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subjective global assessment as a Pre-Operative Nutrition Status Screening Tool for Head and Neck Cancer Patients of a Tertiary Health Care Setting

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Journal of Cancer Therapy 2022年第8期13卷 539-548页

作者： Snany Surendran Uma V. Sankar Santhoshkumar Nochikkattil Reena Cheekapravan Narayanankutty Warrier Sajith Babu Department of Nutrition Oncology MVR Cancer Centre & Research Institute Kozhikkode India Department of Clinical Research MVR Cancer Centre & Research Institute Kozhikkode India Department of Head and Neck Surgical Oncology MVR Cancer Centre & Research Institute Kozhikkode India Department of Clinical Nutrition & Dietetics Malabar Cancer Centre Kannur India Department of Medical Oncology MVR Cancer Centre & Research Institute Kozhikkode India Department of Head and Neck Surgical Oncology Malabar Cancer Centre Kannur India

Introduction: In India, 57% of patients with head and neck cancers are documented with nutritional compromise. Active nutritional support has been shown to improve outcomes and reduce the cost of treatment in severely malnourished patients. The assessment of nutritional status should be a priority when initiating medical nutrition therapy. We evaluated the agreement between subjective and Objective evaluation of pre-operative nutrition status of head and neck cancer patients in a tertiary cancer centre. Methods: Two hundred and thirty seven head and neck cancer patients who underwent surgery were eligible. The patients included both males (147) and females (90) with age varying between 23 - 88 years. All patients were screened for pre-operative nutrition status objectively as well as subjectively. The association of pre-operative SGA scores (A, B and C) subjectively, and PNS score (0, 1, 2) objectively were tested for statistical significance. Results: The cancer sites included tongue in 82, buccal mucosa in 30, thyroid in 28, alveolus in 18, glottis in 10, RMT in 10, nasal cavity in 9, FOM in 8. The pre-operative nutrition status based on subjective scores are A in 156 (65.8%), B in 75 (32%) and C in 6 (2.5%). The objective parameters obtained on the basis of BMI, % weight loss, PNI and S. albumin values are PNS 0 in 161 (67.9%), PNS 1 in 71 (30%) and PNS 2 in 5 (2.1%) patients. As the kappa coefficient p-0.56, there is moderate agreement between the pre-operative nutrition status subjectively as well as objectively. Conclusion: subjective global assessment is a simple and inexpensive way to screen the pre-operative nutrition status when compared to the other objective assessment tool. SGA has moderate agreement with expensive and complicated objective assessment tools. So it can be a reliable tool for assessing the pre-operative nutrition status.

关键词： subjective global assessment Nutrition assessment Head and Neck Cancer

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Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients

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World Journal of Gastroenterology 2010年第26期16卷 3310-3317页

作者： Seung Wan Ryu In Ho Kim Department of Surgery and Division of Gastrointestinal Surgery The Keimyung University School of Medicine Daegu 700-712 South Korea

AIM: To evaluate the prevalence of preoperative and postoperative malnutrition and the relationships between objective and subjective nutritional assessment of gastric cancer patients. METHODS: From October 2005 to July 2006, we studied 80 patients with no evidence of recurrent disease and no loss to follow-up after curative surgery for gastric cancer. In this group, 9 patients underwent total gastrectomy and 71 patients subtotal gastrectomy. At admission, 6 and 12 mo after surgery, the patients were assessed on the subjective global assessment (SGA), nutritional risk screening (NRS-2002), nutritional risk index (NRI) and by anthropometric measurements and laboratory data. Differences between the independent groups were assessed with the Student's t test and oneway analysis of variance. Spearman's rank correlation coefficients were calculated to evaluate the association between the scores and variables. RESULTS: The prevalence of malnutrition at admissionwas 31% by SGA and 43% by NRS-2002. At admission, the anthropometric data were lower in the malnourished groups defined by the SGA and NRS-2002 assessments, but did not differ between the groups using the NRI assessment. Body weight (BW), body mass index (BMI), triceps skin fold and midarm circumference were significantly reduced, but the total lymphocyte count, albumin, protein, cholesterol and serum iron levels did not decrease during the postoperative period. Six months after surgery, there was a good correlation between the nutritional assessment tools (SGA and NRS-2002) and the other nutritional measurement tools (BW, BMI, and anthropometric measurements). However, 12 mo after surgery, most patients who were assessed as malnourished by SGA and NRS-2002 had returned to their preoperative status, although their BW, BMI, and anthropometric measurements still indicated a malnourished status. CONCLUSION: A combination of objective and subjective assessments is needed for the early detection of the nutritional status

关键词： Gastrectomy Malnutrition Nutritional assessment Nutritional risk screening Postoperative follow up subjective global assessment

