolled in the observational longitudinal study. The significant outcomes, including the Piper Fatigue Scale-12 (PFS-12), the Scored Patient-Generated Subjective Global Assessment (PG-SGA), four body composition indices, and the Hospital Anxiety and Depression Scale (HADS), were assessed weekly from pre-treatment until the completion of radiotherapy (T0-T7) to explore their relationship. RESULTS The trajectories of PFS-12 and all dimensions for 105 participants reached a peak during the fifth week. Sensory fatigue consistently received the highest scores (T0 = 1.60 ± 2.20, T5 = 6.15 ± 1.57), whereas behavior fatigue exhibited the fastest increase over time (T0 = 1.11 ± 1.86, T5 = 5.47 ± 1.70). Higher PG-SGA scores were found to be weakly explainable for aggravating fatigue (β = 0.02 ~ 0.04). Unlike generalized additive mixed models, marginal structural models (MSM) produced larger effect values (β = 0.12 ~ 0.21). Additionally, body composition indices showed weakly negative relationships with fatigue in MSMs one week in advance. CONCLUSIONS The PG-SGA may be a more accurate predictor of future-week fatigue than individual body composition indicators, particularly when HADS is controlled for as a time-dependent confounder.
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Affiliation(s)
- Jihong Song
- School of NursingHealth Science Center, Xi'an Jiaotong UniversityXi'anChina
- School of NursingFujian Medical UniversityFuzhouChina
| | - Xinru Yang
- School of NursingFujian Medical UniversityFuzhouChina
| | - Jieling Wu
- School of NursingFujian Medical UniversityFuzhouChina
| | - Zilan Wu
- School of NursingFujian Medical UniversityFuzhouChina
| | - Litao Zhuo
- School of NursingFujian Medical UniversityFuzhouChina
| | - Jinsheng Hong
- Department of RadiotherapyCancer Center, the First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of RadiotherapyNational Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
| | - Li Su
- Department of RadiotherapyCancer Center, the First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of RadiotherapyNational Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
| | - Wenlong Lyu
- Department of RadiotherapyCancer Center, the First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of RadiotherapyNational Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
| | - Jinru Ye
- Department of RadiotherapyCancer Center, the First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
- Department of RadiotherapyNational Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical UniversityFuzhouChina
| | - Yan Fang
- Nursing DepartmentThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Zhiying Zhan
- Department of Epidemiology and Health StatisticsFujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical UniversityFuzhouChina
| | - Hairong Zhang
- Fujian Center for Disease Control and PreventionFuzhouChina
| | - Xiaomei Li
- School of NursingHealth Science Center, Xi'an Jiaotong UniversityXi'anChina
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Zheng X, Ruan X, Wang X, Zhang X, Zang Z, Wang Y, Gao R, Wei T, Zhu L, Zhang Y, Li Q, Liu F, Shi H. Bayesian diagnostic test evaluation and true prevalence estimation of malnutrition in gastric cancer patients. Clin Nutr ESPEN 2024; 59:436-443. [PMID: 38220406 DOI: 10.1016/j.clnesp.2023.12.019] [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: 09/06/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND & AIMS Malnutrition is prevalent among gastric cancer (GC) patients, necessitating early assessment of nutritional status to guide monitoring and interventions for improved outcomes. We aim to evaluate the accuracy and prognostic capability of three nutritional tools in GC patients, providing insights for clinical implementation. METHODS The present study is an analysis of data from 1308 adult GC patients recruited in a multicenter from July 2013 to July 2018. Nutritional status was assessed using Nutritional Risk Screening 2002 (NRS-2002), Patient-Generated Subjective Global Assessment (PG-SGA) and Global Leadership Initiative on Malnutrition (GLIM) criteria. Bayesian latent class model (LCM) estimated the malnutrition prevalence of GC patients, sensitivity and specificity of nutritional tools. Cox regression model analyzed the relationship between nutritional status and overall survival (OS) in GC patients. RESULTS Among 1308 GC patients, NRS-2002, PG-SGA, and GLIM identified 50.46%, 76.76%, and 68.81% as positive, respectively. Bayesian LCM analysis revealed that PG-SGA had the highest sensitivity (0.96) for malnutrition assessment, followed by GLIM criteria (0.78) and NRS-2002 (0.65). Malnutrition or being at risk of malnutrition were identified as independent prognostic factors for OS. Use any of these tools improved survival prediction in TNM staging system. CONCLUSION PG-SGA is the most reliable tool for diagnosing malnutrition in GC patients, whereas NRS-2002 is suitable for nutritional screening in busy clinical practice. Given the lower sensitivity of NRS-2002, direct utilization of GLIM for nutritional assessment may be necessary. Each nutritional tool should be associated with a specific course of action, although further research is needed.
