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Wang P, Tan Y, Soh KL, Soh KG, Ning C, Xue L, Lu Y, Yang J. Nutrition Risk Screening 2002 for Adult Cancer Patients: A Systematic Review and Meta-Analysis. Nutr Cancer 2024; 76:573-583. [PMID: 38757365 DOI: 10.1080/01635581.2024.2352901] [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: 11/16/2023] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/18/2024]
Abstract
It is critical to screen and assess malnutrition in cancer patients early. However, there is no uniform standard for nutritional risk screening and malnutrition assessment. We aimed to analyze the effects of the Nutrition Risk Screening 2002 (NRS2002) in screening for nutritional risk among adult cancer patients, using the Patient-Generated Subjective Global Assessment (PG-SGA) as the reference standard. A systematic search was performed using PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and China Science and Technology Journal Database (VIP). Studies comparing NRS2002 with PG-SGA in adult cancer patients were included. To assess the quality of the included studies, the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used. The combined sensitivity, specificity, diagnostic odds ratio (DOR), and the area under the receiver-operating characteristic curve (AUC) were calculated. In addition, sensitivity, subgroup, and publication bias analyses were performed. Thirteen articles involving 3,373 participants were included. The combined sensitivity, specificity, DOR, and AUC were 0.62 (95% CI, 0.60-0.64), 0.86 (95% CI, 0.84-0.88), 11.23 (95% CI, 8.26-15.27), and 0.85 (95% CI, 0.82-0.88), respectively. For adult cancer patients, NRS2002 has moderate sensitivity, high specificity, and high AUC in screening for nutritional risk.
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Affiliation(s)
- Pengpeng Wang
- Nursing College of Guangxi Medical University, Nanning, Guangxi, China
- Department of Nursing, Universiti Putra Malaysia, Selangor, Serdang, Malaysia
| | - Yanmei Tan
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Kim Lam Soh
- Department of Nursing, Universiti Putra Malaysia, Selangor, Serdang, Malaysia
| | - Kim Geok Soh
- Department of Sports Studies, Universiti Putra Malaysia, Selangor, Serdang, Malaysia
| | - Chuanyi Ning
- Nursing College of Guangxi Medical University, Nanning, Guangxi, China
| | - Li Xue
- Nursing College of Guangxi Medical University, Nanning, Guangxi, China
| | - Yunhong Lu
- Nursing College of Guangxi Medical University, Nanning, Guangxi, China
| | - Jie Yang
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Tan S, Jiang J, Qiu L, Liang Y, Meng J, Tan N, Xiang B. Prevalence of Malnutrition in Patients with Hepatocellular Carcinoma: A Comparative Study of GLIM Criteria, NRS2002, and PG-SGA, and Identification of Independent Risk Factors. Nutr Cancer 2024; 76:335-344. [PMID: 38379140 DOI: 10.1080/01635581.2024.2314317] [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: 06/20/2023] [Revised: 01/08/2024] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Abstract
AIM Malnutrition is prevalent in hepatocellular carcinoma (HCC) patients, linked to poor outcomes, necessitating early intervention. This study aimed to investigate malnutrition in HCC patients, assess Nutrition Risk Screening 2002 (NRS-2002) and Patient-Generated Subjective Global Assessment (PG-SGA) vs. Global Leadership Initiative on Malnutrition (GLIM) criteria, and identify independent risk factors. METHOD A cross-sectional retrospective study was conducted on 207 patients with HCC. Nutritional screening/assessment results and blood samples were collected within 72 h of admission. This study assessed the prevalence of malnutrition using the NRS-2002 and PG-SGA and retrospectively using the GLIM criteria. The performance of the screening tools was evaluated using kappa (K) values. Logistic regression analyses were performed to determine whether laboratory parameters were associated with malnutrition as identified by the GLIM criteria. RESULTS Of the participants, 30.4% were at risk of malnutrition according to NRS-2002. The agreement between the NRS-2002 and GLIM criteria was substantial. The GLIM criteria and PG-SGA diagnosed malnutrition in 43 and 54.6% of the participants, respectively. Age, anemia, and ascites correlated with malnutrition in regression. CONCLUSION The GLIM criteria, along with NRS-2002 and PG-SGA, aid in diagnosing malnutrition in HCC patients. Recognizing risk factors improves accuracy, enabling timely interventions for better outcomes.
