Subjective Global Assessment Scale Research Articles

Construction and validation of a predictive model for the risk of three-month-postoperative malnutrition in patients with gastric cancer: a retrospective case-control study.

This study analyzed both the influencing factors of malnutrition in patients with gastric cancer and established a multi-dimensional risk model to predict postoperative malnutrition three months after surgery. The clinical data of gastric cancer patients hospitalized for the first time and receiving laparoscopic surgery in the general surgery department of our hospital were retrospectively analyzed through the hospital information system and divided into a training set and a validation set in the ratio of 7:3. Nutritional status was assessed using the Patient Generated Subjective Global Assessment scale and follow-up records three months after surgery. Patients were divided into a non-malnutrition group and a malnutrition group, and a risk prediction model was established and displayed in the form of a nomogram. A total of 344 patients were included, with 242 in the training and 102 in the validation set. Tumor node metastasis stage (TNM Stage, P=0.020), cardiac function grading (CFG, P=0.013), prealbumin (PAB, P<0.001), neutrophil-to-lymphocyte ratio (NLR, P=0.027), and enteral nutrition within 48 hours post-operation (EN 48 h post-op, P=0.025) were independent risk factors. We established a prediction model with the above variables and displayed it via a nomogram, then verified its effectiveness through internal and external verification. This revealed a C-index of 0.84 (95% CI: 0.79-0.89), and the area under curve (AUC) areas of 0.840 (training set) and 0.854 (validation set), which was better than the nutritional risk screening 2002 (NRS2002) scale. The calibration curve brier scores were 0.159 and 0.195, and the Hosmer-Lemeshow test chi-square values were 14.070 and 1.989 (P>0.05). The decision curve analysis (DCA) of the training set model indicated the clinical applicability was good and within the threshold probability range of 10%-85%, which was also better than NRS2002. A clinical prediction model including multi-dimensional variables was established based on independent risk factors of malnutrition three months after gastrectomy in patients with gastric cancer. The model yields greater prediction accuracy of the risk of three-month-postoperative malnutrition in patients with gastric cancer, helps screen high-risk patients, formulates targeted nutritional prescriptions early, and improves the overall prognosis of patients.

High Level of Irisin as a Marker of Malnutrition in Head and Neck Cancer Patients Subjected to Radiotherapy.

BackgroundHead and neck cancers (HNC) are the 7th most prevalent neoplasms in the world. In 50% of these patients, body weight loss and malnutrition are observed before the beginning of therapy. It is known that an important role in the pathomechanism of malnutrition and cachexia is played by the development of inflammation, degradation of muscle fibers, and browning of white adipose tissue (WAT). It was demonstrated that even a slight increase in irisin concentration leads to browning of WAT.Material/MethodsThe study group consisted of 50 patients with HNC. The nutritional status of the patients was assessed by the Nutritional Risk Score 2002 (NRS 2002) and Subjective Global Assessment (SGA) scales. Using bioelectrical impedance analysis (BIA), the parameters fat mass (FM) and fat-free mass (FFM) were obtained.ResultsHigher irisin values (1.57 vs 1.18 [ng/ml], P=0.0004) were observed in patients with higher nutritional risk (≥3) evaluated according to the NRS scale. In patients assessed as B or C on the SGA scale, higher values of irisin concentration (1.38 vs 1.07 [ng/ml], P=0.0139) were noted. It was also observed that the level of irisin before treatment was negatively correlated (rho=−0.30, p=0.0350) with FM% and was positively correlated (rho=0.30, p=0.0340) with FFM% in BIA measurements performed after the 7th cycle of RTH.ConclusionsBased on these results, we conclude that patients with malnutrition tend to have higher irisin values compared to normally nourished patients. A high level of irisin may be a useful marker of malnutrition in patients with HNC.

