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.

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.

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.

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.

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.

Relationship of the preoperative NRS 2002 score,PG-SGA score,and serum indices with postoperative complications in patients with gastric cancer

Objective To examine the utility of the Nutrition Risk Screening 2002(NRS 2002),Patient-Generated Subjective Global Assessment(PG-SGA)and serum factors for the preoperative evaluation of gastric cancer patients.Methods We examined 181 gastric cancer patients treated at the First Affiliated Hospital of Guangxi Medical University from January 2015 to January 2018.Nutritional assessments were administered within 48 h of admission.The body mass index(BMI)and serum factors were measured,and information on preoperative nutritional support and postoperative complications was recorded.Results Both the NRS 2002 and PG-SGA had positive correlations with age(P<0.05),and negative correlations with albumin,prealbumin,transferrin,hemoglobin,BMI,and bodyweight(P<0.05).The NRS 2002 and PG-SGA scores were positively correlated with each other(r=0.683,P<0.01),but had poor consistency(κ=0.357,P<0.01).During the preoperative period,33.2%of patients received nutritional support,mainly enteral nutrition.The nutritional risk group(NRS 2002≥3)received more support than the group without nutritional risk(NRS 2002<3;P<0.05).Patients with nutritional risk or malnutrition who received preoperative nutritional support had fewer postoperative complications than unsupported patients.The overall rate of complications was 12.2%,and the rate of severe complications(gradeⅢor above)was 5.5%.The malnutrition and nutritional risk groups had higher rates of severe complications.Conclusions The combined application of the NRS 2002,PG-SGA,BMI,and serum nutritional indices was useful for the nutritional screening and assessment of preoperative gastric cancer patients.The NRS 2002 and PG-SGA provided guidance on the need for nutritional support during the preoperative period.

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.

Nutritional Support During Chemotherapy in a Patient with Advanced Gastric Cancer: A Case Report

Gastric cancer (GC) is one of the most common malignancies in China. GC patients often present with dysphagia and abnormal digestive function, leading to malnutrition or even cachexia. In February 2017, an advanced GC patient at Peking University Cancer Hospital received chemotherapy with the additional support of nutritional treatment. After being treated with the dietary prescription and oral nutritional supplements, the patient’s malnutrition was reversed, and he was able to complete five full cycles of chemotherapy.

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.