Molfino Alessio, Imbimbo Giovanni, Laviano Alessandro
Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
Cancer Manag Res. 2022 Feb 15;14:561-567. doi: 10.2147/CMAR.S294105. eCollection 2022.
Malnutrition is highly common among cancer patients and is associated with a poor quality of life, increased treatment toxicities and decreased survival. The screening of malnutrition should be performed in an early stage of cancer disease and should be rapid, not expensive and highly sensitive to identify the risk of developing malnutrition. Importantly, international clinical guidelines suggest to perform screening for malnutrition in all cancer patients and if the risk is present, they recommend to perform a full nutritional assessment. During the screening phase, different nutritional parameters are considered including the loss of appetite, low food intake, body weight loss and burden of the disease. These items are present in several screening tools, such as the Nutrition Risk Screening (NRS)-2002, the Malnutrition Universal Screening Tool (MUST) and the Mini Nutritional Assessment (MNA) which represent the most widely used tools to screen for an altered nutritional status in cancer patients. Recently, the Global Leadership Initiative on Malnutrition (GLIM) developed an assessment tool for the diagnosis of malnutrition taking into account the presence of i) involuntary body weight loss, ii) body mass index, iii) low muscle mass, iv) low food intake and disease burden/inflammation; in particular, body weight loss, decreased body mass index (BMI), and low muscle mass are considered as phenotypic criteria, whereas reduced food intake, disease burden and inflammation are defined as etiologic criteria. To perform the diagnosis of malnutrition, GLIM consensus considered the presence of at least one phenotypic and one etiologic criterion. The above-mentioned screening tools were validated in different clinical settings and suggesting the use of one tool vs another is challenging considering, among others, different factors including the type and stage of cancer and the setting (i.e., inpatient or outpatient care). Recent data obtained among large cohorts of cancer patients indicate that personalized nutritional therapy reduced mortality risk and ameliorated quality of life and functionality among cancer patients with high nutritional risk, supporting the urgent need for implementing screening and diagnosis of malnutrition in this context.
营养不良在癌症患者中极为常见，与生活质量差、治疗毒性增加及生存率降低相关。营养不良的筛查应在癌症疾病的早期阶段进行，且应快速、经济且高度灵敏，以识别发生营养不良的风险。重要的是，国际临床指南建议对所有癌症患者进行营养不良筛查，若存在风险，则建议进行全面的营养评估。在筛查阶段，会考虑不同的营养参数，包括食欲减退、食物摄入量低、体重减轻和疾病负担。这些项目存在于多种筛查工具中，如营养风险筛查（NRS）-2002、营养不良通用筛查工具（MUST）和微型营养评定（MNA），它们是筛查癌症患者营养状况改变最广泛使用的工具。最近，全球营养不良领导倡议组织（GLIM）开发了一种用于诊断营养不良的评估工具，该工具考虑了以下因素的存在：i）非自愿体重减轻，ii）体重指数，iii）低肌肉量，iv）食物摄入量低和疾病负担/炎症；特别是，体重减轻、体重指数（BMI）降低和低肌肉量被视为表型标准，而食物摄入量减少、疾病负担和炎症被定义为病因标准。为进行营养不良的诊断，GLIM共识认为至少存在一项表型标准和一项病因标准。上述筛查工具在不同临床环境中得到了验证，考虑到包括癌症类型和阶段以及环境（即住院或门诊护理）等不同因素，建议使用一种工具而非另一种工具具有挑战性。最近在大量癌症患者队列中获得的数据表明，个性化营养治疗降低了高营养风险癌症患者的死亡风险，改善了生活质量和功能，支持了在此背景下实施营养不良筛查和诊断的迫切需求。
