Ravasco P, Monteiro-Grillo I, Vidal P M, Camilo M E
Centre of Nutrition and Metabolism, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon, Portugal.
Clin Oncol (R Coll Radiol). 2003 Dec;15(8):443-50. doi: 10.1016/s0936-6555(03)00155-9.
Under-nutrition is a major source of morbidity and mortality in cancer patients. This prospective, cross-sectional study aimed to evaluate the relative contributions of cancer staging, duration and diet on patients' nutritional deterioration.
We included 205 consecutive patients (133 men and 72 women) with head and neck, gastro-oesophageal, colon and rectum cancer, age 53 +/- 12 (33-86) years, referred for radiotherapy (primary, adjunctive to surgery, combined with chemotherapy or with palliative intent). We registered clinical variables, nutritional status (percentage of weight loss, Patient-Generated Subjective Global Assessment and body mass index), nutritional requirements, usual diet intake (diet history) and current intake (24-h recall).
In stage III and IV, we observed a significant decrease of usual and current energy and protein intake (P=0.002), which were not observed in stage I and II. Reduction in nutritional intake was influenced by disease duration (P=0.04), but when the latter was evaluated in a multivariate analysis, current dietary intake was associated only with staging (P=0.004), thus disclosing a distinct pattern of nutritional intake between stages and diagnosis. Using a general linear model, advanced staging showed the most significant association with nutritional depletion (P=0.0001). We also found significant associations for tumour location (P=0.001), disease duration (P=0.002), nutritional intake (P=0.003) and previous surgery or chemotherapy (P=0.02). Percentage weight loss showed a consistently superior performance with regard to clinical variables and ability to detect mild to extreme nutritional changes. Patient-Generated Subjective Global Assessment had a very high sensitivity and specificity, and a strong capacity for detecting patients at nutritional risk compared with body mass index.
Nutritional depletion is multifactorial, dependent mainly on the tumour burden of the host. Percentage weight loss is a sensitive and specific tool that can screen and identify malnutrition effectively. Its joint use with Patient-Generated Subjective Global Assessment, which establishes boundaries for nutritional therapy, will optimise the efficacy of nutritional assessment and support in cancer patients.
营养不良是癌症患者发病和死亡的主要原因。这项前瞻性横断面研究旨在评估癌症分期、病程和饮食对患者营养状况恶化的相对影响。
我们纳入了205例连续的头颈部、胃食管、结肠和直肠癌患者（133例男性和72例女性），年龄53±12（33 - 86）岁，这些患者因放疗前来就诊（包括根治性放疗、手术辅助放疗、放化疗或姑息性放疗）。我们记录了临床变量、营养状况（体重减轻百分比、患者主观整体评定法及体重指数）、营养需求、日常饮食摄入量（饮食史）和当前摄入量（24小时回顾法）。
在III期和IV期，我们观察到日常和当前能量及蛋白质摄入量显著下降（P = 0.002），而I期和II期未观察到这种情况。营养摄入量的减少受病程影响（P = 0.04），但在多因素分析中评估病程时，当前饮食摄入量仅与分期相关（P = 0.004），从而揭示了不同分期和诊断之间营养摄入的独特模式。使用一般线性模型，晚期分期与营养耗竭的关联最为显著（P = 0.0001）。我们还发现肿瘤位置（P = 0.001）、病程（P = 0.002）、营养摄入量（P = 0.003）以及既往手术或化疗（P = 0.02）之间存在显著关联。在检测轻度至重度营养变化方面，体重减轻百分比在临床变量方面表现始终更优。与体重指数相比，患者主观整体评定法具有非常高的敏感性和特异性，且具有很强的检测营养风险患者的能力。
营养耗竭是多因素的，主要取决于宿主的肿瘤负荷。体重减轻百分比是一种敏感且特异的工具，能够有效筛查和识别营养不良。将其与患者主观整体评定法联合使用，可为营养治疗设定界限，这将优化癌症患者营养评估和支持的效果。
