Screening for malnutrition in patients with gastro-entero-pancreatic neuroendocrine tumours: a cross-sectional study

Abstract

ObjectivesTo investigate whether screening for malnutrition using the validated malnutrition universal screening tool (MUST) identifies specific characteristics of patients at risk, in patients with gastro-entero-pancreatic neuroendocrine tumours (GEP-NET).DesignCross-sectional study.SettingUniversity Hospitals Coventry & Warwickshire NHS Trust; European Neuroendocrine Tumour Society Centre of Excellence.ParticipantsPatients with confirmed GEP-NET (n=161) of varying primary tumour sites, functioning status, grading, staging and treatment modalities.Main outcome measureTo identify disease and treatment-related characteristics of patients with GEP-NET who score using MUST, and should be directed to detailed nutritional assessment.ResultsMUST score was positive (≥1) in 14% of outpatients with GEP-NET. MUST-positive patients had lower faecal elastase concentrations compared to MUST-negative patients (244±37 vs 383±20 µg/g stool; p=0.018), and were more likely to be on treatment with long-acting somatostatin analogues (65 vs 38%, p=0.021). MUST-positive patients were also more likely to have rectal or unknown primary NET, whereas, frequencies of other GEP-NET including pancreatic NET were comparable between MUST-positive and MUST-negative patients.ConclusionsGiven the frequency of patients identified at malnutrition risk using MUST in our relatively large and diverse GEP-NET cohort and the clinical implications of detecting malnutrition early, we recommend routine use of malnutrition screening in all patients with GEP-NET, and particularly in patients who are treated with long-acting somatostatin analogues.

Bone Metabolism and Vitamin D Implication in Gastroenteropancreatic Neuroendocrine Tumors

“…Bone health is strictly connected with nutritional status, which has been reported to be altered in 14% to 25% of NET patients [64][65][66]. Particularly, patients with high-grade (G3) NET, progressive disease, and who are undergoing chemotherapy are at high risk of malnutrition (57.9%, 39.5%, and 42.3% respectively) [64].…”

Assessment and State of Nutrition of Patients with Gastroenteropancreatic Neuroendocrine Neoplasms

“…Patients with progressing neoplastic disease are often at the risk of qualitative malnutrition associated with the insufficient consumption of deficit nutrients. In GEP-NET patients, malnutrition may be caused by, e.g., mesenteric tumor infiltration, the disorder of the function of hormones that influence gut transit, or by pharmacological treatment [8]. Moreover, this type of neoplasm often features diarrhea caused by excessive motility of the small intestine, stimulated by the excessive secretion of serotonin precursors [8].…”

Vitamin D and vitamin B12deficiencies in patients with small intestinal carcinoid tumour: is opioid use disorder a confounding factor in the diagnosis?

“…In addition to diarrhoea, several factors have been shown to result in malnutrition in patients with NET such as prior abdominal surgeries, pancreatic insufficiency secondary to tumour involvement or use of somatostatin analogues 18. Somatostatin analogues can impair the absorption of many nutrients and minerals as well as decrease the secretion of several intestinal hormones necessary for proper digestion and absorption of nutrients.…”

“…Poorly differentiated NETs can have more diffuse architecture, irregular nuclei, and less cytoplasmic granularity 22. Following resection, H&E staining and immunohistochemical staining with chromogranin A and synaptophysin are performed for diagnosis18. Chromogranin A is a sensitive but non-specific marker for NETs and is also prognostically significant, with higher levels of chromogranin A indicating a worse prognosis 22.…”