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Affiliation(s)
- Shengqiang Tan
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
- Department of Hepatobiliary Surgery, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Jie Jiang
- Department of Clinical Nutrition, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Liulin Qiu
- Department of Clinical Nutrition, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Yaohao Liang
- Department of Hepatobiliary Surgery, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Jianyi Meng
- Department of Hepatobiliary Surgery, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Ning Tan
- College of Basic Medical Sciences, Guilin Medical University, Guilin, China
| | - Bangde Xiang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
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Zheng K, Lu J, Liu X, Ji W, Liu P, Cui J, Li W. Applied nutritional investigation The clinical application value of the extracellular-water-to-total-body-water ratio obtained by bioelectrical impedance analysis in people with advanced cancer. Nutrition 2021; 96:111567. [PMID: 35074647 DOI: 10.1016/j.nut.2021.111567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/18/2021] [Accepted: 11/28/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Body-composition analysis using bioelectrical impedance analysis is gradually becoming more widely used in clinical practice. The ratio of extracellular water (ECW) to total body water (TBW) is thought to be related to the prognosis of a variety of diseases. However, its performance in people with advanced cancer deserves further discussion. METHODS A retrospective analysis was performed on 784 people with advanced cancer. Anthropometric indicators, serologic indicators, nutritional status, health-related quality of life, and body composition were analyzed. Participants were grouped into two groups according to ECW/TBW ratio. We used t tests and χ2 tests to analyze differences between the groups. Univariate and multivariate Cox regressions were conducted to analyze the factors influencing overall survival. Logistic regression was used to analyze the related factors of malnutrition, and linear regression for factors of health-related quality of life. RESULTS Age, body mass index, Patient-Generated Subjective Global Assessment score, Karnofsky Performance Status questionnaire score, skeletal muscle mass index, and fat-free mass index were statistically different between the non-overhydrated and overhydrated groups. Univariate and multivariate Cox regression models showed that an ECW/TBW ≥ 0.40 is a risk factor for poor prognosis in people with advanced cancer (hazard ratio = 1.511; 95% confidence interval, 1.103-2.070; P = 0.010). Subgroup analyses were next conducted according to tumor type, with ECW/TBW ≥ 0.40 emerging as a risk factor for poor prognosis for people with advanced breast cancer and advanced gastric cancer. Logistic regression showed that ECW/TBW ≥ 0.40 is a risk factor for malnutrition in people with advanced cancer (odds ratio = 1.988; 95% confidence interval, 1.049-3.767; P = 0.035). The univariate and multivariate linear regression models showed that the ECW/TBW ratio is an influencing factor for health-related quality of life in the domains of physical functioning, role functioning, and constipation. CONCLUSION We found that in people with cancer, an ECW/TBW ≥ 0.40 was a risk factor for malnutrition and lower health-related quality of life, and in people with advanced cancer, it was a risk factor for poor prognosis.
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Affiliation(s)
- Kaiwen Zheng
- The First Hospital of Jilin University, Changchun, China.
| | - Jin Lu
- The First Hospital of Jilin University, Changchun, China.
| | - Xiangliang Liu
- The First Hospital of Jilin University, Changchun, China.
| | - Wei Ji
- The First Hospital of Jilin University, Changchun, China.
| | - Pengfei Liu
- The First Hospital of Jilin University, Changchun, China.
| | - Jiuwei Cui
- The First Hospital of Jilin University, Changchun, China.
| | - Wei Li
- The First Hospital of Jilin University, Changchun, China.
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Richards J, Arensberg MB, Thomas S, Kerr KW, Hegazi R, Bastasch M. Impact of Early Incorporation of Nutrition Interventions as a Component of Cancer Therapy in Adults: A Review. Nutrients 2020; 12:nu12113403. [PMID: 33167544 PMCID: PMC7694504 DOI: 10.3390/nu12113403] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022] Open
Abstract
Malnutrition is prevalent among oncology patients and can adversely affect clinical outcomes, prognosis, quality of life, and survival. This review evaluates current trends in the literature and reported evidence around the timing and impact of specific nutrition interventions in oncology patients undergoing active cancer treatment. Previous research studies (published 1 January 2010–1 April 2020) were identified and selected using predefined search strategy and selection criteria. In total, 15 articles met inclusion criteria and 12/15 articles provided an early nutrition intervention. Identified studies examined the impacts of nutrition interventions (nutrition counseling, oral nutrition supplements, or combination of both) on a variety of cancer diagnoses. Nutrition interventions were found to improve body weight and body mass index, nutrition status, protein and energy intake, quality of life, and response to cancer treatments. However, the impacts of nutrition interventions on body composition, functional status, complications, unplanned hospital readmissions, and mortality and survival were inconclusive, mainly due to the limited number of studies evaluating these outcomes. Early nutrition interventions were found to improve health and nutrition outcomes in oncology patients. Future research is needed to further evaluate the impacts of early nutrition interventions on patients’ outcomes and explore the optimal duration and timing of nutrition interventions.
