Validation of nutritional risk index method against patientgenerated subjective global assessment in screening malnutrition in colorectal cancer patients

Objective：To validate malnutrition screening tool of nutrition risk index （NRI） against patent-generated subjective global assessment （PG-SGA） as a gold standard tool in colorectal cancer patients before radiotherapy.Methods：Nutritional status of 52 volunteer colorectal cancer patients with a mean age of 54.1±16.8 years who referred to radiotherapy center were assessed by PG-SGA （gold standard method） and NRI.Serum albumin levels of patients were determined by colorimetric method.A contingency table was used to determine the sensitivity,specificity,and predictive value of the NRI in screening patients at risk of malnutrition,in comparison with the PG-SGA in patients before radiotherapy.Results：The findings of PG-SGA and NRI showed that 52％ and 45％ of patients in our study were moderately or severely malnourished respectively.The NRI had a sensitivity of 66％ and a specificity of 60％ against PG-SGA.The positive predictive value was 64％ and the negative predicative value was 62％.The agreement between NRI and PG-SGA was statistically insignificant （kappa =0.267; P＞0.05）.Conclusions：The findings of present study showed that the prevalence of malnutrition was high in patients with colorectal cancer.Moreover,NRI method had low sensitivity and specificity in assessing nutritional status of patients with cancer.It seems that the combination of anthropometric,laboratory parameters and a subjective scoring system may be helpful tools in screening of malnutrition in cancer patients.

Preliminary validation of Global Leadership Initiative on Malnutrition criteria in cancer patients:A cross-sectional study

Background:The Global Leadership Initiative on Malnutrition(GLIM)has been used in China since 2019.This study aimed to test the use of the GLIM criteria in Chinese cancer patients and to compare the diagnostic performance of the GLIM criteria with the Patient-Generated Subjective Global Assessment(PG-SGA)and modified PG-SGA(mPG-SGA). Methods:A total of 2,000 cancer patients were consecutively screened using the Nutritional Risk Screening 2002 instrument on ad-mission.Patients at nutritional risk(Nutritional Risk Screening 2002 score≥3)were enrolled to obtain the complete GLIM,PG-SGA,and mPG-SGA criteria.To evaluate the convergent validity,Spearman correlation analysis was used to compare the test-retest reliability of the GLIM criteria and its results with the scores of various nutritional tools and objective parameters.Kruskal-Wallis tests and χ2 tests were used to test the discriminant validity among groups with different nutritional status.We calculated the sensitivity,specificity,positive predictive value,and negative predictive value for the various tools. Results:There were 562 patients found to be at nutritional risk,accounting for 28.1%of all patients.One hundred seventy-four patients(8.7%)were diagnosed as moderately malnourished,and 333 patients(16.6%)were severely malnourished based on the PG-SGA.When assessed using the GLIM criteria,185 patients(9.3%)were diagnosed as moderately malnourished and 311 patients(15.5%)were severely malnourished.The content validity of the GLIM criteria was 95%,evaluated by 60 medical staff members.The test-retest reliability was good.For the diagnosis of malnutrition versus the PG-SGA,the sensitivity of the GLIM was"good"(90.5%;95%confidence interval[95%CI]=88.0%-93.1%),with a positive predictive value of 92.5%(95%CI=90.2%-94.9%),but the spec-ificity and negative predictive value were"poor."Similar results were obtained when the mPG-SGA was used as the criterion. Conclusions:Overall,this cross-sectional study suggests that the GLIM criteria comprise a valid and reliable tool to assess the nutri-tional status of Chinese cancer patients.

Combining the Patient-Generated Subjective Global Assessment (PGSGA) and Objective Nutrition Assessment Parameters Better Predicts Malnutrition in Elderly Patients with Colorectal Cancer

