GLIM-Defined Malnutrition in Patients with Head and Neck Cancer during the Qualification Visit for Home Enteral Nutrition.

Zuzanna Przekop,Dorota Szostak-Węgierek,Mariusz Panczyk,Jacek Sobocki,Magdalena Milewska

doi:10.3390/nu14030502

Abstract

Patients with head and neck cancer (HNC) present multiple symptoms that increase the risk of malnutrition. Nutritional care, including enteral nutrition (EN), plays a crucial role in the management of this group of patients. The aim of the study was to determine the Global Leadership Initiative on Malnutrition (GLIM)-based stages of malnutrition and the relationship with selected biochemical parameters during the home enteral nutrition (HEN) qualification visit of patients with HNC. The retrospective analysis involved 224 patients with HNC referred for HEN. The following parameters were evaluated: body mass index (BMI), percent weight loss, and laboratory tests (serum albumin, total serum protein, C-reactive protein (CRP), and total lymphocyte count (TLC)). Malnutrition was defined using GLIM-based criteria. The prevalence of malnutrition based on GLIM criteria was 93.75% (15.18% moderately malnourished, 78.57% severely malnourished). There was a positive correlation between malnutrition based on GLIM criteria, serum albumin, and CRP. In the model assessing the odds of severe malnutrition according to the criteria of GLIM, TLC and CRP had a statistically significant effect on the chance in the probability of qualifying a patient to the severe malnutrition group, but the strength of the results was weak. The prevalence of malnutrition in HNC patients enrolled to HEN is high and most of them are severely malnourished. This suggests that it is important to identify more efficiently patients with risk of malnutrition at an earlier stage. GLIM criteria for malnutrition can be easily applied in this group of patients, but the definition of inflammation criteria should be clarified.

Highlights

A tumor in the advanced stage leads to increased catabolism and anorexia or even anorexia-cachexia syndrome composed of weight loss and negative shift in body composition [1–3]
The prevalence of malnutrition, during the qualification visit for home enteral nutrition, according to body mass index (BMI) value, was 46.0%, while the percentage of overweight patients was 10.7% and the prevalence of malnutrition, according to the Global Leadership Initiative on Malnutrition (GLIM) criteria, in the whole group was 93.75%, which was higher than the results of other authors
This study highlights that the patients enrolled in the home enteral nutrition procedure are malnourished and most of them are severely malnourished

Summary

Introduction

Malnutrition is one of the most common conditions in cancer diseases. A tumor in the advanced stage leads to increased catabolism and anorexia or even anorexia-cachexia syndrome composed of weight loss and negative shift in body composition [1–3]. Anorexia can be induced or aggravated by enhanced systemic inflammation that is related to cancer. Zeng et al analyzed biochemistry-based indexes and their effect on toxicity. The authors reported that albumin and lymphocytes-monocytes ratio were independent prognostic factors for overall survival [4]. Both inflammation and nutritional status have impact on the patient’s prognosis

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