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Affiliation(s)
- Xite Zheng
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, 100069, China
| | - Xiaoli Ruan
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, 100069, China
| | - Xiaonan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, 100069, China
| | - Xiaorui Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, 100069, China
| | - Zhaoping Zang
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, 100069, China
| | - Yijie Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, 100069, China
| | - Ran Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, 100069, China
| | - Tong Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, 100069, China
| | - Lingyan Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, 100069, China
| | - Yijun Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, 100069, China
| | - Quanmei Li
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, 100069, China
| | - Fen Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, 100069, China.
| | - Hanping Shi
- Department of Gastrointestinal Surgery, Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China; Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China; Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.
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Wang PP, Soh KL, Binti Khazaai H, Ning CY, Huang XL, Yu JX, Liao JL. Nutritional Assessment Tools for Patients with Cancer: A Narrative Review. Curr Med Sci 2024; 44:71-80. [PMID: 38289530 DOI: 10.1007/s11596-023-2808-4] [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: 06/20/2023] [Accepted: 10/08/2023] [Indexed: 02/24/2024]
Abstract
Cancer patients are at high risk of malnutrition, which can lead to adverse health outcomes such as prolonged hospitalization, increased complications, and increased mortality. Accurate and timely nutritional assessment plays a critical role in effectively managing malnutrition in these patients. However, while many tools exist to assess malnutrition, there is no universally accepted standard. Although different tools have their own strengths and limitations, there is a lack of narrative reviews on nutritional assessment tools for cancer patients. To address this knowledge gap, we conducted a non-systematic literature search using PubMed, Embase, Web of Science, and the Cochrane Library from their inception until May 2023. A total of 90 studies met our selection criteria and were included in our narrative review. We evaluated the applications, strengths, and limitations of 4 commonly used nutritional assessment tools for cancer patients: the Subjective Global Assessment (SGA), Patient-Generated Subjective Global Assessment (PG-SGA), Mini Nutritional Assessment (MNA), and Global Leadership Initiative on Malnutrition (GLIM). Our findings revealed that malnutrition was associated with adverse health outcomes. Each of these 4 tools has its applications, strengths, and limitations. Our findings provide medical staff with a foundation for choosing the optimal tool to rapidly and accurately assess malnutrition in cancer patients. It is essential for medical staff to be familiar with these common tools to ensure effective nutritional management of cancer patients.
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Affiliation(s)
- Peng-Peng Wang
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400, Malaysia.
- Nursing College of Guangxi Medical University, Nanning, 530021, China.
| | - Kim Lam Soh
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400, Malaysia.
| | - Huzwah Binti Khazaai
- Department of Biomedical Sciences, Universiti Putra Malaysia, Serdang, 43400, Malaysia
| | - Chuan-Yi Ning
- Nursing College of Guangxi Medical University, Nanning, 530021, China
| | - Xue-Ling Huang
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jia-Xiang Yu
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400, Malaysia
| | - Jin-Lian Liao
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