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Affiliation(s)
- Julie Richards
- Abbott Nutrition, Bob Evans Farms, Columbus, OH 43212, USA
- Correspondence: ; Tel.: +1-740-497-7708
| | - Mary Beth Arensberg
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA; (M.B.A.); (S.T.); (K.W.K.); (R.H.)
| | - Sara Thomas
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA; (M.B.A.); (S.T.); (K.W.K.); (R.H.)
| | - Kirk W. Kerr
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA; (M.B.A.); (S.T.); (K.W.K.); (R.H.)
| | - Refaat Hegazi
- Abbott Nutrition Division of Abbott, Columbus, OH 43219, USA; (M.B.A.); (S.T.); (K.W.K.); (R.H.)
| | - Michael Bastasch
- Department of Medicine and Division of Radiation Oncology, University of Texas East Health, Athens, TX 75751, USA;
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Wolf PG, Manero J, Harold KB, Chojnacki M, Kaczmarek J, Liguori C, Arthur A. Educational video intervention improves knowledge and self-efficacy in identifying malnutrition among healthcare providers in a cancer center: a pilot study. Support Care Cancer 2020; 28:683-689. [PMID: 31123871 PMCID: PMC7252495 DOI: 10.1007/s00520-019-04850-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/30/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE Cancer is the second leading cause of death in the USA, and malnutrition secondary to cancer progression and treatment side effects is common. While abundant evidence indicates that nutrition support improves patient outcomes, it is estimated that up to half of malnutrition cases are misclassified or undiagnosed. The use of a multidisciplinary team to assess nutrition status has been observed previously to reduce delays in nutritional support. Hence, educating all members of the oncology healthcare team to assess nutrition status may encourage earlier diagnosis and lead to improved patient outcomes. Thus, the objective was to perform a pilot study to assess change in knowledge and self-efficacy among oncology team members after watching an educational video about malnutrition. METHODS A pre-test post-test educational video intervention was given to 77 ambulatory oncology providers during weekly staff meetings at a community ambulatory oncology center in central Illinois. Change in knowledge and self-efficacy in malnutrition assessment and diagnosis was measured and acceptability of the brief educational video format was also observed. RESULTS Mean test scores improved by 1.95 ± 1.48 points (p < 0.001). Individual occupational groups improved scores significantly (p ≤ 0.005) except for specialty clinical staff. Self-efficacy improved from 38 to 70%. 90.8% of participants indicated the educational video improved their confidence in assessing malnutrition. CONCLUSIONS The educational video was well accepted and improved knowledge and self-efficacy of malnutrition assessment and diagnosis among ambulatory oncology providers. Wider implementation of such an educational intervention and longitudinal testing of knowledge retention and behaviors change is warranted.
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Affiliation(s)
- Patricia G Wolf
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Joanna Manero
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Kirsten Berding Harold
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Morgan Chojnacki
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Jennifer Kaczmarek
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Carli Liguori
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Anna Arthur
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
- Carle Cancer Center, Carle Foundation Hospital, 386A Bevier Hall, 905 S. Goodwin Ave, Urbana, IL, 61801, USA.