NUTRITIONAL ASSESSMENT ON ESRD PATIENTS USING SGA SCALE : A CROSS SECTIONAL STUDY

Back ground information: The aim of the study is to assess the nutritional status among ESRD patients on Haemodialysis by means of Subjective Global Assessment ( SGA) and also to know the impact of comorbid illnesses on nutritional status. Materials and methods: The study group included respondents suffering from ESRD who were patients of the Dialysis centre at Vedanta Hospitals in Guntur. The study was conducted in 50 Dialysis patients ( 36 men and 14 women).Those patients who met the study criteria were enrolled into the study. Relevant data such as demographics details, comorbid illnesses, past medical history, duration of dialysis, dialysis complications, were collected from patient proforma and a standardized SGA scale and other relevant biochemical parameters like Serum Albumin, and C reactive protein were used to evaluate the nutritional status of the patients. Statistical consideration:All the raw data was collected,entered in Excel sheet 2007 in windows 7 version. Statistical analysis methods like Pearson correlation coefficient test was used to compare variables and p value Results:The study shows that malnutition was significantly higher among those who had received HD for &gt;3 years(p=0.008). HD patients with increase in number of comorbidities and the number of chronic medications taken had a significantly higher level of SGA (p&lt;0.001).There is a moderate positive correlation between SGA score and CRP values(p&lt;0.0001 the result is significant at p&lt;0.05)A regression analysis is done for SGA and serum albumin findings showed that a negative correlation was there between SGA and serum albumin values (p value is 0.480905) the result is not significant at p&lt;0.05. Conclusion: In our study there is a positive correlation between SGA and CRP values and a negative correlation between SGA score and serum albumin values. No significant association was found between a patients BMI and their nutritional status and also observed that socioeconomical status had a impact on nutritional status.

A Prospective Review of Preoperative Nutritional Status and Its Influence on the Outcome of Abdominal Surgery.

AimTo assess the incidence of malnutrition in a surgical gastroenterology unit and analyze its impact on postoperative complication rates.MethodData were prospectively accrued from patients admitted for emergency or elective surgery to the gastrointestinal surgery unit at Jaslok Hospital between May 2013 and May 2014. The nutritional status was preoperatively assessed by using anthropometric parameters like body mass index (BMI), midarm circumference (MAC), and tissue skinfold thickness (TSFT). In addition, a subjective global assessment scale (SGA), serum albumin, and absolute lymphocyte count (ALC) were used. Patients with BMI <18.5, MAC <24 cm in males and <22 cm in females, and TSFT <10 mm were considered malnourished. Patients with serum albumin between 3 and 3.5 g/dl were considered mild, 2.4-2.9 g/dl was moderate, and <2.4 g/dl were severely malnourished. Patients with ALC between 1200 and 2000/cm were labelled mild, between 800 and 1199/cm were moderate, and <800/cm were severely malnourished. As per SGA, well-nourished had less than 5% weight loss or if more than 5%, with recent gain and improved appetite, mild/moderately malnourished had 5% to 10% weight loss with no gain, mild subcutaneous fat loss, and those severely malnourished had more than 10% weight loss, severe subcutaneous fat loss, and muscle wasting. Postoperative complications were graded as per the Clavien-Dindo classification. Patients with grades 1 and 2 complications were labelled as minor and the rest as major.ResultMen in the age group of 40-60 years comprised the majority of the study population. The most frequent reason for admission was cholelithiasis. The overall incidence of malnutrition was 22.16%. Out of the 96 patients who had complications, 45 had minor and 41 had significant complications. Amongst the well-nourished, the incidence of complications was 26.62% of which the majority were minor complications. Severely malnourished patients had a high complication rate (63.38%); 32% out of the 63.38% developed significant complications. The majority of the patients suffering from severe malnutrition belonged to the sub-group with chronic pancreatitis and carcinoma of the pancreas. According to the chi-square analysis of the data, ALC, serum albumin, and SGA correlate with the postoperative complication rate with a p-value <0.05 as significant. On the contrary, BMI, MAC, and TSFT did not correlate with postoperative complications.ConclusionPreoperative malnutrition is common among patients undergoing abdominal surgeries in the urban private health care sector. Although there have been studies that have analyzed the incidence of malnutrition in patients undergoing oncological surgeries, there is limited literature on malnutrition among patients subjected to gastrointestinal surgeries. We conclude that simple bedside nutritional assessment tools like serum albumin, absolute lymphocyte count, and SGA can accurately identify malnourished patients preoperatively and are good predictors of postoperative complications. Hence, it is imperative to assess and attempt to improve the nutritional status of the patients preoperatively.

Early Post-Transplant Leptin Concentration Changes in Kidney Transplant Recipients.

