Accuracy of isolated nutrition indicators in diagnosing malnutrition and their prognostic value to predict death in patients with gastric and colorectal cancer: A prospective study

Abstract

Background The study aims to evaluate the accuracy of isolated nutrition indicators in diagnosing malnutrition in patients with gastric and colorectal cancer and their association with mortality. Methods Prospective cohort study involving patients with cancer (n = 178) attending a reference center of oncology at any point in the disease trajectory or treatment. Nutrition status was evaluated in a unique moment by body mass index (BMI), Patient‐Generated Subjective Global Assessment (PG‐SGA), handgrip strength (HGS), and calf circumference (CC). Kappa coefficient, accuracy, sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC) were calculated for each nutrition indicator (PG‐SGA as the reference method). The Cox proportional hazards model was used to assess hazard ratio (HR) and CI of mortality. Results From the total patients, 11% were underweight, 48% were malnourished (PG‐SGA B or C), 43% had low HGS, and 55% presented low CC. There were 46 deaths (25.8%). BMI, HGS, and CC showed poor and fair agreements (κ < 0.30 for all ) and poor accuracy (AUC < 0.70 for all) in identifying malnutrition by PG‐SGA. After the adjustment for confounders (age, treatment performed, site, and stage of cancer), PG‐SGA (HR, 2.9; 95% CI, 1.5–5.9) and low CC (HR, 2.4; 95% CI, 1.1–5.2) were independent predictors of mortality. Conclusion The nutrition indicators are not accurate in diagnosing malnutrition, whereas PG‐SGA and low CC could predict mortality in gastric and colorectal cancer patients. Thus, CC should be combined with PG‐SGA in nutrition assessments.

Low‐cost and fast‐performing indicators of muscle mass loss are good predictors of clinical outcomes in hospitalized patients: A longitudinal observational study

“…A prospective Brazilian study involving 250 oncologic patients showed a 3.01-fold higher risk of mortality (HR = 3.01; 95% CI, 1.52-5.98) 30 in patients with low CC. Sousa et al 31 have also reported that low CC was an independent predictor of mortality (HR = 2.4; 95% CI, 1.1-5.2) in a prospective cohort study including 178 patients with gastric and colorectal cancer.…”

Associations of patient-generated subjective global assessment (PG-SGA) and NUTRISCORE with survival in gastric cancer patients: timing matters, a retrospective cohort study

“…Another cohort study of 120 palliative care patients in Brazil, including the patients with gastrointestinal tumors (25.8%, n = 31), evaluated the PG-SGA within 24h of hospitalization and found that one score increase in the PG-SGA scores was associated with a 4% increase in mortality [31]. In a Brazilian prospective study of 178 patients with gastric and colorectal cancer, malnourished status assessed by PG-SGA was associated with a 2.9 times higher risk of overall mortality [32]. Those studies included patients with metastatic gastric cancer or palliative care, whereas we included the patients who underwent curative gastrectomy.…”

Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating

“…Medical professionals and cancer patients alike believe toxicities are inevitable and general amelioration techniques are often overlooked. Difficulty eating and malnutrition during cancer therapy are common problems that can be assessed with many tools [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]. The challenge is to have an acceptable quality and quantity of nutrient intake with minimal toxicity without compromising effective cancer treatment.…”

“…Malnutrition in cancer patients is a common problem. There are many indices and tools to define malnutrition, cachexia, and sarcopenia [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]62,[69][70][71][72][73][74][75][76][77]. Although weight loss from the time of diagnosis is one measure, the quantity and quality of food in the diet and information from the patient generated subjective global assessment (PG-SGA) tool can provide more specific information [35,36,45,51,62,66,[69][70][71][72][73][78][79][80].…”