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Lima JD, Simoes E, de Castro G, Morais MRP, de Matos‐Neto EM, Alves MJ, Pinto NI, Figueredo RG, Zorn TM, Felipe‐Silva AS, Tokeshi F, Otoch JP, Alcantara P, Cabral FJ, Ferro ES, Laviano A, Seelaender M. Tumour-derived transforming growth factor-β signalling contributes to fibrosis in patients with cancer cachexia. J Cachexia Sarcopenia Muscle 2019; 10:1045-1059. [PMID: 31273954 PMCID: PMC6818454 DOI: 10.1002/jcsm.12441] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 04/05/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cachexia is a paraneoplastic syndrome related with poor prognosis. The tumour micro-environment contributes to systemic inflammation and increased oxidative stress as well as to fibrosis. The aim of the present study was to characterise the inflammatory circulating factors and tumour micro-environment profile, as potentially contributing to tumour fibrosis in cachectic cancer patients. METHODS 74 patients (weight stable cancer n = 31; cachectic cancer n = 43) diagnosed with colorectal cancer were recruited, and tumour biopsies were collected during surgery. Multiplex assay was performed to study inflammatory cytokines and growth factors. Immunohistochemistry analysis was carried out to study extracellular matrix components. RESULTS Higher protein expression of inflammatory cytokines and growth factors such as epidermal growth factor, granulocyte-macrophage colony-stimulating factor, interferon-α, and interleukin (IL)-8 was observed in the tumour and serum of cachectic cancer patients in comparison with weight-stable counterparts. Also, IL-8 was positively correlated with weight loss in cachectic patients (P = 0.04; r = 0.627). Immunohistochemistry staining showed intense collagen deposition (P = 0.0006) and increased presence of α-smooth muscle actin (P < 0.0001) in tumours of cachectic cancer patients, characterizing fibrosis. In addition, higher transforming growth factor (TGF)-β1, TGF-β2, and TGF-β3 expression (P = 0.003, P = 0.05, and P = 0.047, respectively) was found in the tumour of cachectic patients, parallel to p38 mitogen-activated protein kinase alteration. Hypoxia-inducible factor-1α mRNA content was significantly increased in the tumour of cachectic patients, when compared with weight-stable group (P = 0.005). CONCLUSIONS Our results demonstrate TGF-β pathway activation in the tumour in cachexia, through the (non-canonical) mitogen-activated protein kinase pathway. The results show that during cachexia, intratumoural inflammatory response contributes to the onset of fibrosis. Tumour remodelling, probably by TGF-β-induced transdifferentiation of fibroblasts to myofibroblasts, induces unbalanced inflammatory cytokine profile, angiogenesis, and elevation of extracellular matrix components (EMC). We speculate that these changes may affect tumour aggressiveness and present consequences in peripheral organs.
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Affiliation(s)
- Joanna D.C.C. Lima
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | - Estefania Simoes
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | - Gabriela de Castro
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | - Mychel Raony P.T. Morais
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | | | - Michele J. Alves
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
- Department of PathologyOhio State UniversityColumbusOHUSA
| | - Nelson I. Pinto
- Department of PhysiologyFederal University of São PauloSão PauloBrazil
| | - Raquel G. Figueredo
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | - Telma M.T. Zorn
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
| | | | - Flavio Tokeshi
- Department of Clinical SurgeryUniversity of São PauloSão PauloBrazil
| | - José P. Otoch
- Department of Clinical SurgeryUniversity of São PauloSão PauloBrazil
| | - Paulo Alcantara
- Department of Clinical SurgeryUniversity of São PauloSão PauloBrazil
| | | | - Emer S. Ferro
- Department of PharmacologyUniversity of São PauloSão PauloBrazil
| | | | - Marilia Seelaender
- Cancer Metabolism Research Group, Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
- Department of Clinical SurgeryUniversity of São PauloSão PauloBrazil
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Bicakli DH, Uslu R, Güney SC, Coker A. The Relationship Between Nutritional Status, Performance Status, and Survival Among Pancreatic Cancer Patients. Nutr Cancer 2019; 72:202-208. [PMID: 31271302 DOI: 10.1080/01635581.2019.1634217] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Aim: The purpose of this study was to identify the nutritional and performance status of Pancreatic Cancer (PanCa) patients and to determine the relationship between these parameters and their survival time.Material and Methods: Ninety-six PanCa patients [59.6% F, 61.4% M; mean age: 60.7 (min:28, max:80) years] were followed up for 6-24 months. The Patient Generated Subjective Global Assessment (PG-SGA) and Eastern Comparative Oncology Group (ECOG) scale were performed. Anthropometric measurements [height, weight, mid-upper arm circumference (MUAC), calf circumference (CC) and triceps skin fold thickness (TSF)], hand grip strength (HGS) were recorded. Survival analyses were conducted using Kaplan-Meier curves.Results: Malnutrition was observed in 85.5% (n = 82) and 54.2% of all patients had poor performance status. A positive correlation was observed between malnutrition and ECOG scale of the patients (P < .01). Antropometric measurements for women and men, respectively, were 34.4 ± 3.03-34.6 ± 3.43 cm for CC; 26.9 ± 3.47-26.05 ± 3.37 cm for MUAC; 20.5 ± 6.3-13.02 ± 7.7 mm for TSF; - 31.02 ± 7.64-20.13 ± 6.04 kg for HGS. Survival time of patients with SGA-A and B was 38.0 ± 6.6 months and of those with SGA-C was 12.0 ± 3.1 months (P = .000).Conclusion: Malnutrition negatively affected both performance status and survival time among PanCa patients.
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Affiliation(s)
| | - Ruchan Uslu
- Department of Medical Oncology, Ege University School of Medicine, Bornova, Turkey
| | - Sedat Can Güney
- Department of Internal Medicine, Ege University School of Medicine, Bornova, Turkey
| | - Ahmet Coker
- Department of General Surgery, Ege University School of Medicine, Bornova, Turkey
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