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.

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.

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.

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.

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.

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.

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.

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.

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.

Antituberculosis Drug-Induced Liver Injury: An Ignored Fact, Assessment of Frequency, Patterns, Severity and Risk Factors

Background/Aims: Antituberculosis drug-induced liver injury (TB DILI) is a frequent medical problem in Pakistan. Critical understanding of various aspects of TB DILI is not only important to manage liver injury but may also prevent unnecessary discontinuation of antituberculosis treatment. The study is aimed to determine the frequency, types, severity and patterns of TB DILI. Study further evaluates various risk factors of TB DILI. Materials and Methods: This is a prospective cohort study of two seventy-eight patients with the diagnosis of tuberculosis, where patients were followed during tuberculosis treatment. TB DILI was defined in accordance to international DILI expert working group. Results: Out of two seventy eight-patients, ninety-five (34.14%) had TB DILI. The most common pattern of TB DILI was hepatocellular (63.15%) followed by mixed (23.15%) and Cholestatic (13.68%). Most of the patients had mild DILI (43.15%) followed by moderate (30.52%), severe (20.01%) and very severe (5.26%). Age > 35 years, concomitant hepatotoxic drugs, extrapulmonary TB and malnutrition are important risk factors for TB DILI. Conclusion: All patterns of TB DILI with varying severity were present. Age > 35 years, malnutrition, extrapulmonary TB and concomitant use of hepatotoxic drugs were risk factors for TB DILI.

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.

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。

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。

NRS-2002与PG-SGA在中晚期肿瘤患者营养筛查及评估中的应用

目的 研究欧洲营养风险筛查工具(NRS-2002)与主观整体评估量表(PG-SGA)在中晚期肿瘤患者营养筛查及评估中的应用效果。方法 回顾性分析2020年1月至2022年1月长安医院收治的116例中晚期肿瘤患者的临床资料,根据其在入院后接受的营养状况筛查和评估结果的不同分为营养正常组72例和营养不良组44例。比较两组患者的NRS-2002与PG-SGA评分情况、NRS-2002与PG-SGA不同分组患者的营养指标水平、应用NRS-2002与PG-SGA评分分组后两组患者近期的疗效及远期生存情况;采用Spearman秩相关分析法分析NRS-2002与PG-SGA评分与中晚期肿瘤患者营养指标的相关性。结果 营养正常组患者的NRS-2002与PG-SGA评分分别为(2.07±0.79)分、(3.52±1.01)分,明显低于营养不良组的(4.69±0.74)分、(5.22±1.14)分,差异均有统计学意义(P<0.05);NRS-2002评分中营养正常组患者的基础代谢、总水分、体质量指数、腰臀比、血红蛋白、白蛋白、前白蛋白、红细胞计数、血糖等营养指标水平明显高于营养不良组,PG-SGA评分中营养正常组的基础代谢、总水分、体质量指数、腰臀比、血红蛋白、白蛋白、前白蛋白、红细胞计数、血糖等营养指标水平也明显高于营养不良组,差异均有统计学意义(P<0.05);经Spearman秩相关分析法分析结果显示,NRS-2002和PG-SGA评分均与患者体质量指数、红细胞计数、血红蛋白、白蛋白、前白蛋白呈负相关(P<0.05);营养正常组患者的近期总有效率为94.44%,明显高于营养不良组的70.45%,差异有统计学意义(P<0.05);营养正常组患者的中位生存时间为(12.86±2.27)个月,明显长于营养不良组的(8.26±1.41)个月,生存率为93.06%,明显高于营养不良组的65.91%,而局部复发和远处转移率分别为16.67%、6.94%,明显低于营养不良组患者的34.09%、34.09%,差异均具有统计学意义(P<0.05)。结论 NRS-2002与PG-SGA均是筛查和评估中晚期肿瘤患者营养状态的有效方法,能及时发现患者的营养风险,以便及时对患者营养不良状况进行纠正,值得临床推广应用。

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。

改良版患者主观整体评估可用于原发性肝癌患者营养不良的评估

目的研究原发性肝癌患者的营养状况,比较患者主观整体评估(PG-SGA)和改良版患者主观整体评估(mPG-SGA)评估营养不良的能力。方法纳入2022年4月至2023年9月于西南医科大学附属医院首诊为原发性肝癌的249例患者,采用PG-SGA和m PG-SGA评估患者营养状况,通过Spearman相关分析比较不同营养指标与两种量表评估结果的相关性,绘制受试者操作特征(ROC)曲线评价m PG-SGA的准确性,计算Kappa系数评价两种量表的一致性。结果249例原发性肝癌患者中,PG-SGA和m PG-SGA分别诊断出中、重度营养不良患者196例(78.71%)、189例(75.90%)。以PG-SGA为标准,对于营养良好/轻度营养不良、中度营养不良及重度营养不良3种不同营养状态,mPG-SGA均表现出较好的准确性,AUC值分别为0.982、0.938、0.977(P<0.001),并具有强一致性(Kappa=0.951,P<0.001)。通过性别、年龄、吸烟史、饮酒史、临床分期、体质指数(BMI)分层分析发现,BMI<18.5 kg/m^(2)的患者中,mPG-SGA对营养良好/轻度营养不良、中度营养不良及重度营养不良3种不同营养状态表现出较强的一致性(Kappa=0.762,P=0.001),除外BMI<18.5 kg/m^(2)的其余临床特征分层分析中,mPG-SGA对3种不同营养状态均表现出强一致性(Kappa>0.9,P<0.001)。结论原发性肝癌患者营养不良发生率高,mPG-SGA与PG-SGA具有良好的准确性及一致性,是一种更简便、适用于评估原发性肝癌患者营养不良的工具。