Background and Objectives: Kidney transplant recipients represent a unique population with metabolic abnormalities, altered nutritional and immune status, as well as an imbalanced regulation of adipocytokine metabolism. Leptin is a hormonally active protein mainly produced by fat tissue that modulates appetite, satiety, and influences growth, energy, and bone metabolism. There has been great interest in the role of this hormone in chronic kidney disease-related protein energy wasting; thus, a positive leptin correlation with body mass index and fat mass was confirmed. This study was designed to determine the association of pre and post-kidney transplant leptin concentration with nutritional status and body composition. Materials and Methods: We studied 65 kidney transplant recipients. Nutritional status was evaluated before kidney transplantation and 6 months later using three different malnutrition screening tools (Subjective Global Assessment Scale (SGA), Malnutrition Inflammation Score (MIS), and Geriatric Nutritional Risk Index (GNRI)), anthropometric measurements, and body composition (bioelectrical impedance analysis (BIA)). Demographic profile, serum leptin levels, and other biochemical nutritional markers were collected. Statistical analysis was performed with R software. Results: Median age of the studied patients was 45 years, 42% were females, and 12% had diabetes. Leptin change was associated with body weight (p < 0.001), waist circumference (p < 0.001), fat mass (p < 0.001) and body fat percentage (p < 0.001), decrease in parathyroid hormone (PTH) (p < 0.001) transferrin (p < 0.001), diabetes mellitus (p = 0.010), and residual renal function (p = 0.039), but not dependent on dialysis vintage, estimated glomerular filtration rate (eGFR), or delayed graft function at any time during the study. After adjustment for age and sex, body mass index (BMI) (p < 0.001), fat mass (p < 0.001), and body fat percentage (p < 0.001) were independent variables significantly associated with post-transplant leptin change. Lower leptin values were found both before and after kidney transplantation in the SGA B group. GNRI as a nutritional status tool was strongly positively related to changes in leptin within the 6-month follow-up period. Conclusions: Kidney transplant recipients experience change in leptin concentration mainly due to an increase in fat mass and loss of muscle mass. GNRI score as compared to SGA or MIS score identifies patients in whom leptin concentration is increasing alongside an accumulation of fat and decreasing muscle mass. Leptin concentration evaluation in combination with BIA, handgrip strength measurement, and GNRI assessment are tools of importance in defining nutrition status in the early post-kidney transplant period.

MO601THE ASSESSMENT OF NUTRITIONAL STATUS AND MORTALITY IN GERIATRIC PATIENTS WITH CKD 3B-5 STAGES

Abstract Background and Aims:. the prevalence of chronic kidney disease (CKD) increases with age–almost 50% of people over the age of 70 have stage 3-5 CKD. Geriatric patients with pre-dialysis stages of CKD are recommended to assess the risk of absolute probability of death of the patient both in the case of starting dialysis and without it. Malnutrition in this group of patients is the risk factor of mortality. The EQUAL study, a European Quality Study on treatment in advanced chronic kidney disease, showed that according to the Subjective Global Assessment Scale the majority of the geriatric patients with with incident glomerular filtration rate &amp;lt;20mL/min/1.73m 2 (nondialysis) had a normal nutritional status (SGA 6-7), 26% had moderate PEW (SGA 3-5), and less than 1% had severe PEW (SGA 1-2). The aim is to assess prevalence of protein-energy wasting (PEW) and the absolute risk of death over 5 years in the geriatric patients with advanced chronic kidney disease (CKD). Method Materials and methods: a study of 151 geriatric patients with stage 3B-5 CKD, average age 77 ±8.6. Patient inclusion criteria: age 60-90 years, CKD stage 3B-5 (GFR in CKD-EPI &amp;lt;= 45 ml / min / 1.73 m2. Patient exclusion criteria: oncological diseases; acute infections; severe mental illness (including alcoholism), any serious somatic diseases, according to the researcher. The patients were assessed by Subjective Global Assessment; to assess the estimated 5-year mortality rate, patient indicators were evaluated on the Banzal scale. All patients were evaluated for laboratory data (absolute number of lymphocytes, hemoglobin, red blood cells, creatinine, urea, total protein, blood albumin, total cholesterol, blood potassium, and proteinuria); The study group consisted of 105 patients with stage 3B CKD, 35 patients with stage 4 CKD, and 11 patients with stage 5 CKD. Results according to the SGA 66,7% of patients with CKD 3b stage have normal nutritional status, 26,6% patients are mild to moderate malnourishment, 6,7 % are malnourished. 60% of patients with CKD 4 stage have normal nutritional status, 31,2% patients had moderate PEW, 8,8% had severe PEW. In patients with CKD 5 72,7% had moderate PEW, 27,3% had severe PEW. The level of total protein in the blood serum is correlated with nutritional disorders on the SGA scale(r=-0.52) in geriatric patients with predialysis stages of CKD. During assessing the absolute risk of death within 5 years (Bansal Score) in 20.9% of patients with CKD3B, the estimated mortality rate was 40%, in 12.4% 54%, in 25.7% 69% and higher. All patients with stage 5 CKD had a mortality risk of 40% or higher. Indicators of the the Bansal scale significantly increased with a decrease in GFR (r= - 0.68, r=-0.46). The Banzal mortality index (r=0.32) significantly increased with increasing the level of serum phosphorus and uremia. Conclusion. The prevalence of nutritional disorders are observed in 33-40% of elderly patients with stage 3B-4 CKD and until 75% with stage 5CKD. During assessing the absolute risk of death over 5 years in the study population of geriatric patients with CKD stages 3B-5, a high risk on the Bansal scale (69% or higher) was observed in 25.7% with CKD stage 3B, 60%