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Malnutrition and non-compliance to nutritional recommendations in patients with cirrhosis are associated with a lower survival

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World Journal of Hepatology 2020年第10期12卷 829-840页

作者： Dana Crisan Bogdan Procopet Alexandra Epure Horia Stefanescu Alina Suciu Andreea Fodor Emil Mois Rares Craciun Nicolae Crisan Internal Medicine Department “Iuliu Hatieganu”University of Medicine and PharmacyCluj-Napoca 400126Romania 3rd Medical Clinic “Iuliu Hatieganu”University of Medicine and PharmacyCluj-Napoca 400126Romania Hepatology Unit “Prof.Dr.Octavian Fodor”Regional Institute of Gastroenterology and HepatologyCluj-Napoca 400162Romania Surgery Department “Prof.Dr.Octavian Fodor”Regional Institute of Gastroenterology and HepatologyCluj-Napoca 400126Romania Hepatology Unit “Prof.Dr.Octavian Fodor”Regional Institute of Gastroenterology and HepatologyCluj-Napoca 400126Romania

BACKGROUND Malnutrition is frequently encountered in patients with cirrhosis and appears to significantly impact their *** evaluating the burden of malnutrition in cirrhosis is gathering momentum,as suggested by multiple recently published reports,there is still a persistent scarcity of solid data in the field,especially with regards to the role of nutritional *** To assess the prevalence of malnutrition in patients with advanced cirrhosis and to evaluate its impact on *** One hundred and one consecutive patients with advanced cirrhosis were screened for malnutrition using the subjective global assessment(SGA)criteria and the mid-arm circumference(MAC).Malnutrition was defined as SGA class B and C and MAC<10th *** patients were interviewed regarding their food intake using an adapted ***,total energy intake was calculated and further subdivided in main *** data were then compared to the available recommendations at the time of analysis to assess *** 54/79 patients(68.4%)in the decompensated group had malnutrition,while only 3/22 patients(13.6%)were malnourished in the compensated *** a median follow-up time of 27 mo(0-53),the overall mortality was 70%.Survival was significantly lower among patients with *** mortality rates were 50%at 1 year and 63%at 2 years for the patients with malnutrition,compared to 21%at 1 year and 30%at 2 years for patients without malnutrition(P=0.01).On multivariate analysis,the factors independently associated with mortality were age,creatinine level and adherence to the protein intake *** mortality was lower in patients with the appropriate protein intake:8%at 1 year and 28%at 2 years in the adherent group,compared to 47%at 1 year and 56%at 2 years in the non-adherent *** The prevalence of malnutrition is high among patients with advanced cirrhosis and might be related in part to a low adherenc

关键词： Malnutrition Decompensated cirrhosis Survival subjective global assessment Protein intake

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Malnutrition negatively impacts the quality of life of patients with cirrhosis: An observational study

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World Journal of Hepatology 2017年第5期9卷 263-269页

作者： Gabriela Rojas-Loureiro Alfredo Servín-Caamano Elizabeth Pérez-Reyes Luis Servín-Abad Fátima Higuerade la Tijera Liver Clinic Gastroenterology DepartmentHospital General de México“Dr.Eduardo Liceaga” Internal Medicine Department Hospital General de México“Dr.Eduardo Liceaga” Gastroenterologist at Lakeland Regional Medical Center

AIMTo verify how malnutrition is related to health-related quality of life (HRQL) impairment in patients with cirrhosis. METHODSData was retrospectively abstracted from medical records and obtained by direct interview. We included patients with cirrhosis from any etiology, evaluated at the Liver Clinic from Gastroenterology Department in a tertiary healthcare center, from June 2014 to June 2016. Child-Pugh score, data about complications, and demographic, clinical and anthropometric characteristics of patients were obtained. Nutritional status was evaluated by the subjective global assessment (SGA). HRQL was evaluated through the Chronic Liver Disease Questionnaire. Patients were requested to assess their global HRQL with the following code: 0 = impairment of HRQL, when it was compared with other healthy subjects; 1 = good HRQL, if it was similar to the quality of life of other healthy subjects. To compare the primary outcome between malnourished and well-nourished groups, the χ2 test, Fisher’s exact test or Student’s t-test were used, based on the variable type. Associations between predictor variables and deterioration of HRQL were determined by calculating the hazard ratio and 95% confidence interval using Cox proportional hazards regression. RESULTSA total of 127 patients with cirrhosis were included, and the mean age was 54.1 ± 12.3 years-old. According to Child-Pugh scoring, 25 (19.7%) were classified as A (compensated), 76 (59.8%) as B, and 26 (20.5%) as C (B/C = decompensated). According to SGA, 58 (45.7%) patients were classified as well-nourished. Sixty-nine patients identified HRQL as good, and 76 patients (59.8%) perceived impairment of their HRQL. Multivariate analysis to determine associations between predictor variables and self-perception of an impairment of HRQL found strong association with malnutrition (P P CONCLUSIONMalnutrition is a key factor related to impairment of HRQL in patients with cirrhosis.