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Chen JJ, Zhu ZY, Bian JJ, Lin F. Nutrition-associated health levels in persons with cancer: item response modelling based on the International Classification of Functioning, Disability and Health. Eur J Phys Rehabil Med 2023; 59:593-604. [PMID: 37733333 PMCID: PMC10664767 DOI: 10.23736/s1973-9087.23.07987-x] [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: 03/25/2023] [Revised: 06/06/2023] [Accepted: 07/21/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The nutritional status of individuals with cancer is a crucial determinant of their health and well-being, and addressing nutrition-related functioning conditions is essential for maintaining physical activity levels and participating in daily activities. AIM This study aims to identify an evidence-based International Classification of Functioning, Disability and Health (ICF) scale using item response theory for nutrition conditions in patients with cancer, which can differentiate and assess nutrition-related functioning conditions of cancer survivors. DESIGN Cross-sectional study. SETTING Sir Run Run Hospital, Nanjing Medical University. POPULATION One hundred cancer patients were enrolled. METHODS Via convenience sampling, the study administered a questionnaire consisting of 89 ICF items to participants. The original five-point rating system was binarized (1 = no problem, 0 = problem). Through data shaping, non-parametric IRT analysis and parametric IRT analysis, psychometric properties of nutritional ICF scale were calculated using R software. RESULTS The study extracted a unidimensional scale with 32 items and constructed 2-parameter logistic model with good fitness, whose root mean square error approximation (RMSEA) = 0.0759, Tucker-Lewis Index (TLI) = 0.9655, and Comparative Fit Index (CFI) = 0.9677. The model demonstrated high reliability, as indicated by a Cronbach's α of 0.95, Guttman λ2 of 0.95, Molenaar Sijtsma statistic of 0.96 and a latent class reliability coefficient (LCRC) of 0.98. Besides, there was a strong correlation between the total score of 32 ICF items and the score of Patient-Generated Subjective Global Assessment (PG-SGA, P<0.001, r=-0.77) and Mini Nutritional Assessment (MNA, P<0.001, r=0.76), suggesting the 32-item scale had high validity. CONCLUSIONS The study constructed an evidence-based ICF scale for nutrition conditions in patients with cancer with 32-item and 2PLM for evaluating nutrition-associated health level in persons with cancer, including high validity and reliability. CLINICAL REHABILITATION IMPACT The IRT model based on ICF provided a promising assessment tool to discriminate nutrition-associated health level of persons with cancer, and offered an auxiliary method for selecting rehabilitation intervention targets. This has the potential to lead to improved outcomes in cancer treatment and increased quality of life for cancer survivors.
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Affiliation(s)
- Jin-Jin Chen
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zi-Yan Zhu
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jia-Jia Bian
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Feng Lin
- Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu, China -
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Döring K, Wiechers L, Büntzel J, Büntzel J. Why We Should Look at Dinner Plates: Diet Changes in Cancer Patients. Curr Oncol 2023; 30:2715-2728. [PMID: 36975418 PMCID: PMC10047165 DOI: 10.3390/curroncol30030205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Objective: Malnutrition is often underestimated in the context of cancer therapy: the dietary trends initiated by patients after diagnosis are usually neither known to nor evaluated by the medical staff. Here, we propose a combined screening instrument evaluating malnutrition and dietary trends. Methods: The validated screening tool NRS-2002 was combined with a four-item questionnaire assessing whether (1) patients preferred certain foods, (2) avoided certain foods, (3) used dietary supplements or followed a special diet since the time of cancer diagnosis. The screening tool was routinely used by cancer patients in the daily practice of three oncological departments. The presented analysis was performed retrospectively and anonymized. Results: Overall, 102 cancer patients undergoing systemic therapy (CP), 97 undergoing radiation therapy (RP), and 36 head–neck cancer patients (HNP) were screened. The CP cohort showed a higher rate of malnutrition (50.00%) than the HNP (28.13%) or RP (26.80%) cohort. Overall, diet changes were observed in 33.63% of all patients. Avoiding meat, stimulants, or hard and edgy food was often mentioned in free text answers, while patients reported a preference for fruit and vegetables. Nutritional supplements were used by 28.76% of the patients. While dietary changes were common, only 6.64% of the patients mentioned adhering to a specific cancer diet. Conclusion: Malnutrition is still underestimated nowadays. Diet trends, especially avoiding certain foods, are common in cancer patients, while adhering to a specific cancer diet is an exception. Diet trends should be assessed and addressed to avoid or aggravate malnutrition.