MALNUTRITION IN LIVER CIRRHOSIS

Malnutrition is a common complication of liver disease and it adversely affects patient outcome. Aetiologic factors include hypermetabolism, malabsorption, altered nutrient metabolism and anorexia. Use of traditional nutritional assessment tools, such as anthropometry along with subjective global assessment scale and biometric measures, should be done to evaluate cirrhotic patients for malnutrition. Improvements in nutritional status can improve outcomes of patients with advanced liver disease.

A multicenter study of malnutrition status in chronic kidney disease stages I-V-D from different socioeconomic groups.

There is a paucity of data on malnutrition in different socioeconomic status in chronic kidney disease (CKD) patients. Hence, this cross-sectional study was undertaken in CKD-ND and CKD-D. The aim of the study was to assess the prevalence of malnutrition in the various stages of CKD among the various socioeconomic groups, namely the low-income groups and the upper-middle-income groups. This is a cross-sectional study conducted among 394 patients. The patient data were obtained from three institutions: Institution 1, Institution 2, and Institution 3. Patients were predominantly from the South Indian population and were between the age groups of 18 and 80 years. Measurements: malnutrition was assessed using anthropometry, body composition monitor, biochemical parameters, and dietary recall. Subjective Global Assessment Scale for nondialyzed patients and Malnutrition-Inflammation Score for dialyzed patients were also collected . As per the CKD stages, we found the percentage of malnutrition to be 7% in Stage III, 14% in Stage IV, 18% in Stage V, and 68% in Stage V-D in the upper-middle-income group, whereas it was 10% in Stage III, 26% in Stage IV, 40% in Stage V, and 93% in Stage V-D in the low-income group. The severity of malnutrition was stratified according to the stages of CKD, and it was found to be higher in progressive stages of CKD among the low-income groups as compared to the high-income groups.

Risk stratification for patients awaiting kidney transplantation: Role of bioimpedance derived edema index and nutrition status.

Recent studies demonstrate that the edema index (ECW/TBW) may be a significant predictor of poor outcomes as a composite of overhydration and protein-energy wasting. There is no consensus regarding ECW/TBW cut-off values. We aimed to determine the performance of ECW/TBW in all-cause mortality prediction and to establish certain cut-off values in patients on chronic hemodialysis. Body composition of 158 hemodialysis patient was performed by using InBody S10 (Biospace, Seoul, Korea) analyzer. Demographic profile and laboratory data were collected. Subjective Global Assessment Scale (SGA) was used to assess nutrition status. In the mean follow up of 3.5±1.15 years, two independent clinicians evaluated death cases and factors for all-cause mortality were established. Statistical analysis was performed with R software. 73 of 158 hemodialysis patients were on kidney transplant waiting list. Mean age of study subjects was 53.6±15.1 years, 51.9% were females, and 13.9% had diabetes. During the follow-up period, 17.72% of patients died. They had significantly higher ECW/TBW values 0.393 vs 0.408, p<0.001. Subjects with lower edema index had better nutrition according to SGA (SGA A 0.391; SGA B 0.400; SGA C 0.413; p<0.001). The calculated ECW/TBW cut-off point for all-cause mortality was 0.4055, with sensitivity of 84.6%, specificity of 69.8%. On the other hand, the cut-off point for SGA scores B and C was 0.396 with sensitivity of 72.7% and specificity of 68.7%. The manufacturer provided ECW/TBW cut-off point of 0.400 should be addressed carefully, because it varies depending on the selected outcome and population studied. InBody ECW/TBW reference values from 0.390 to 0.410 are the most promising in hemodialysis population to assess all-cause mortality, nutrition status and body composition.