Background Malnutrition is common in colorectal cancer(CRC)patients,especially in elderly patients.The Patient-Generated Subjective Global Assessment(PG-SGA)is a widely used tool developed to detect malnutrition.The aim of this study was to compare the value of the PG-SGA and objective nutrition assessment parameters,in order to identify a better predictive index for malnutrition in elderly patients with CRC.Methods A total of 131 elderly patients(age≥60 years)with CRC were included and were evaluated for their individual nutritional status using the PG-SGA.Anthropometric and serological indicators were also assayed within 48 h of admission to the hospital.Body composition analysis was implemented by bioelectrical impedance analysis(BIA)instrument.The Chi-squared test,univariate and multivariate logistic regression analysis,or Spearman’s rank correlation analysis were used to determine the differences among the above indices and parameters with regard to predicting malnutrition.Results According to the PG-SGA score,the incidence of total malnutrition in elderly patients with CRC was 80.92%(PG-SGA score≥2),which increased with age.It was found that 28%of the patients with PG-SGA classification A(PG-SGA score 0-1)had a low fat-free mass index(FFMI).Compared with those with PG-SGA A,patients with PG-SGA C PG-SGA score≥9)showed an increased neutrophil to lymphocyte ratio(NLR)and an increased platelet and lymphocyte ratio(PLR)(median=1.78 VS.2.35,P=0.015 and median=108.8 VS.141.6,P=0.001,respectively).In terms of objective nutrition assessment parameters,severely malnourished CRC patients had significantly lower values of serum albumin(ALB),and retinol conjugated protein(RBP)than those who were well-nourished[(38.35±4.84)g/L VS.(40.56±3.44)g/L,P=0.039 and(30.31±15.83)mg/L VS.(39.01±11.95)mg/L,P=0.033,respectively].The Spearman’s rank correlation analysis showed that the PG-SGA findings had positive correlations with the NLR and PLR;while it had negative correlations with the FFMI,body mass index(BMI),ALB,prealbumin,and RBP.Conclusions In clinical practice,a comprehensive nutritional diagnosis,including the PG-SGA score and these objective indicators,can avoid the underdiagnosis of malnutrition,and is more suitable to detect malnutrition(as well as its causes)in elderly patients with CRC.

Subjective Global Assessment as a Pre-Operative Nutrition Status Screening Tool for Head and Neck Cancer Patients of a Tertiary Health Care Setting

Introduction: In India, 57% of patients with head and neck cancers are documented with nutritional compromise. Active nutritional support has been shown to improve outcomes and reduce the cost of treatment in severely malnourished patients. The assessment of nutritional status should be a priority when initiating medical nutrition therapy. We evaluated the agreement between Subjective and Objective evaluation of pre-operative nutrition status of head and neck cancer patients in a tertiary cancer centre. Methods: Two hundred and thirty seven head and neck cancer patients who underwent surgery were eligible. The patients included both males (147) and females (90) with age varying between 23 - 88 years. All patients were screened for pre-operative nutrition status objectively as well as subjectively. The association of pre-operative SGA scores (A, B and C) subjectively, and PNS score (0, 1, 2) objectively were tested for statistical significance. Results: The cancer sites included tongue in 82, buccal mucosa in 30, thyroid in 28, alveolus in 18, glottis in 10, RMT in 10, nasal cavity in 9, FOM in 8. The pre-operative nutrition status based on subjective scores are A in 156 (65.8%), B in 75 (32%) and C in 6 (2.5%). The objective parameters obtained on the basis of BMI, % weight loss, PNI and S. albumin values are PNS 0 in 161 (67.9%), PNS 1 in 71 (30%) and PNS 2 in 5 (2.1%) patients. As the kappa coefficient p-0.56, there is moderate agreement between the pre-operative nutrition status subjectively as well as objectively. Conclusion: Subjective global assessment is a simple and inexpensive way to screen the pre-operative nutrition status when compared to the other objective assessment tool. SGA has moderate agreement with expensive and complicated objective assessment tools. So it can be a reliable tool for assessing the pre-operative nutrition status.

Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients

AIM: To evaluate the prevalence of preoperative and postoperative malnutrition and the relationships between objective and subjective nutritional assessment of gastric cancer patients. METHODS: From October 2005 to July 2006, we studied 80 patients with no evidence of recurrent disease and no loss to follow-up after curative surgery for gastric cancer. In this group, 9 patients underwent total gastrectomy and 71 patients subtotal gastrectomy. At admission, 6 and 12 mo after surgery, the patients were assessed on the subjective global assessment (SGA), nutritional risk screening (NRS-2002), nutritional risk index (NRI) and by anthropometric measurements and laboratory data. Differences between the independent groups were assessed with the Student's t test and oneway analysis of variance. Spearman's rank correlation coefficients were calculated to evaluate the association between the scores and variables. RESULTS: The prevalence of malnutrition at admissionwas 31% by SGA and 43% by NRS-2002. At admission, the anthropometric data were lower in the malnourished groups defined by the SGA and NRS-2002 assessments, but did not differ between the groups using the NRI assessment. Body weight (BW), body mass index (BMI), triceps skin fold and midarm circumference were significantly reduced, but the total lymphocyte count, albumin, protein, cholesterol and serum iron levels did not decrease during the postoperative period. Six months after surgery, there was a good correlation between the nutritional assessment tools (SGA and NRS-2002) and the other nutritional measurement tools (BW, BMI, and anthropometric measurements). However, 12 mo after surgery, most patients who were assessed as malnourished by SGA and NRS-2002 had returned to their preoperative status, although their BW, BMI, and anthropometric measurements still indicated a malnourished status. CONCLUSION: A combination of objective and subjective assessments is needed for the early detection of the nutritional status in case of gastric cancer patients after gastrectomy.