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Affiliation(s)
- Katja Döring
- Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, 30625 Hannover, Germany
- Department of Radiation Therapy and Radiation Oncology, University Hospital Göttingen, 37075 Göttingen, Germany
| | - Lara Wiechers
- Department of Radiation Therapy and Radiation Oncology, University Hospital Göttingen, 37075 Göttingen, Germany
| | - Jens Büntzel
- Department of Otolaryngology, Head Neck Surgery, Südharz Hospital, 99734 Nordhausen, Germany
| | - Judith Büntzel
- Department of Hematology and Medical Oncology, University Hospital, Robert-Koch-Straße 40, 37075 Göttingen, Germany
- Correspondence:
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Lee JY, Oh EG, Hyung WJ, Kim HI. Translation and validation of the Patient-Generated Subjective Global Assessment against the Mini-Nutritional Assessment for patients with gastric cancer. Asia Pac J Oncol Nurs 2022; 10:100148. [PMID: 36386273 PMCID: PMC9664357 DOI: 10.1016/j.apjon.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022] Open
Abstract
Objective This study aimed to (1) translate the PG-SGA into Korean according to a translation guideline, (2) validate the translated version against the Mini-Nutritional Assessment, and (3) determine the prevalence of malnutrition in patients with gastric cancer. Methods The translation of the PG-SGA was based on the Guidelines for Translation by the International Society for Pharmacoeconomics and Outcomes Research Task Force for Translation and Cultural Adaptation Group. The translated version was validated in 226 patients with gastric cancer, using the area under the receiver operating characteristic curve analysis (AUC-ROC), measures of sensitivity, specificity, and the Youden index. The prevalence of malnutrition was analyzed using descriptive statistics. Results The AUC-ROC Korean version of the PG-SGA was 0.85, and a score of 12 was the most optimal cut-off score, with a sensitivity of 78.6% and a Youden index of 0.54. One-third of participants were malnourished, and 70% of them had more than one physical symptom affecting their food intake. Conclusions The Korean version of the PG-SGA is an effective and valid assessment tool for evaluating malnutrition in patients with gastric cancer. A new cut-off score could be used in patients with gastric cancer to assess malnutrition. The Korean version of PG-SGA has undergone a systematic translation process. It is a valid instrument for assessing malnutrition in patients with gastric cancer. Nurses could assess patients’ symptoms related to food intake using PG-SGA.
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Xu J, Jie Y, Sun Y, Gong D, Fan Y. Association of Global Leadership Initiative on Malnutrition with survival outcomes in patients with cancer: A systematic review and meta-analysis. Clin Nutr 2022; 41:1874-1880. [DOI: 10.1016/j.clnu.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 02/07/2023]
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Malnutrition Screening and Assessment. Nutrients 2022; 14:nu14122392. [PMID: 35745121 PMCID: PMC9228435 DOI: 10.3390/nu14122392] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 01/04/2023] Open
Abstract
Malnutrition is a serious problem with a negative impact on the quality of life and the evolution of patients, contributing to an increase in morbidity, length of hospital stay, mortality, and health spending. Early identification is fundamental to implement the necessary therapeutic actions, involving adequate nutritional support to prevent or reverse malnutrition. This review presents two complementary methods of fighting malnutrition: nutritional screening and nutritional assessment. Nutritional risk screening is conducted using simple, quick-to-perform tools, and is the first line of action in detecting at-risk patients. It should be implemented systematically and periodically on admission to hospital or residential care, as well as on an outpatient basis for patients with chronic conditions. Once patients with a nutritional risk are detected, they should undergo a more detailed nutritional assessment to identify and quantify the type and degree of malnutrition. This should include health history and clinical examination, dietary history, anthropometric measurements, evaluation of the degree of aggression determined by the disease, functional assessment, and, whenever possible, some method of measuring body composition.
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Ruan X, Wang X, Zhang Q, Nakyeyune R, Shao Y, Shen Y, Niu C, Zhu L, Zang Z, Wei T, zhang X, Ruan G, Song M, Miles T, Liu F, Shi H. The performance of three nutritional tools varied in colorectal cancer patients: a retrospective analysis. J Clin Epidemiol 2022; 149:12-22. [DOI: 10.1016/j.jclinepi.2022.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/07/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