Occurrence of malnutrition in cancer patients during radiotherapy

Objective To investigate the malnutrition status of cancer patients undergoing radiotherapy, and to provide research basis for later nutrition intervention. Methods Using convenient sampling method, 380 patients with cancer treated by radiotherapy in Shanghai and Zhejiang provincial Class Ⅲ Grade A hospitals from February to November 2018 were selected as the research subjects. The incidence of malnutrition, laboratory indicators on admission and discharge, and the incidence of significant weight loss during hospitalization were investigated. Malnutrition was assessed by Patient-Generated Subjective Global Assessment Scale (PG-SGA) . Results Among 380 cancer patients receiving radiotherapy, 48.9% (186/380) suffered from or suspected malnutrition at admission, of which 7.6% (29/380) suffered from severe malnutrition. At discharge, 64.2% (244/380) of radiotherapy patients developed or suspected malnutrition, of which 18.9% (72/380) suffered from severe malnutrition. In addition, 56.3% (214/380) patients lost weight during radiotherapy, and 12.4% (47/380) patients showed significant weight loss. Compared with that at admission, the levels of serum albumin and hemoglobin decreased significantly (P<0.05) . Conclusions The incidence of malnutrition is high in cancer patients during radiotherapy. Early nutritional assessment should be given at admission and early nutritional intervention should be given to malnutrition patients. Key words: Neoplasms; Radiotherapy; Malnutrition; Weight loss

Does the nutritional status of acute stroke patients affect the neurological status in the early post-stroke period?

ABSTRACTAccording to recent reports, malnutrition may be associated with a worse prognosis in stroke patients. The aim of this study was to determine the nutritional status of stroke patients and its impact on neurological and functional status of patients in the early post-stroke period. Our prospective study included a total of 128 patients admitted to the Stroke Unit. The assessment was made in the patients within the first week after the onset of stroke symptoms. Groups of patients with abnormal body mass index (BMI <20kg/m2 or >25kg/m2) were compared to the group of normal BMI, serum albumin, total cholesterol, HDL and LDL levels were determined in each patient within 24h following admission. The analysis showed that the patients with lower levels of serum albumin and triglycerides had higher scores in the National Institutes of Health Stroke Scale (NIHSS) on admission. Patients with a higher risk of malnutrition, confirmed by the Subjective Global Assessment scale, had higher NIHSS scores. The study showed a positive relationship between the nutritional status and worse neurological status of patients in the early post-stroke period.Abbreviation: NIHSS; Rankin scale

Quality of life and nutritional status of cancer patients on chemotherapy

Background: Cancer is the second cause of disease-related deaths worldwide. Malnutrition among cancer patients is very common, with an estimated incidence of approximately 40 to 80%. While it is already a proven fact that malnutrition is prevalent among cancer patients, its impact on the quality of life of patients has not been adequately studied, particularly in the local setting. Purpose: To assess quality of life, nutrition status and to determine the affects of nutrition status on quality of life of cancer patients treated chemotherapy at Oncology Department, Hue University of Medicine and Pharmacy Hospital. Methods: A cross sectional study with 70 cancer patients admitted for chemotherapy recruited from at oncology department, Hue University of Medicine and Pharmacy Hospital during March to September 2018. The EORTC QLQ-C30 were used to assess quality of life and Subjective Global Assessment scale were used to assess nutrition status. T-test, ANOVA, Mann Whitney, Kruskal Wallis were used to determine the correlation between 2 factors. Pearson and Spearman Coefficient were used to measure the strength of relationship between the factors. Results: Patient’s mean age was 58.93 ± 13.26, males were 61.3%. There were 67.14% patients with SGA A, 14.29% were classified SGA-B (moderately malnourished) and 18.57% were classified SGA C (severely malnourished). The global health scale, the functional scales were in the limit of the EORTC reference value, meanwhile the toxicities -related symptom scales were worse than the EORTC reference value. Patients were statistically different across the Subjective Global Assessment groups according to emotional (p &lt; 0.05), and cognitive functioning (p &lt; 0.05) nausea and vomiting (p &lt; 0.05). Conclusions: This study showed that there were the effects of nutrition status on quality of life in patients treated chemotherapy. Key words: Quality of life, nutritional status, cancer, chemotherapy

