de Sousa Iasmin Matias, Silva Flávia Moraes, de Carvalho Ana Lucia Miranda, da Rocha Ilanna Marques Gomes, Fayh Ana Paula Trussardi
Postgraduate Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Brazil.
Postgraduate Program in Health Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Brazil.
JPEN J Parenter Enteral Nutr. 2022 Mar;46(3):508-516. doi: 10.1002/jpen.2199. Epub 2021 Jun 29.
The study aims to evaluate the accuracy of isolated nutrition indicators in diagnosing malnutrition in patients with gastric and colorectal cancer and their association with mortality.
Prospective cohort study involving patients with cancer (n = 178) attending a reference center of oncology at any point in the disease trajectory or treatment. Nutrition status was evaluated in a unique moment by body mass index (BMI), Patient-Generated Subjective Global Assessment (PG-SGA), handgrip strength (HGS), and calf circumference (CC). Kappa coefficient, accuracy, sensitivity, specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC) were calculated for each nutrition indicator (PG-SGA as the reference method). The Cox proportional hazards model was used to assess hazard ratio (HR) and CI of mortality.
From the total patients, 11% were underweight, 48% were malnourished (PG-SGA B or C), 43% had low HGS, and 55% presented low CC. There were 46 deaths (25.8%). BMI, HGS, and CC showed poor and fair agreements (κ < 0.30 for all ) and poor accuracy (AUC < 0.70 for all) in identifying malnutrition by PG-SGA. After the adjustment for confounders (age, treatment performed, site, and stage of cancer), PG-SGA (HR, 2.9; 95% CI, 1.5-5.9) and low CC (HR, 2.4; 95% CI, 1.1-5.2) were independent predictors of mortality.
The nutrition indicators are not accurate in diagnosing malnutrition, whereas PG-SGA and low CC could predict mortality in gastric and colorectal cancer patients. Thus, CC should be combined with PG-SGA in nutrition assessments.
本研究旨在评估孤立营养指标在诊断胃癌和结直肠癌患者营养不良中的准确性及其与死亡率的关联。
前瞻性队列研究，纳入在疾病轨迹或治疗过程中任何时间点就诊于肿瘤参考中心的癌症患者（n = 178）。通过体重指数（BMI）、患者主观整体评定法（PG-SGA）、握力（HGS）和小腿围度（CC）在单一时间点评估营养状况。计算每个营养指标（以PG-SGA作为参考方法）的kappa系数、准确性、敏感性、特异性、阳性和阴性预测值以及受试者工作特征曲线下面积（AUC）。采用Cox比例风险模型评估死亡率的风险比（HR）和置信区间（CI）。
在所有患者中，11%体重过轻，48%营养不良（PG-SGA为B或C级），43%握力低，55%小腿围度低。有46例死亡（25.8%）。BMI、HGS和CC在通过PG-SGA识别营养不良方面显示出较差和一般的一致性（所有κ<0.30）以及较差的准确性（所有AUC<0.70）。在对混杂因素（年龄、所进行的治疗、癌症部位和分期）进行调整后，PG-SGA（HR，2.9；95%CI，1.5 - 5.9）和低小腿围度（HR，2.4；95%CI，1.1 - 5.2）是死亡率的独立预测因素。
营养指标在诊断营养不良方面不准确，而PG-SGA和低小腿围度可预测胃癌和结直肠癌患者的死亡率。因此，在营养评估中应将小腿围度与PG-SGA相结合。