Prospective study evaluating the value of subjective global assessment and national risk score 2002 for post-operative risk detection in living related donor liver transplant recipients

Background: Chronic liver disease may be associated with protein energy malnutrition. Those malnourished patients undergoing liver transplantation suffer great morbidities and even mortalities. Estimating the degree of malnutrition in patients with end stage liver disease is a difficult job, Subjective Global Assessment (SGA) and Nutritional Risk Score-2002 (NRS-2002) are among many tools that can give an overview for the nutritional status of the patients. Aim: To detect the efficacy and the predictive validity of SGA and NRS 2002 for post-operative risk detection for liver transplant patients. Patients & Methods: 30 recipients of end stage liver disease had undergone a nutritional assessment by SGA score & NRS-2002 score, to be compared with the parameters of outcome of post-operative liver transplantation (ALT, AST, INR, Bilirubin, time spent in ICU, hospital infective episodes & number of antibiotic courses). Results: Patients declared as malnourished by SGA and NRS-2002 had higher post operative ALT & AST value, more prolonged INR, spent more time at ICU and hospital, suffered from more infective episodes and had more antibiotic courses in a significant statistical manner. Conclusion: SGA and NRS-2002 could be useful, simple and dependable tools to be used for risk detection of post-operative morbidities after liver transplantation.

Validity of the Patient-Generated Subjective Global Assessment(PG SGA)in Colorectal Cancer Patients in China

Objective The patient-generated subjective global assessment(PG-SGA)is a nutritional assessment tool specially designed for cancer patients.This study tested the validity of the PG-SGA for the nutritional assessment of colorectal cancer(CRC)patients in China.Methods A total of 8,093 Chinese patients with any stage CRC were enrolled in this cross-sectional,observational study.Within the first 48 hours of admission,patients were evaluated using the PG-SGA,nutritional risk screening 2002(NRS 2002),Karnofsky Performance Status(KPS),and some anthropometric parameters,including the triceps skinfold thickness(TSF),mid-arm circumference(MAC),mid-arm muscle circumference(MAMC),hand grip strength(HGS),maximum left calf circumference(MLCC),and maximum right calf circumference(MRCC),among others.Spearman’s correlation test was performed to analyze item-total score correlations and correlations between the total PG-SGA score and other parameters or performance scores,further testing convergent validity.The discriminative ability of the PG-SGA was measured by comparing different characteristics between several nutritional groups.A principal component analysis was performed with selected parameters to evaluate the construct validity.Results The average total PG-SGA score of all patients was 5.69±4.46,and they had a median age of 59 years(interquartile range(IQR),51-67 years)and an average body mass index(BMI)of 22.57±3.29 kg/m^(2).The item-total correlations of the total PG-SGA score between the global PG-SGA rating(Spearman,r=0.94)and PG-SGA score(patient-generated)(Spearman,r=0.97)were strong.Significant correlations were also found between the total PG-SGA score and other nutritional screening tools,including the BMI(Spearman,r=-0.26),KPS(Spearman,r=-0.36),and NRS 2002(Spearman,r=-0.47).Well-nourished(41.2%),mildly or moderately malnourished(35.3%)and severely malnourished(23.5%)groups defined according to the PG-SGA had significantly different characteristics.Patients with a worse nutritional status tended to have a decreased BMI(well-nourished,23.32 kg/m^(2)vs.mildly or moderately malnourished,22.52 kg/m^(2)vs.severely malnourished,21.35 kg/m^(2);P<0.001),hemoglobin,body fat mass,muscle mass,protein mass,TSF,MAC,HGS,MAMC,and MLCC,and a dramatically increased C-reactive protein level.The Kaiser-Meyer-Olkin measure was>0.7,and the P value of Bartlett’s test of sphericity was<0.001.One component was extracted by the principal component analysis,and the analysis showed that the total PG-SGA score explained the total variances of 97.3%.Conclusion The PG-SGA is a valid tool for evaluating the nutritional status for Chinese CRC patients.