患者主观整体状况评估在结直肠癌中的预后价值及其列线图模型的构建

目的探讨患者主观整体评估(PG-SGA)在结直肠癌中的预后价值,并构建一个联合患者营养状况与临床病理参数的列线图模型。方法选取2016年1月至2020年1月期间于南京中医药大学南通附属医院接受根治性手术的202例结直肠癌患者进行回顾性分析,使用PG-SGA量表评估患者术前营养状况,评估其对患者总生存(OS)率的影响。通过单、多变量Cox回归分析确定结直肠癌患者的独立预后因素,并构建列线图模型,C指数和校准曲线用于评价模型的预测能力。结果根据PG-SGA量表,33.7%的患者存在中度营养不良,26.7%为严重营养不良。严重营养不良患者肿瘤直径更大(P=0.044),术后接受辅助化疗的比例明显更低(P=0.029)。营养良好、中度营养不良及严重营养不良患者的5年OS率分别为81.6%、63.2%和46.5%,组间差异均有统计学意义(P<0.05)。肿瘤大小(P=0.046)、pT分期(P=0.002)、淋巴结转移(P=0.001)、脉管侵犯(P<0.001)与PG-SGA量表评估结果(P<0.001)是结直肠癌患者的独立预后因素。基于上述预后参数构建列线图模型,C指数为0.781(95%CI=0.671~0.890),校准曲线显示模型预测概率与实际生存概率具有良好一致性。结论PG-SGA量表评分是结直肠癌患者一项有用的生存预测工具,联合临床病理参数可进一步优化患者的预后风险分层。

艾灸疗法对脾肾阳虚型腹膜透析患者胃肠功能障碍的影响

目的:观察艾灸疗法对脾肾阳虚型腹膜透析患者胃肠功能障碍的疗效,并探讨相关机制。方法:将72例脾肾阳虚型腹膜透析胃肠功能障碍患者按随机数字表法分为对照组和艾灸组各36例,最终69例患者完成研究,对照组35例,艾灸组34例。两组患者均接受西医常规基础治疗,艾灸组患者在此基础上接受艾灸足三里、三阴交治疗。两组均以4周为1个疗程,持续治疗3个疗程。比较两组治疗前后的胃肠道症状分级量表(GSRS)评分、主观整体营养评估(SGA)评分及血清胃泌素(GAS)、胃动素(MOT)、胆囊收缩素(CCK)水平,评价两组胃肠道症状疗效。结果:治疗后,两组GSRS评分均较治疗前降低,SGA评分均较治疗前升高,血清GAS、MOT、CCK水平均较治疗前降低,差异均有统计学意义(P<0.01)。治疗后,艾灸组GSRS评分低于对照组,SGA评分高于对照组,血清GAS、MOT、CCK水平低于对照组,差异均有统计学意义(P<0.05)。艾灸组胃肠道症状总有效率高于对照组,两组胃肠道症状疗效比较,差异有统计学意义(P<0.05)。结论:艾灸疗法能缓解脾肾阳虚型腹膜透析患者的胃肠道症状,改善其营养状态,作用机制可能与调节GAS、MOT、CCK水平有关。

积极综合护理模式在慢性心衰伴心肾综合征患者中的应用效果及对症状改善、MQSGA评分的影响

目的探讨积极综合护理模式在慢性心衰伴心肾综合征(CRS)患者中的应用效果。方法选择2020年1月至2022年1月收治的50例慢性心衰伴CRS患者为研究对象,经随机数字表法将其分为常规组和研究组,各25例。常规组予以一般性基础护理,研究组予以积极综合护理模式。比较两组的护理效果。结果研究组的呼吸困难、贫血、水肿及乏力改善时间均显著短于常规组(P<0.05)。干预后,两组的体质量指数(BMI)均明显升高,改良主观综合性营养评估法(MQSGA)评分均明显降低,且研究组优于常规组(P<0.05)。干预后,两组的自我感受负担量表(SPBS)评分均降低,简易应对方式问卷(SCSQ)评分均升高,且研究组优于常规组(P<0.05)。结论积极综合护理模式有助于缓解慢性心衰伴CRS患者的临床症状及自我感受负担,提高患者的体质量,改善其疾病应对态度及营养状况。

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.