Zhang Jinhui, Quan Yumeng, Wang Xiaolin, Wei Xiaolei, Shen Xueli, Li Xue, Liang Tao
Department of Medical Oncology, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, China.
BMC Cancer. 2025 Jul 19;25(1):1191. doi: 10.1186/s12885-025-14558-2.
BACKGROUND & AIMS: The epidemiological characteristics of malnutrition in cancer patients remain unclear. The Global Leadership Initiative on Malnutrition (GLIM) criteria, published in 2019, were established to compare the prevalence of malnutrition globally, drive the development of standardized care practices, and promote improved clinical outcomes. This study aimed to systematically assess the prevalence and related factors of malnutrition in cancer patients based on the GLIM criteria, and to evaluate its association with clinical outcomes.
Two authors independently searched PubMed, Web of Science, the Cochrane Library, and Embase up to July 20, 2024. Eligible studies were observational (cross-sectional or cohort), involved adult cancer patients, and assessed nutritional status using the GLIM criteria. Studies were required to report at least one of the following outcomes: prevalence of malnutrition, associated factors, or relevant clinical outcomes. Heterogeneity was assessed using the I² and Q tests. A random-effects model was used when significant heterogeneity was present (I²>50%, P < 0.05); otherwise, a fixed-effects model was applied. PROSPERO registration number: CRD420251053345.
A total of 20 cross-sectional studies and 45 cohort studies were included, all of which reported the prevalence of malnutrition and together covered over 30,000 cancer patients. Three studies examined factors influencing malnutrition. Nine studies evaluated its impact on overall survival (OS), while three assessed its effect on postoperative complications. Overall, the prevalence of malnutrition was 41% (95% CI: 36-45%), with moderate malnutrition at 19% (95% CI: 16-23%) and severe malnutrition at 20% (95% CI: 17-23%). The main factors influencing malnutrition in cancer patients were tumor-related symptoms. Malnutrition in cancer patients is significantly associated with OS (HR = 2.04, 95% CI: 1.56-2.67). Specifically, the risk is significantly increased in patients with moderate malnutrition (HR = 1.34, 95% CI: 1.07-1.72), and even higher in those with severe malnutrition (HR = 1.92, 95% CI: 1.55-2.39). Additionally, malnutrition in cancer patients is also significantly associated with an increased risk of postoperative complications (OR = 1.90, 95% CI: 1.41-2.55).
Malnutrition prevalence is high among cancer patients, primarily due to tumor-related symptoms. It significantly increases the risk of poor clinical outcomes, with a more pronounced effect in patients suffering from severe malnutrition.
癌症患者营养不良的流行病学特征尚不清楚。2019年发布的全球营养不良领导倡议（GLIM）标准旨在比较全球营养不良的患病率，推动标准化护理实践的发展，并促进改善临床结局。本研究旨在基于GLIM标准系统评估癌症患者营养不良的患病率及相关因素，并评估其与临床结局的关联。
两位作者独立检索了截至2024年7月20日的PubMed、科学网、考克兰图书馆和Embase。符合条件的研究为观察性研究（横断面研究或队列研究），涉及成年癌症患者，并使用GLIM标准评估营养状况。研究需报告以下至少一项结果：营养不良的患病率、相关因素或相关临床结局。使用I²和Q检验评估异质性。当存在显著异质性时（I²>5０%，P<0.05），使用随机效应模型；否则，应用固定效应模型。国际前瞻性系统评价注册编号：CRD420251053345。
共纳入20项横断面研究和45项队列研究，所有研究均报告了营养不良的患病率，共涵盖30000多名癌症患者。三项研究探讨了影响营养不良的因素。九项研究评估了其对总生存期（OS）的影响，三项评估了其对术后并发症的影响。总体而言，营养不良的患病率为41%（95%CI：36-45%），中度营养不良为19%（95%CI：16-23%），重度营养不良为20%（95%CI：17-23%）。影响癌症患者营养不良的主要因素是肿瘤相关症状。癌症患者的营养不良与总生存期显著相关（HR=2.04，95%CI：1.56-2.67）。具体而言，中度营养不良患者的风险显著增加（HR=1.34，95%CI：1.07-1.72），重度营养不良患者的风险更高（HR=1.92，95%CI：1.55-2.39）。此外，癌症患者的营养不良也与术后并发症风险增加显著相关（OR=1.90，95%CI：１.41-2.55）。
癌症患者中营养不良的患病率很高，主要原因是肿瘤相关症状。它显著增加了临床结局不良的风险，对重度营养不良患者的影响更为明显。