Comparison of two nutritional assessment methods in gastroenterology patients

AIM:To investigate and compare efficacy and differences in the nutritional status evaluation of gastroenterology patients by application of two methods:subjective global assessment(SGA) and nutritional risk index(NRI).METHODS:The investigation was performed on 299 hospitalized patients,aged 18-84 years(average life span 55.57 ± 12.84),with different gastrointe-stinal pathology,admitted to the Department of Gastroenterohepatology,Clinical and Hospital Center "Bezanijska Kosa" during a period of 180 d.All the patients,after being informed in detail about the study and signing a written consent,underwent nutritional status analysis,which included two different nutritional indices:SGA and NRI,anthropometric parameters,bioelectrical impedance analysis,and biochemical markers,within 24 h of admission.RESULTS:In our sample of 299 hospitalized patients,global malnutrition prevalence upon admission varied from 45.7% as assessed by the SGA to 63.9% by NRI.Two applied methods required different parameters for an adequate approach:glucose level(5.68 ± 1.06 mmol/L vs 4.83 ± 1.14 mmol/L,F = 10.63,P = 0.001);body mass index(26.03 ± 4.53 kg/m2 vs 18.17 ± 1.52 kg/m2,F = 58.36,P < 0.001);total body water(42.62 ± 7.98 kg vs 36.22 ± 9.32 kg,F = 7.95,P = 0.005);basal metabolic rate(1625.14 ± 304.91 kcal vs 1344.62 ± 219.08 kcal,F = 9.06,P = 0.003) were very important for SGA,and lymphocyte count was relevant for NRI:25.56% ± 8.94% vs 21.77% ± 10.08%,F = 11.55,P = 0.001.The number of malnourished patients rose with the length of hospital stay according to both nutritional indices.The discriminative function analysis(DFA) delineated the following parameters as important for prediction of nutritional status according to SGA assessment:concentration of albumins,level of proteins,SGA score and body weight.The DFA extracted MAMC,glucose level and NRI scores were variables of importance for the prediction of whether admitted patients would be classif ied as well or malnourished.CONCLUSION:SGA showed higher sensitivity to predictor factors.Assessment of nutritional status requires a multidimensional approach,which includes different clinical indices and various nutritional param eters.

Malnutrition negatively impacts the quality of life of patients with cirrhosis: An observational study

AIMTo verify how malnutrition is related to health-related quality of life (HRQL) impairment in patients with cirrhosis. METHODSData was retrospectively abstracted from medical records and obtained by direct interview. We included patients with cirrhosis from any etiology, evaluated at the Liver Clinic from Gastroenterology Department in a tertiary healthcare center, from June 2014 to June 2016. Child-Pugh score, data about complications, and demographic, clinical and anthropometric characteristics of patients were obtained. Nutritional status was evaluated by the Subjective Global Assessment (SGA). HRQL was evaluated through the Chronic Liver Disease Questionnaire. Patients were requested to assess their global HRQL with the following code: 0 = impairment of HRQL, when it was compared with other healthy subjects; 1 = good HRQL, if it was similar to the quality of life of other healthy subjects. To compare the primary outcome between malnourished and well-nourished groups, the χ2 test, Fisher’s exact test or Student’s t-test were used, based on the variable type. Associations between predictor variables and deterioration of HRQL were determined by calculating the hazard ratio and 95% confidence interval using Cox proportional hazards regression. RESULTSA total of 127 patients with cirrhosis were included, and the mean age was 54.1 ± 12.3 years-old. According to Child-Pugh scoring, 25 (19.7%) were classified as A (compensated), 76 (59.8%) as B, and 26 (20.5%) as C (B/C = decompensated). According to SGA, 58 (45.7%) patients were classified as well-nourished. Sixty-nine patients identified HRQL as good, and 76 patients (59.8%) perceived impairment of their HRQL. Multivariate analysis to determine associations between predictor variables and self-perception of an impairment of HRQL found strong association with malnutrition (P P CONCLUSIONMalnutrition is a key factor related to impairment of HRQL in patients with cirrhosis.

Malnutrition and Quality of Life in Chinese Cancer Patients: a Clinical Study of 23,994 Subjects