关键词： Malnutrition subjective global assessment Health-related quality of life Cirrhosis Chronic liver disease questionnaire

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Comparison of two nutritional assessment methods in gastroenterology patients

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World Journal of Gastroenterology 2010年第16期16卷 1999-2004页

作者： Branka F Filipovi Milan Gaji Nikola Milini Branislav Milovanovi Branislav R Filipovi Mirjana Cvetkovi Nela ibali Department of Gastroenterohepatology Clinical and Hospital Center "Bezanijska Kosa" School of Medicine Institute for Medical Statistics Faculty of Cardiology School of Medicine Laboratory for Neurocardiology Clinical and Hospital Center "Bezanijska Kosa" Institute of Anatomy "Niko Miljanic" School of Medicine Biochemical Laboratory Clinical and Hospital Center "Bezanijska Kosa"

AIM:To investigate and compare efficacy and differences in the nutritional status evaluation of gastroenterology patients by application of two methods:subjective global assessment(SGA) and nutritional risk index(NRI).METHODS:The investigation was performed on 299 hospitalized patients,aged 18-84 years(average life span 55.57 ± 12.84),with different gastrointe-stinal pathology,admitted to the Department of Gastroenterohepatology,Clinical and Hospital Center "Bezanijska Kosa" during a period of 180 *** the patients,after being informed in detail about the study and signing a written consent,underwent nutritional status analysis,which included two different nutritional indices:SGA and NRI,anthropometric parameters,bioelectrical impedance analysis,and biochemical markers,within 24 h of ***:In our sample of 299 hospitalized patients,global malnutrition prevalence upon admission varied from 45.7% as assessed by the SGA to 63.9% by *** applied methods required different parameters for an adequate approach:glucose level(5.68 ± 1.06 mmol/L vs 4.83 ± 1.14 mmol/L,F = 10.63,P = 0.001);body mass index(26.03 ± 4.53 kg/m2 vs 18.17 ± 1.52 kg/m2,F = 58.36,P assessment:concentration of albumins,level of proteins,SGA score and body *** DFA extracted MAMC,glucose level and NRI scores were variables of importance for the prediction of whether admitted patients would be classif ied as well or ***:SGA

关键词： Nutritional status subjective global assessment Nutritional risk index Comparison

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Nutritional Screening in a University Hospital:Comparison between Oncologic and Non-Oncologic Patients

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Food and Nutrition Sciences 2015年第1期6卷 75-82页

作者： Selma F.C.Cunha Lidiane S.Tanaka Roberta G.Salomao Danielle M.Macedo Thatiane D.Santos Fernanda M.Peria Division of Clinical Nutrition Department of Internal MedicineSchool of Medicine of Ribeirao PretoUniversity of Sao PauloRibeirao PretoBrazil Parenteral and Enteral Nutrition Team of Clinical Hospital School of Medicine of Ribeirao PretoUniversity of Sao PauloRibeirao PretoBrazil Division of Oncology Department of Internal MedicineSchool of Medicine of Ribeirao PretoUniversity of Sao PauloRibeirao PretoBrazil

Background & Aims: We compared the screening nutritional data of patients with malignant and non-malignant disease, and classified their nutritional risk according to the primary tumor’s site. Methods: subjective global assessment was applied to 3008 patients within 48 h of admission to a public university. Subjects were divided into Oncologic Group (n = 576) or Non-Oncologic Group (n = 2432) according to the presence of neoplasms or other diseases respectively. These data were compared by the t-student test and classic chi-square test, with statistical significance set at p < 0.05. Results: The Oncologic Group presented a higher prevalence of weight loss (60.3% vs. 49.3%), quantitative (40.7% vs. 28.5%) and qualitative (16.4% vs. 7.6%) alterations in the food intake pattern, gastrointestinal symptoms and muscle waste (23.2% vs. 13.2%) as compared to the Non-Oncologic Group. Also, there was a higher prevalence of nutritional disturbances in the Oncologic Group, with 49.5% of the subjects moderately (or suspected to be malnourished) and 12.7% severely mal-nourished. Severe malnourishment was mainly observed in patients with head and neck (25%), upper digestive tract (21.9%) and soft tissue and bones (17.9%) tumors. Conclusion: When compared to other hospitalized patients, patients with neoplastic disease were in higher nutritional risk.

关键词： Nutritional Screening Malnutrition subjective global assessment Hospital Setting Neoplasia

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