Abstract
Protein-calorie malnutrition is very frequent in cancer patients and is associated with an increase in morbidity and mortality. Recently, the Global Leadership Initiative on Malnutrition (GLIM) criteria were proposed to standardize the diagnosis of malnutrition. Nevertheless, these criteria were not validated in prospective studies. Our objective is to determine the prevalence of malnutrition in cancer inpatients using different diagnostic classifications, including GLIM criteria, and to establish their association with length of stay and mortality. Hence, we designed a prospective study. Within the first 24 hours of admission to the Inpatient Oncology Unit, subjective global assessment (SGA) was carried out, and anthropometric data (body mass index (BMI), mid-arm circumference (MAC), arm muscle circumference (AMC), fat-free mass index (FFMI)) and hand grip strength (HGS) were obtained to assess the reduction of muscle mass according to GLIM criteria. Length of stay, biomarkers (albumin, prealbumin, C-reactive protein (CRP)), and in-hospital and six-month mortality were evaluated. Regarding the 282 patients evaluated, their mean age was 60.4 ± 12.6 years, 55.7% of them were male, and 92.9% had an advanced-stage tumor (17.7% stage III, 75.2% stage IV). According to SGA, 81.6% of the patients suffered from malnutrition (25.5% moderate malnutrition, and 56.1% severe malnutrition), and, based on GLIM criteria, malnutrition rate was between 72.2 and 80.0% depending on the used tool. Malnourished patients (regardless of the tool used) showed significantly worse values concerning BMI, length of stay, and levels of CRP/albumin, albumin, and prealbumin than normally nourished patients. In logistic regression, adjusted for confounding variables, the odds ratio of death at six months was significantly associated with malnutrition by SGA (odds ratio 2.73, confidence interval (CI) 1.35–5.52, p = 0.002), and by GLIM criteria calculating muscle mass with HGS (odds ratio 2.72, CI 1.37–5.40, p = 0.004) and FFMI (odds ratio 1.87, CI 1.01–3.48, p = 0.047), but not by MAC or AMC. The prevalence of malnutrition in advanced-stage cancer inpatients is very high. SGA and GLIM criteria, especially with HGS, are useful tools to diagnose malnutrition and have a similar predictive value regarding six-month mortality in cancer inpatients.
Highlights
Disease-related malnutrition is an alteration of intake and/or assimilation of nutrients, which leads to changes in the body composition and reduced functional capacity [1]
At the moment of their admission, a nutritional status screening according to malnutrition screeningthe toolfollowing (MUST) was performed, detecting malnutrition risk in 82.9% (234) of patients: 14.9% moderate risk, and 68.1% high risk (Table 2)
According to subjective global assessment (SGA), 81.6% (230) of patients presented malnutrition, and, according to Global Leadership Initiative on Malnutrition (GLIM) criteria, malnutrition was detected in 72.2–80% depending on the tool used (Figure 2)
Summary
Disease-related malnutrition is an alteration of intake and/or assimilation of nutrients, which leads to changes in the body composition and reduced functional capacity [1]. Malnutrition and cancer cachexia are common among these patients, being present in up to 80% of them and increasing morbidity and mortality [5] Notwithstanding, this process can be accompanied by a normal or high body mass index (BMI) [7], which supports the importance of performing a proper nutritional assessment. To estimate fat-free mass, the consensus proposes several techniques that were validated, such as dual-energy X-ray absorptiometry, bioelectrical impedance analysis, computed tomography, or magnetic resonance imaging. These techniques may not be available at the bedside. Other techniques for functional assessment like hand grip strength (HGS) could be considered as a supportive measure
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