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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: 8] [Impact Index Per Article: 2.7] [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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Global Leadership Initiative on Malnutrition criteria as a nutrition assessment tool for patients with cancer. Nutrition 2021; 91-92:111379. [PMID: 34303957 DOI: 10.1016/j.nut.2021.111379] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/08/2021] [Accepted: 05/30/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Since the launch of Global Leadership Initiative on Malnutrition (GLIM), there has been an urgent need to validate the new criteria, especially in patients with cancer. The aim of this study was to evaluate and validate the use of the GLIM criteria in patients with cancer. METHOD This multicenter cohort study compared the GLIM with the scored Patient-Generated Subjective Global Assessment (sPG-SGA). The 1-y survival rate, multivariate Cox regression analysis, κ-value, sensitivity, specificity, receiver operating characteristic (ROC) curve, and time-dependent ROC analysis were applied to identify the performance of the GLIM. RESULTS Among the 3777 patients in the study, 50.9% versus 49.1% or 36.3% versus 63.7% of the patients were defined as well-nourished and malnourished by GLIM or sPG-SGA, respectively. GLIM presented moderate consistency (κ = 0.54, P < 0.001), fair sensitivity and specificity (70.5 and 88.3%) compared with sPG-SGA. There was no difference in the 1-y survival rate in malnourished patients (76.9 versus 76.4%, P = 0.711), but it was significantly different in well-nourished patients (85.8 versus 90.3%, P < 0.001) between GLIM and sPG-SGA. The above difference was eliminated after omitted nutritional risk screening (NRS)-2002 screening before GLIM (88.1 versus 90.3%, P = 0.078). Omitting NRS-2002 screening before GLIM did not change the 1-y survival rate in well-nourished or malnourished patients by GLIM with NRS-2002 screening (76.9 versus 78.9%, P = 0.099; 85.8% versus 88.1%, P = 0.092) although it significantly raised the rate of malnutrition to 72.5%. The combination of "weight loss and cancer" showed better performance than other combinations. CONCLUSIONS GLIM could be a convenient alternative to sPG-SGA in nutrition assessment for patients with cancer. The combination of "weight loss and cancer" was better than other combinations. Considering the higher risk for malnutrition in patients with cancer, NRS-2002 screening may not be needed before GLIM.
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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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Aprile G, Basile D, Giaretta R, Schiavo G, La Verde N, Corradi E, Monge T, Agustoni F, Stragliotto S. The Clinical Value of Nutritional Care before and during Active Cancer Treatment. Nutrients 2021; 13:nu13041196. [PMID: 33916385 PMCID: PMC8065908 DOI: 10.3390/nu13041196] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/18/2022] Open
Abstract
Malnutrition and muscle wasting are frequently reported in cancer patients, either linked to the tumor itself or caused by oncologic therapies. Understanding the value of nutritional care during cancer treatment remains crucial. In fact, cancer-associated sarcopenia plays a key role in determining higher rates of morbidity, mortality, treatment-induced toxicities, prolonged hospitalizations and reduced adherence to anticancer treatment, worsening quality of life and survival. Planning baseline screening to intercept nutritional troubles earlier, organizing timely reassessments, and providing adequate counselling and dietary support, healthcare professional may positively interfere with this process and improve patients' overall outcomes during the whole disease course. Several screening tools have been proposed for this purpose. Nutritional Risk Screening (NRS), Mini Nutritional Assessment (MNA), Patient Generated Subjective Global Assessment (PG-SGA) are the most common studied. Interestingly, second-level tools including skeletal muscle index (SMI) and bioelectric impedance analysis (BIA) provide a more precise assessment of body composition, even if they are more complex. However, nutritional assessment is not currently used in clinical practice and procedures must be standardized in order to improve the efficacy of standard chemotherapy, targeted agents or even checkpoint inhibitors that is potentially linked with the patients' nutritional status. In the present review, we will discuss about malnutrition and the importance of an early nutritional assessment during chemotherapy and treatment with novel checkpoint inhibitors, in order to prevent treatment-induced toxicities and to improve survival outcomes.
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Affiliation(s)
- Giuseppe Aprile
- Department of Oncology, AULSS8 Berica, 36100 Vicenza, Italy; (D.B.); (R.G.)
- Correspondence: ; Tel.: +39-0444753906
| | - Debora Basile
- Department of Oncology, AULSS8 Berica, 36100 Vicenza, Italy; (D.B.); (R.G.)
| | - Renato Giaretta
- Department of Oncology, AULSS8 Berica, 36100 Vicenza, Italy; (D.B.); (R.G.)
| | - Gessica Schiavo
- Clinical Nutritional Unit, AULSS8 Berica, 36100 Vicenza, Italy;
| | - Nicla La Verde
- Department of Oncology, PO Sacco, ASST Fatebenefratelli Sacco, 20131 Milano, Italy;
| | - Ettore Corradi
- Clinical Nutritional Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy;
| | - Taira Monge
- Clinical Nutrition, S. Giovanni Battista Hospital, 10126 Torino, Italy;
| | - Francesco Agustoni
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Silvia Stragliotto
- Department of Oncology, Istituto Oncologico Veneto—IRCCS, 31033 Padova, Italy;
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