Background Malnutrition is common in patients with cancer,and can negatively impact their quality of life(QoL)and even survival.However,there is currently no large data available on the prevalence of malnutrition in Chinese cancer patients.This study evaluated the prevalence of malnutrition and the QoL of Chinese patients with locoregional,recurrent or metastatic cancer.Methods We conducted a nationwide observational,multi-center,hospital-based cross-sectional study within the Chinese Society of Nutritional Oncology(CSNO)Network.All of the patients were diagnosed with one of the following 18 different types of malignant tumors:lung cancer,gastric cancer,liver cancer,colorectal cancer,breast cancer,esophageal cancer,cervical cancer,endometrial cancer,nasopharyngeal carcinoma,malignant lymphoma,leukemia,pancreatic cancer,ovarian cancer,prostate cancer,bladder cancer,brain cancer,biliary tract malignant tumors or gastrointestinal stromal tumors.These patients were enrolled from 72 hospitals located in different regions of China.The patients’nutritional status was evaluated based on the body mass index(BMI),loss of bodyweight,laboratory measurements and patient generated-subjective global assessment(PG-SGA)scores.The cancer patients’physical status and QoL were assessed by the Karnofsky Performance Status(KPS)questionnaire and the European Organization for Research and Treatment of Cancer(EORTC)QLQ-C30 questionnaire,respectively.Results From December 2013 to April 2016,23,994 patients hospitalized for cancer treatment(such as surgery,chemotherapy or radiotherapy)were enrolled in the study.The patients included 12,494(52.9%)males and 11,124(47.1%)females.The mean age was 55.8±13.7 years.The proportions of patients in cancer stagesⅠ,Ⅱ,Ⅲ,Ⅳand uncertain were 11.5%,20.3%,27.5%,30.2%and 10.5%,respectively.Among the 23,994 inpatients,the proportions of patients who were underweight(BMI<18.5 kg/m2),normal(18.5 kg/m2<BMI<24 kg/m2),overweight(24 kg/m2≤BMI<28 kg/m2)and obese(BMI≥28 kg/m2)were 9.3%,59.9%,26.1%and 4.7%,respectively.A total of 18.3%(4,101/22,424)of patients had lost 5%or more of their bodyweight within the past month and 19.6%(2,463/12,538)of patients had lost 10%or more of their bodyweight within the past 6 months.According to the PG-SGA scores,26.6%of the patients were severely malnourished(score≥9),31.3%were moderately malnourished(scores 4~8).A total of 22.2%of patients had a serum albumin level lower than 35g/L.Only 8.6%(2056/23,991)of the patients had severe KPS scores(≤60).The patients with these severe KPS scores were most frequently among those with cancers of the brain(19.7%),prostate(18.0%),pancreas(15.5%)and bladder(15.0%).Based on the QLQ-C30 score,11.6%of patients had a poor QoL.The PG-SGA score and global QoL were correlated(r=-0.593,P<0.001).Conclusion The prevalence of malnutrition in patients with cancer is relatively high,and is related to a poorer QoL.The present findings should be kept in mind when assessing cancer patients,because addressing the patient’s problems in nutritional status would be expected to improve both the clinical outcomes and QoL in cancer patients with malnutrition.

The Role of the PNI and NLR in Nutritional Risk Screening and Assessment of Gastric Cancer Patients

Background The use of nutritional risk screening and assessment is becoming increasingly common in cancer patients.The Nutritional Risk Screening 2002(NRS 2002)is a nutritional risk screening programe with good utility.The patient generated-subjective global assessment(PG-SGA)is a method used to assess the nutritional status of cancer patients.The prognostic nutritional index(PNI)and neutrophil to lymphocyte ratio(NLR)are considered to be predictors of the prognosis following treatment for patients with a variety of cancers.However,the relationship between the PNI and NLR in the nutritional screening and assessment in patients with gastric cancer is unknown.Methods A retrospective analysis was performed on 378 patients with gastric cancer who underwent surgery at the First Affiliated Hospital of Guangxi Medical University from August 2019 to December 2020.NRS 2002 and PG-SGA were performed within 24 hours of admission,and indicators such as the serum albumin level,body mass index(BMI),PNI and NLR were measured.Results In the grouping based on the NRS2002,patients in the positive group(NRS 2002≥3)had a higher platelet value,a higher median NLR,and a lower PNI than those in the negative group(NRS 2002<3)(295.50±118.49×10^(9)/L vs.269.36±93.52×10^(9)/L,2.38 vs.1.77,42.36±5.96 vs.46.64±4.29).Based on the PG-SGA grouping,the serum albumin level and lymphocyte count were highest in the mild group(PG-SGA:score 2-3),(36.94±3.51 g/L and 1.91±0.7610^(9)/L)and lowest within the severe group(PG SGA score≥9)(34.09±4.18 g/L and 1.51±0.6410^(9)/L).The BMI was highest in the mild group(23.35±3.00 kg/m^(2))and lowest in the severe group(20.63±2.97 kg/m^(2)),and the PNI was also highest in the mild group(46.50±5.17)and lowest in the severe group(41.64±5.53).However,the NLR was lowest in the mild group(median 1.91)and highest in the severe group(median 2.44).Conclusion The PNI and NLR in gastric cancer patients are closely related to the results of the nutritional risk screening and assessment,suggesting that they may be useful to guide the nutritional interventions for gastric cancer patients.

Malnutrition as a predictor of prolonged length of hospital stay in patients with gynecologic malignancy: A comparative analysis

Objective To explore the consistency of the Patient-generated Subjective Global Assessment(PG-SGA)and Nutritional Risk Screening-2002(NRS-2002)for nutritional evaluation of patients with gynecologic malignancy and their predictive effect on the length of hospital stay(LOS).Methods We recruited 147 hospitalized patients with gynecologic malignancy from Nanfang Hospital in 2017.Their nutritional status was assessed using the PG-SGA and NRS-2002.The consistency between the two assessments was compared via the Kappa test.The relationship between malnutrition and LOS was analyzed using crosstabs and Spearman’s correlation.Results The PG-SGA demonstrated that 66.7%and 54.4%of patients scoring≥2 and≥4 were malnourished,respectively.Furthermore,the NRS-2002 indicated that 55.8%of patients were at nutritional risk.Patients with ovarian cancer had a relatively high incidence of malnutrition.However,this was only significant for patients who scored≥4 in the PG-SGA(P=0.001 and P=0.019 for endometrial carcinoma and cervical cancer,respectively).The PG-SGA and NRS-2002 showed good consistency in evaluating the nutritional status of patients with gynecologic malignancy(0.689,0.643 for PG-SGA score≥2,score≥4 and NRS-2002,respectively).Both the scores of PG-SGA and NRS-2002 were positively correlated with LOS.Furthermore,prolonged LOS was higher in patients with malnutrition than in those with adequate nutrition.Conclusion The PG-SGA and NRS-2002 shared a good consistency in evaluating the nutritional status of patients with gynecologic malignancy.Both assessments could be used as predictors of LOS.