Malnutrition Assessment in Hemodialysis Patients: Role of Bioelectrical Impedance Analysis Phase Angle

To determine the most potent bioelectrical impedance analysis (BIA) marker of malnutrition and to adjust its application to hemodialysis (HD) patients. An observational study. A total of 99 patients on maintenance HD were enrolled in the study. The nutritional state of the patients was examined before and after the HD procedure using Subjective Global Assessment Scale (SGA), serum albumin, body mass index and BIA-derived fat-free mass index, reactance, resistance, and phase angle (PA). Malnutrition defined by the SGA questionnaire was used to detect the most potent marker of malnutrition. This marker was further analyzed and corrected for the excess fluid, age, and gender producing the nutritional state-specific cutoffs. The SGA rates of nutritional state were as follows: 57.6% (57) well nourished, 28.3% (28) moderately malnourished, and 14.1% (14) severely malnourished. Multivariate forward logistic regression analysis of the nutrition markers revealed PA as the most potent malnutrition predictor (odds ratio=3.69; 95% confidence interval [CI]: 1.59-8.62; P=.002). PA was adjusted for the excess fluid (5.00±0.97 vs 4.87±1.08 P< .001). Patients were assigned into groups with adjusted PA values below the 5th through the 50th percentile of the mean PA reference value. The moderately malnourished patients were most accurately identified by the percentile group of <25th (area under the curve=0.70; 95% CI: 0.60-0.81; P=.001), and the severely malnourished patients were most accurately identified by the percentile group of <15th (area under the curve=0.74; 95% CI: 0.62-0.85; P=.005). Malnutrition is present almost in a half of the HD patients. BIA-provided PA is the most potent predictor of malnutrition. PA can be adjusted for the excess fluid after HD, age, and gender and used accordingly.

Impact of Interdialytic Weight Gain (IDWG) on Nutritional Parameters, Cardiovascular Risk Factors and Quality of Life in Hemodialysis Patients

Abstract Introduction. The amount of interdialytic weight gain (IDWG) considering body weight is of great importance in hemodialysis patients. In general practice, patients are asked to get standard weight between two hemodialysis sessions. However, it should be individualized considering patient’s weight. We aimed to determine the association between the IDWG and the nutritional parameters, cardiovascular risk factors, and quality of life. Methods. Thrity-two patients receiving hemodialysis at least for one year were enrolled into the study. Patients were monitored for 12 consecutive hemodialysis sessions; and the arithmetic mean of IDWG was calculated. IDWG% was calculated in accordance with patients’ dry weight. Data of patients with IDWG&lt;3% (Group I) and IDWG≥3 (Group II) were compared. Sociodemographic variables, laboratory, anthropometric measurements, blood pressure, left ventricular mass index, Subjective Global Assessment Scale and SF-36 Quality of Life Scale were applied to evaluate the patients. Results. 59.4% (n=19) and 40.6% (n=13) of patients were included in Group I and Group II, respectively. In Group II, albumin (p=0.02), potassium (p=0.02), phosphorus (p=0.04), nPCR (p=0.03), physical function (p=0.04), role limitations caused by physical problems (p=0.04), general health (p=0.03), physical quality of life (p=0.04) scores were significantly higher. A significant correlation was detected between IDWG and physical and mental quality of life, total score SF-36, albumin, total protein and the potassium values. Conclusions. Patients with an IDWG ≥ 3% have better nutritional parameters and quality of life scales. The limiting of IDWG to 1-2 kg, ingoring patient weight may give rise to malnutrition and a reduced quality of life.

