Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer

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Abstract

Introduction: Esophageal cancer is the fourth most common cause of cancer death in China. Patients with esophageal cancer are more likely to suffer from malnutrition. The purpose of this study is to assess nutritional status of patients with esophageal cancer from multiple perspectives and analyze the risk factors. Methods: A total of 1482 esophageal cancer patients were enrolled in the study. We investigated the Scored Patient Generated Subjective Global Assessment (PG-SGA) scores, NRS-2002 scores, Karnofsky performance status scores, anthropometric, and laboratory indicators of patients. Unconditional logistic regression analysis was applied to identify the risk factors of nutritional status. Results: PG-SGA (≥4) and NRS-2002 (≥3) showed the incidence of malnutrition were 76% and 50%, respectively. In the patients with PG-SGA score ≥4, the proportion of patients who did not receive any nutritional support was 60%. The incidence of malnutrition in females was significantly higher than that in males. Besides, abnormality rates of Red blood cell (P < 0.001), MAC (P = 0.037), and MAMC (P < 0.001) in males was significantly higher than that in females, while abnormality rates of TSF (P < 0.001) was lower than that in females. After adjusted with the other potential risk factors listed, unconditional logistic regression analysis indicated smoking (odds ratio: 2.868, 95% confidence interval: 1.660-4.954), drinking (OR: 1.726, 95% CI: 1.099-2.712), family history (OR: 1.840, 95% CI: 1.132-2.992), radiotherapy or chemotherapy (OR: 1.594, 95% CI: 1.065-2.387), and pathological stage (OR: 2.263, 95% CI: 1.084-4.726) might be the risk factors of nutritional status, while nutritional support can reduce the risk of malnutrition. Conclusion: Effective nutritional risk assessment methods and nutritional intervention measures can be adopted according to the research data to improve quality of life of esophageal cancer patients.

Introduction

Esophageal cancer is the sixth most common malignant tumor and the fourth most common cause of cancer death in China.1 It is estimated that about 375,000 Chinese will die from Esophageal cancer in 2015, accounting for 13.3% of all cancer deaths.2

Influenced by the disease itself and the treatment of cancer, the nutritional problems of patients with malignant tumors are more serious. Malnutrition has been shown to have negative effect on cancer patients, such as reducing the tolerance and efficacy of their treatment,3 increasing the risk for clinical and surgical complications,4 and lengthening hospital stay with a concomitant increase in health care costs.5 It is estimated that 10%-20% of cancer patients die from malnutrition, not cancer itself.6 Esophageal cancer, as a kind of upper gastrointestinal cancer, directly affects the intake of food and has a higher risk of malnutrition. Most of the patients diagnosed with esophageal cancer are advanced, about 40%-60% of the patients were malnourished at the time of admission.7 Progressive dysphagia8 and significant weight loss9 are the typical symptomatic presentation of advanced esophageal cancer patients and concurrent radiotherapy and chemotherapy is an effective way of esophageal cancer treatment.10 The characteristics of esophageal cancer make patients with esophageal cancer are more likely to suffer from malnutrition.

The importance of nutritional status of cancer patients is widely recognized, and various methods to assess nutritional status of patients are emerging. The Patient Generated Subjective Global Assessment (PG-SGA) is a specific nutritional assessment and screening tool for cancer patients, it is significantly associated with subjective and objective parameters and widely recognized method of assessing nutritional status.11 NRS-2002 is a nutritional risk screening method recommended by the European Society of Parenteral Nutrition (ESPEN) for hospitalized patients12 and the Karnofsky performance status (KPS) available to monitor the variation in vitality and dependence levels can also reflect the nutritional status of cancer patients to a certain extent.13 Besides, anthropometry and laboratory examinations can provide objective measurements to reflect the nutritional status of cancer patients.

Studies confirmed that understanding the nutritional status of patients and implementing nutritional intervention can improve the quality of life and reduce the risk of malnutrition. However, no single method or indicator can accurately assess the overall nutritional status of patients. Up to now, study on comprehensive assessment of nutritional status of patients with esophageal cancer has not yet been found. In the current study, we attempt to evaluate the nutritional status of patients with esophageal cancer from multiple perspectives. The PG-SGA, NRS-2002, and KPS scores of 1482 esophageal cancer patients were estimated and classic anthropometric and laboratory indicators that can reflect the nutritional status of patients were collected. In addition, unconditional logistic regression analysis was carried out to identify the factors that might affect nutritional risk of esophageal cancer patients.

Section snippets

Subjects

In the cross-sectional study, a total of 1482 esophageal cancer patients in 72 hospitals in China came from a Program on Nutrition Status and its Clinical Outcome of Common Cancers supported by Chinese Society for Oncological Nutrition & Supportive Care in 2013. All participants followed strict inclusion and exclusion criteria: (1) age ≥18 years; (2) pathology diagnosed with esophageal cancer; (3) conscious, and no communication disorders; (4) informed consent; (5) deem the patients as 1 case

The Characteristics of Esophageal Cancer Patients

A total of 1482 esophageal cancer patients were included in the study, of which 273(18.42%) were females and 1209 (81.58%) were males with a mean age of 62.68 ± 10.91 years. There were 35.09% (519) esophageal cancer patients with moderately malnourished status (scores 4-8), 46.93% (694) with severely malnourished status (score≥9), 11.49% (170) with suspicious malnourished status (scores 2-3), and only 6.49% (96) with well-nourished status (scores 0-1). We observed 613(41.39%) patients received

Discussion

The PG-SGA was recommended as a nutritional screening tool specifically for oncology patients.18 It could detect subtle changes in nutritional risk in a short time and most of PG-SGA can be done by patients alone.19 It was widely recognized that PG-SGA was a quick, valid, and reliable nutrition risk screening tool. In a previous article, we evaluated the nutritional risk of 16 common malignant tumors in 23904 cancer patients by PG-SGA methods and the results showed malnutrition risk is highest

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    This work was financially supported by Chinese Society for Oncological Nutrition & Supportive Care; The National Key Research and Development Program (2017YFC1309200); Support program for scientific and technological innovation talents of Henan Universities (19HASTIT005); Medical Science and Technology Key Projects of Henan Province and Zhengzhou (192102310088, SBGJ2018089, 19A32000820);The National Natural Science Foundation of China (U1604168).

    Conflicts of Interest: The authors declare that they have no competing interests.

    1

    Hanping Shi, Chunhua Song, and Tao Li contributed equally to this work.

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