Comparison of Four Tools Used for Nutritional Screening and Assessment in Cancer Patients:An Prospective Observational Study in China

The purpose of this study was to investigate and compare the efficacy of four screening tools commonly used to evaluate the nutritional status of cancer patients.A total of 173 patients(average age 50.7±12.9,89 males,84 females)with different pathology at admission were assessed using four nutritional screening tools,including the Body Mass Index(BMI),the Nutritional Risk Index(NRI),Patient-Generated Subjective Global Assessment(PG-SGA),and the Nutrition Risk Screening 2002(NRS 2002).The prevalence of malnourished/at high nutritional risk classified by the BMI,NRI,PG-SGA,and NRS 2002 were 12.7%,32.4%,65.3%,and 20.8%,respectively.Using the PG-SGA as a gold standard,the specificity and positive predictive value of the BMI and NRS 2002 were both 100%.The NRS 2002(K=0.245,P<0.001)and NRI(K=0.301,P<0.001)were found to be in poor agreement with the PG-SGA.The results for the BMI showed a moderate agreement(K=0.713,P<0.001)with the NRS 2002.There was a high prevalence of malnutrition in cancer patients,especially when assessed by the PG-SGA,which was superior to the BMI,NRI,and NRS 2002 in this study.The NRS 2002 may be used to screen for malnutrition and the risk of malnutrition in cancer patients before the implementation of the PG-SGA.

Nutritional Assessment of Gynecological Cancer Patients in China

Background Malnutrition is common among cancer patients,but few studies have evaluated the nutritional status among gynecological cancer patients in China.This study aimed to assess the nutritional status of women with gynecological cancer using the patient-generated subjective global assessment(PG-SGA).Methods Data for gynecological cancer patients treated at 44 tertiary hospitals were retrieved from a multicenter study on tumor nutrition.The R Software was used for statistical analyses.Univariate analyses of PG-SGA scores were performed using the Chi-squared test for categorical variables and the Wilcoxon-rank sum test or Kruskal-Wallis test for continuous variables,as appropriate.The significance level was 0.05.Results Data for 1962 women with three types of gynecological cancer(cervical,uterine and ovarian cancer)were used for the data analysis.The median PG-SGA score was 4(interquartile range,IQR:1,8),the median participants’age was 51(IQR:46,59)years old,and the patients had a median BMI of 22.9(IQR:20.7,25.4).The percentages of women who had a medical co-morbidity,or had undergone any radical resection,chemotherapy,or radiotherapy were approximately 27.7%,55.4%,52.5%,and 30.2%,respectively.The levels of serum albumin and high density lipoprotein cholesterol(HDL-C)were 40.1g/L(IQR:36.8,43.1)and 1.2mmol/L(IQR:1.0,1.5),respectively.The identified risk factors for malnutrition based on the PG-SGA score were age(0.05±0.01,p=0.002),BMI(-0.34±0.04,p<0.001),having a medical co-morbidity(0.95±0.33,p=0.004),receiving radiotherapy(1.52±0.31,p<0.001),the serum albumin level(-0.18±0.03,p<0.001),and the HDL-C(-1.12±0.35,p=0.001)as indicated by a linear regression analysis.Conclusions A higher PG-SGA score is positively associated with the age of the patient,having a medical co-morbidity,and receiving radiotherapy,and is negatively related to the patients’BMI and serum albumin and HDL-C levels.