Effects of Administering Dietetics to Cancer Patients Receiving Radiotherapy on Preventing and Decreasing Malnutrition

The aim of this research was to determine the effect of dietetics in preventing and reducing malnutrition in cancer patients receiving radiotherapy. This study enrolled 147 cancer patients receiving radiotherapy who had just started treatment at Inonu University, Malatya, Turkey. All of the enrolled patients had just started radiotherapy, could communicate readily, and agreed to take part in the study. The data were obtained using patient information sheets, the Subjective Global Assessment Scale (SGA), and anthropometric measurements. Weight measurements were performed in the experimental group after education and revealed that weight increased in 23% of patients, decreased in 40.5%, and remained stable in 36.5% of subjects. In the control group, 23.3% of patients exhibited an increase in weight, 43.8% experienced a decrease, and 32.9% remained stable. Statistical analyses revealed a significant difference among groups after education (p<0.05). The use of dietetics (nutrition education) reduced malnutrition. Therefore, nurses should administer dietetics regularly to patients undergoing radiotherapy to reduce malnutrition. Keywords: Cancer, radiotherapy, malnutrition, education

Outcomes of a culturally responsive health promotion program for elderly Korean survivors of gastrointestinal cancers: A randomized controlled trial

This single-blind, prospective, randomized controlled trial was designed to evaluate the effects of a culturally responsive health promotion program for elderly Korean (CHP-K) survivors of gastrointestinal (GI) cancers. The program consisted of 8 weeks of Qi exercise and face-to-face counseling on physical and psychological factors. A total of 63 Korean GI cancer survivors, aged ≥65 years, who had completed their active cancer treatment, were recruited from a cancer center in South Korea. Outcomes included the amount of exercise, body weight, BMI, the Patient Generated Subjective Global Assessment scale, the M.D. Anderson Symptom Inventory, and self-efficacy and self-esteem scales. Repeated measures MANCOVA revealed a significant difference over time between the groups (Wilks' Lambda F1,62 = 5.361, p = 0.007). Univariate RM-ANCOVA for each outcome measure revealed statistically significant differences between groups. These results suggested that the participation in the CHP-K may have enhanced the health of elderly Korean GI cancer survivors.

Changes in nutritional status in ICU patients receiving enteral tube feeding: A prospective descriptive study

This study aimed to assess the changes in nutritional status in Korean ICU patients receiving enteral feeding, and to understand the contribution of baseline nutritional status and energy intake to nutritional changes during the ICU stay. This was a prospective study of nutritional changes in 48 ICU patients receiving enteral feeding for 7 days. The Subjective Global Assessment scale was used upon admission. In addition, anthropometric measures (triceps skinfold thickness, mid-arm circumference, mid-arm muscle circumference, body mass index and percent ideal body weight) and biochemical measures (albumin, prealbumin, transferrin, haemoglobin and total lymphocyte count) were evaluated twice, upon admission and 7 days after admission. Seventy-five percent of ICU patients were severely malnourished at admission. Although the nutritional status worsened in both the patients with suspected malnourishment and the patients with severe malnutrition at admission, the nutritional status worsened significantly more in the patients with severe malnutrition than in the patients with suspected malnourishment. Moreover, a number of nutritional measures significantly decreased more in underfed patients than in adequately fed patients. The most significant predicting factor for underfeeding was under-prescription. The ICU patients in our study were severely malnourished at admission, and their nutritional status worsened during their ICU stay even though enteral nutritional support was provided. The changes in nutritional status during the ICU stay were related to the patients' baseline nutritional status and underfeeding during their ICU stay. This study highlights an urgent need to provide adequate nutritional support for ICU patients.

Validation of the Chinese version of the Subjective Global Assessment scale of nutritional status in a sample of patients with gastrointestinal cancer

