Long Zhiwen, Huang Shan, Zhang Jie, Zhang Deng, Yin Jun, He Chengyuan, Zhang Qinqiu, Xu Huilin, He Huimin, Sun Ho Ching, Xie Ke
Recovery Plus Clinic, Chengdu, China.
Department of Oncology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.
JMIR Form Res. 2022 Oct 26;6(10):e40316. doi: 10.2196/40316.
Malnutrition is a common and severe problem in patients with cancer that directly increases the incidence of complications and significantly deteriorates quality of life. Nutritional risk screening and dietary assessment are critical because they are the basis for providing personalized nutritional support. No digital smartphone-based self-administered tool for nutritional risk screening and dietary assessment among hospitalized patients with cancer has been developed and evaluated.
This study aims to develop a digital smartphone-based self-administered mini program for nutritional risk screening and dietary assessment for hospitalized patients with cancer and to evaluate the validity of the mini program.
We have developed the R+ Dietitian mini program, which consists of 3 parts: (1) collection of basic information of patients, (2) nutritional risk screening, and (3) dietary energy and protein assessment. The face-to-face paper-based Nutritional Risk Screening (NRS-2002), the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF), and 3 days of 24-hour dietary recall (3d-24HRs) questionnaires were administered according to standard procedure by 2 trained dietitians as the reference methods. Sensitivity, specificity, positive predictive value, negative predictive value, κ value, and correlation coefficients (CCs) of nutritional risk screened in R+ Dietitian against the reference methods, as well as the difference and CCs of estimated dietary energy and protein intakes between R+ Dietitian and 3d-24HRs were calculated to evaluate the validity of R+ Dietitian.
A total of 244 hospitalized patients with cancer were recruited to evaluate the validity of R+ Dietitian. The NRS-2002 and PG-SGA-SF tools in R+ Dietitian showed high accuracy, sensitivity, and specificity (77.5%, 81.0%, and 76.7% and 69.3%, 84.5%, and 64.5%, respectively), and fair agreement (κ=0.42 and 0.37, respectively; CC 0.62 and 0.56, respectively) with the NRS-2002 and PG-SGA-SF tools administered by dietitians. The estimated intakes of dietary energy and protein were significantly higher (P<.001 for both) in R+ Dietitian (mean difference of energy intake: 144.2 kcal, SD 454.8; median difference of protein intake: 10.7 g, IQR 9.5-39.8), and showed fair agreement (CC 0.59 and 0.47, respectively), compared with 3d-24HRs performed by dietitians.
The identified nutritional risk and assessment of dietary intakes of energy and protein in R+ Dietitian displayed a fair agreement with the screening and assessment conducted by dietitians. R+ Dietitian has the potential to be a tool for nutritional risk screening and dietary intake assessment among hospitalized patients with cancer.
Chinese Clinical Trial Registry ChiCTR1900026324; https://www.chictr.org.cn/showprojen.aspx?proj=41528.
营养不良是癌症患者中常见且严重的问题，直接增加了并发症的发生率，并显著降低生活质量。营养风险筛查和饮食评估至关重要，因为它们是提供个性化营养支持的基础。目前尚未开发和评估基于数字智能手机的、供住院癌症患者自我管理的营养风险筛查和饮食评估工具。
本研究旨在开发一种基于数字智能手机的、供住院癌症患者自我管理的营养风险筛查和饮食评估小程序，并评估该小程序的有效性。
我们开发了“R+营养师”小程序，它由三部分组成：（1）患者基本信息收集；（2）营养风险筛查；（3）饮食能量和蛋白质评估。由两名经过培训的营养师按照标准程序实施面对面纸质版营养风险筛查（NRS-2002）、患者主观全面评定简表（PG-SGA-SF）和3天24小时饮食回顾（3d-24HRs）问卷作为参考方法。计算“R+营养师”中营养风险筛查相对于参考方法的灵敏度、特异度、阳性预测值、阴性预测值、κ值和相关系数（CCs），以及“R+营养师”与3d-24HRs之间估计的饮食能量和蛋白质摄入量的差异及CCs，以评估“R+营养师”的有效性。
共招募244名住院癌症患者来评估“R+营养师”的有效性。“R+营养师”中的NRS-2002和PG-SGA-SF工具显示出较高的准确性、灵敏度和特异度（分别为77.5%、81.0%和76.7%以及69.3%、84.5%和64.5%），与营养师实施的NRS-2002和PG-SGA-SF工具有较好的一致性（κ值分别为0.42和0.37；CCs分别为0.62和0.56）。“R+营养师”中估计的饮食能量和蛋白质摄入量显著更高（两者P均<0.001）（能量摄入量的平均差异：144.2千卡，标准差454.8；蛋白质摄入量的中位数差异：10.7克，四分位距9.5 - 39.8），与营养师实施的3d-24HRs相比，一致性较好（CCs分别为0.59和0.47）。
“R+营养师”中识别的营养风险以及饮食能量和蛋白质摄入量评估与营养师进行的筛查和评估有较好的一致性。“R+营养师”有潜力成为住院癌症患者营养风险筛查和饮食摄入量评估的工具。
中国临床试验注册中心ChiCTR1900026324；https://www.chictr.org.cn/showprojen.aspx?proj=41528 。
