Department of Anesthesiology, Institut Claudius Regaud, 20-24 rue du Pont Saint-Pierre, Toulouse, France.
Br J Cancer. 2010 Mar 16;102(6):966-71. doi: 10.1038/sj.bjc.6605578. Epub 2010 Feb 16.
This epidemiological observational study aimed at determining the prevalence of malnutrition in non-selected adults with cancer, to identify risk factors of malnutrition and correlate the results with length of stay and 2-month mortality.
This prospective multicentre 1-day study conducted in 17 French Comprehensive Cancer Centres included 1545 patients. Body mass index (BMI), weight loss (WL) in the past 6 months and age were routinely recorded according to the French national recommendations for hospitalised patients; malnutrition was rated as absent, moderate or severe according to the level of WL and BMI. Age, sex, tumour site, type of hospitalisation and treatment, disease stage, World Health Organisation performance status (PS) and antibiotic therapy were the potential malnutrition risk factors tested. Follow-up at 2 months allowed to determine the correlation with length of stay and mortality.
Malnutrition was reported in 30.9% of patients, and was rated as severe in 12.2%. In multivariate analysis, only pre-existing obesity (BMI> or =30), PS > or =2 and head-and-neck or upper digestive cancers were associated with increased risk of malnutrition. Antibiotics use was significantly higher in malnourished patients (35.5 vs 22.8%; P<0.001). Severe malnutrition was independently associated with mortality. The median length of stay was 19.3+/-19.4 days for malnourished patients vs 13.3+/-19.4 days for others (P<0.0001).
In French Comprehensive Cancer Centres, one out of three cancer patients are malnourished and this was associated with a longer length of stay. Pre-existing obesity could be identified as a new risk factor for malnutrition in our cancer patient population perhaps because of a misidentification or a delay in nutrition support in this category of patients.
本项观察性流行病学研究旨在明确非选择性成年癌症患者的营养不良发生率，确定营养不良的危险因素，并将研究结果与住院时间和 2 个月死亡率相关联。
本项在法国 17 个综合癌症中心进行的前瞻性多中心 1 日研究纳入了 1545 例患者。根据法国国家推荐方案对住院患者常规记录体质指数（BMI）、过去 6 个月体重下降（WL）和年龄；根据 WL 和 BMI 水平评定营养不良为无、中度或重度。年龄、性别、肿瘤部位、住院和治疗类型、疾病分期、世界卫生组织表现状态（PS）和抗生素治疗为测试的潜在营养不良危险因素。2 个月随访以确定与住院时间和死亡率的相关性。
30.9%的患者报告存在营养不良，其中 12.2%为重度营养不良。多变量分析显示，仅存在肥胖（BMI≥30）、PS≥2 和头颈部或上消化道癌症与营养不良风险增加相关。营养不良患者抗生素使用率显著较高（35.5%比 22.8%；P＜0.001）。重度营养不良与死亡率独立相关。营养不良患者的中位住院时间为 19.3±19.4 天，而无营养不良患者为 13.3±19.4 天（P＜0.0001）。
在法国综合癌症中心，每 3 例癌症患者中就有 1 例存在营养不良，且这与住院时间延长相关。预先存在的肥胖可能成为本癌症患者人群中营养不良的新危险因素，原因可能是该类患者的营养支持被错误识别或延迟。