Background and aims To verify the validity of the Subjective Global Assessment (SGA) on the nutritional assessment and prognosis prediction in Chinese patients with gastrointestinal cancer. Methods Five hundred and five patients with newly diagnosed gastrointestinal cancer who underwent surgeries were enrolled between August 2004 and August 2006. The sample consisted of 307 males (60.8%) and 198 females (39.2%). The nutritional status was assessed using SGA for each patient prior to operation. Simultaneously, anthropometric parameters and laboratory tests including serum albumin (ALB) and prealbumin (PA) levels were also obtained. The postoperative evaluation included length of stay, occurrence of complications, and in-hospital medical expenditures. Results Based on the results of preoperative SGA, the patients were classified into 3 groups: well nourished (group A), mildly to moderately malnourished (group B), and severely malnourished (group C). The number in each group was 275 (54.4%), 214 (42.4%), and 16 (3.2%), respectively. ANOVA tests revealed significant group differences existed for body mass index (BMI), triceps skinfold thickness (TSF), PA, ALB, length of stay, and in-hospital medical expenditures ( p < 0.05). The more severely malnourished the patient, the BMI, TSF, PA, and ALB became lower, the length of stay became longer and the medical cost became higher. The occurrence of postoperative complications did not show significant difference among the different SGA groups ( X 2 = 4.16, p = 0.125). And patients in different cancer stages (TNM staging) had no statistical differences in terms of their length of stay ( F = 1.433, p = 0.232) and the occurrence of postoperative complications ( X 2 = 4.836, p = 0.184). Conclusions The SGA is safe, inexpensive, and easy to use clinically for nurses. This study demonstrated that it can be a reliable method to assess the nutritional status of Chinese patients with gastrointestinal cancer. The SGA could also help predict certain health outcomes, such as length of stay, in-hospital medical expenditures.

Should Patient-Rated Performance Status Affect Treatment Decisions in Advanced Lung Cancer?

The Eastern Cooperative Oncology Group (ECOG) score is a well known prognostic factor and almost always used to determine eligibility for clinical trials. The patient-rated performance status score (Pt-PS), section of the patient generated subjective global assessment scale, has identical criteria to the physician-rated ECOG scale (MD-PS). We compared the Pt-PS with MD-PS in patients with advanced non-small cell lung cancer and compared the effect of each rating on eligibility for a hypothetical clinical trial. Consecutive patients with newly diagnosed advanced non-small cell lung cancer completed a patient generated subjective global assessment self-rated questionnaire, which was then correlated (kappa statistic) with the ECOG PS recorded at the same time. Patients were treated with standard chemotherapy. Survival was determined using Kaplan-Meier statistics. One hundred nine patients (M:F-54:55) were recruited. Pt-PS differed from MD-PS in 59 (54%) instances (p = 0.0001). When scores were not congruent, 41/59 (69%) patients evaluated themselves as having a worse PS than the physician's rating. Pt-PS was 0 to 1 in 60 (55%) patients whereas MD-PS was 0 to 1 in 78 (72%) patients. The functional status irrespective of evaluator was predictive of survival (p = 0.001 for MD-PS and p = 0.001 for Pt-PS). However, the median survival in those with MD-PS >/=2 was 3.3 (CI; 1.7-4.9) months whereas individuals with Pt-PS >/=2 had a median survival of 6.2 (CI; 5.4-6.9) months. Pt-PS and MD-PS were not congruent in over half of the cases, with Pt-PS scores usually poorer. Almost half the patients would have excluded themselves from a hypothetical clinical trial (Pt-PS >/=2). This requires prospective evaluation.

Nutrition du patient cancéreux : la pratique clinique

Malnutrition is common in patients with cancer and must be actively treated at the different steps of management, given its prognostic value. Several mechanisms are involved in the onset of malnutrition: food intake reduction (anorexia), metabolic disorders, therapies side effects. Consequences concern both the energetic balance disorder and the decrease of protein reserves, leading to a proteino-energetic malnutrition. The assessment of malnutrition must be systematically realised as soon as the diagnostic is done, and regularly repeated. The evaluation is performed with the loss of weight measure, the clinical examination and the serum levels of albumin and prealbumin, which are sufficient most of the time. The body mass index, the subjective global assessment scale and the Buzby's nutritional risk index can also be useful. In perioperative time, a patient exhibiting a severe malnutrition (loss of weight > 10 % or albumin < 30 g/l) must receive a perioperative renutrition, preferentially by the enteral route. The development of the enteral immunonutrition and of the glutamine supplementation in parenteral nutrition are clearly more efficient than standard solutions. During chemoradiotherapy, parenteral nutrition must remain uncommon, as its beneficial effect is not demonstrated. Enteral renutrition must be reserved to severely malnourished patients, in whom malnutrition can compromise the treatment course. In patients with cachexia, indications of artificial nutrition are very limited. Nutritional management, especially by oral or enteral route, takes place in a multidisciplinary approach of palliative care. New solutions targeted on the cancerous cachexia are now being developed and assessed.