Extension Protocol for the Investigation on Nutrition Status and Clinical Outcome of Patients with Common Cancers in China(INSCOC)Study:2021 update

Background Malnutrition is common in patients with cancer,and this adversely affects the survival and quality of life of patients.Chinese Society for Nutritional Oncology issued a multi-center,large-scale,long-term follow-up prospective study,the Investigation on Nutrition Status and Clinical Outcome of Patients with Common Cancers in China(INSCOC study)since 2013.This is an extension to the previous 2013-2020 study protocol.This study still sought to:①address the prognostic impact of nutritional factors and quality of life on cancer patient survival;②describe the overall and cancer-specific incidence and/or distribution of malnutrition and different measurements of patient quality of life.Methods and study design This is an observational,multi-centered,hospital-based prospective cohort study.Data collection will be performed at baseline(within 48 hours after patient admission),during the hospital stay and 30 days after hospital admission.Follow-up will be conducted for 1-20 years after enrollment.The primary outcome will be the all-cause mortality/overall survival,and secondary outcomes will be the length of hospital stay and costs of hospitalization.Study factors will include demographic characteristics,tumor characteristics,information about chronic diseases,hematological measurements(e.g.,red blood cell count,total lymphocyte counts,hemoglobin,albumin,prealbumin,creatinine,C-reactive protein,IL-6),anthropometric measurements(e.g.,height,weight,arm circumference,arm muscle circumference,triceps skinfold thickness,and waist circumference),body composition parameters,PG-SGA scores,quality of life(as indicated by the QLQ-C30 questionnaire),muscle mass(as indicated by the calf circumference),muscle strength(as indicated by the handgrip strength),muscle function(as indicated by the six-meter walking speed test)and physical status assessments(as indicated by the Karnofsky Performance Status scores).This clinical study protocol was approved by local Ethics Committees of all the participating hospitals.Written informed consent is required for each subject included.Discussion This multi-center,large-scale,long-term follow up prospective study will help improve the diagnosis of malnutrition in cancer patients and identify the risk factors associated with adverse clinical outcomes.The anticipated results of this study will highlight the need for a truly scientific appraisal of nutrition therapy in Chinese oncology populations,and finally help treat the potentially reversible elements of malnutrition in cancer patients to improve their clinical outcomes in the future.

Malnutrition and non-compliance to nutritional recommendations in patients with cirrhosis are associated with a lower survival

BACKGROUND Malnutrition is frequently encountered in patients with cirrhosis and appears to significantly impact their prognosis.While evaluating the burden of malnutrition in cirrhosis is gathering momentum,as suggested by multiple recently published reports,there is still a persistent scarcity of solid data in the field,especially with regards to the role of nutritional interventions.AIM To assess the prevalence of malnutrition in patients with advanced cirrhosis and to evaluate its impact on survival.METHODS One hundred and one consecutive patients with advanced cirrhosis were screened for malnutrition using the Subjective Global Assessment(SGA)criteria and the mid-arm circumference(MAC).Malnutrition was defined as SGA class B and C and MAC<10th percentile.All patients were interviewed regarding their food intake using an adapted questionnaire.Subsequently,total energy intake was calculated and further subdivided in main nutrients.The data were then compared to the available recommendations at the time of analysis to assess adherence.RESULTS 54/79 patients(68.4%)in the decompensated group had malnutrition,while only 3/22 patients(13.6%)were malnourished in the compensated group.After a median follow-up time of 27 mo(0-53),the overall mortality was 70%.Survival was significantly lower among patients with malnutrition.The mortality rates were 50%at 1 year and 63%at 2 years for the patients with malnutrition,compared to 21%at 1 year and 30%at 2 years for patients without malnutrition(P=0.01).On multivariate analysis,the factors independently associated with mortality were age,creatinine level and adherence to the protein intake recommendations.The mortality was lower in patients with the appropriate protein intake:8%at 1 year and 28%at 2 years in the adherent group,compared to 47%at 1 year and 56%at 2 years in the non-adherent group.CONCLUSION The prevalence of malnutrition is high among patients with advanced cirrhosis and might be related in part to a low adherence to nutritional recommendations,especially with regards to protein intake.

3种营养筛查工具在骨与软组织肿瘤患者营养不良风险评估中的临床价值

目的:调查骨与软组织肿瘤患者营养不良风险的发生情况,探索营养风险筛查2002(NRS2002)、通用筛查工具(MUST)、患者主观整体评估简表(PG-SGASF)等3种营养筛查工具在骨与软组织肿瘤患者营养不良风险评估中的临床价值。方法:对山西省肿瘤医院骨与软组织科2023年8月—2024年5月的所有入院成年患者进行问卷调查,调查内容包括:患者一般情况(年龄、性别、身高、体重);患者体重在近2周、1个月、2个月、3个月、6个月的变化情况;饮食改变情况以及影响饮食的原因等。整理完成NRS2002、MUST、PG-SGASF得分。结合患者临床资料疾病诊断、治疗情况进行统计分析。率的比较采用卡方检验,定量资料两组比较采用Mann-Whitney检验,多组比较采用Kruskal-WallisH检验,绘制韦恩图、ROC曲线。结果:合格问卷633份,男性327例、女性306例,平均年龄(54.41±14.35)岁。骨与软组织肿瘤患者营养不良风险在14%~22%之间,恶性肿瘤患者营养不良风险发生率更高。3种筛查结果绘制韦恩图显示,NRS2002与MUST一致性更高。以NRS2002为基础绘制ROC曲线(曲线下面积:MUST:0.9287,PG-SGASF:0.596)。结论:骨与软组织肿瘤患者营养不良风险发生率较其他类型肿瘤患者偏低,但恶性度越高营养不良风险越大。NRS2002有一定的漏诊情况,MUST简易且全面,PG-SGASF更适合用于评估。

基于患者主观整体评估的个体化营养干预在胃癌根治术后辅助化疗患者中的应用效果

目的探讨基于患者主观整体评估(PG-SGA)的个体化营养干预在胃癌根治术后辅助化疗患者中的应用效果。方法根据干预方式的不同将108例胃癌根治术后辅助化疗患者分为对照组(n=48)和观察组(n=60),对照组患者接受常规干预,观察组患者在对照组患者的基础上接受基于PG-SGA的个体化营养干预,比较两组患者的营养指标[白蛋白(ALB)、前白蛋白(PAB)、总蛋白(TP)、预后营养指数(PNI)]、免疫功能指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))、生活质量[欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)]及满意情况。结果干预后,两组患者ALB、PAB、TP、PNI、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)及EORTC QLQ-C30各维度评分均高于本组干预前,观察组患者ALB、PAB、TP、PNI、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、EORTC QLQ-C30各维度评分及总满意度均高于对照组,差异均有统计学意义(P﹤0.05)。结论基于PG-SGA的个体化营养干预应用于胃癌根治术后辅助化疗患者,可以改善患者的营养状态及免疫功能,提高患者的生活质量及满意度。

基于患者自评-主观全面评定量表的个性化营养干预在胃癌术后化疗患者中的应用效果

目的探讨基于患者自评-主观全面评定量表(PG-SGA)的个性化营养干预在胃癌术后化疗患者中的应用效果。方法根据干预方式的不同将132例胃癌术后化疗患者分为对照组(n=65)和观察组(n=67),对照组患者采取常规干预,观察组患者在对照组的基础上采取基于PG-SGA的个性化营养干预。比较两组患者的胃肠功能恢复指标、营养指标[血红蛋白(Hb)、白蛋白(ALB)、总蛋白(TP)]、免疫功能指标[免疫球蛋白(Ig)A、IgM、IgG、CD3^(+)、CD4^(+)、CD8^(+)]、生活质量[欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)]以及不良反应发生情况。结果观察组患者腹胀改善时间、首次排气时间及肠鸣音恢复时间均明显短于对照组,差异均有统计学意义(P﹤0.01)。干预后,两组患者Hb、ALB、TP水平均高于本组干预前,观察组患者Hb、ALB、TP水平均高于对照组,差异均有统计学意义(P﹤0.05)。干预后,两组患者IgA、IgG、IgM、CD3^(+)、CD4^(+)水平均高于本组干预前,CD8^(+)水平均低于本组干预前,观察组患者IgA、IgG、IgM、CD3^(+)、CD4^(+)水平均高于对照组,CD8^(+)水平低于对照组,差异均有统计学意义(P﹤0.05)。干预后,两组患者EORTC QLQ-C30各维度评分均高于本组干预前,观察组患者EORTC QLQ-C30各维度评分均高于对照组,差异均有统计学意义(P﹤0.05)。观察组患者的不良反应总发生率低于对照组(P﹤0.05)。结论基于PG-SGA的个性化营养干预应用于胃癌术后化疗患者,能够改善患者的营养状态及免疫功能,促进患者胃肠功能恢复,提高患者生活质量,降低不良反应发生率。

维持性血液透析病人营养筛查与评估护理质量敏感指标体系的构建及应用

目的:探讨维持性血液透析(MHD)病人营养筛查与评估护理质量敏感指标体系的应用效果。方法:选择来我院门诊就诊的160例长期MHD病人为研究对象,其中,MHD病人营养筛查与评估护理质量敏感指标体系实施前(2022年10月—12月)及实施后(2023年1月—3月)各80例。成立指标研究小组,通过文献回顾、专家函询构建MHD病人营养筛查与评估护理质量敏感指标体系,并将其应用于MHD病人。比较MHD病人营养筛查与评估护理质量敏感指标体系实施前后优先改进指标落实率、营养不良检出率、病人满意度。结果:指标体系实施后营养筛查执行率、营养评估落实率、营养筛查与评估工具使用正确率、病人营养宣教内容知晓率均高于实施前;营养不良检出率为7.50%,高于实施前(0);病人对工作流程、服务态度、专业技能、临床效果、综合护理服务质量的满意度高于实施前,差异均有统计学意义(P<0.05)。结论:应用MHD病人营养筛查与评估护理质量敏感指标体系能够提高MHD病人营养筛查与评估的护理质量及营养不良检出率,提升病人满意度。