Malnutrition by European Society for Clinical Nutrition and Metabolism criteria predicts prognosis in patients with gastrointestinal and hepatobiliary-pancreatic cancer

Nozomi Aotani; Sonoko Yasui-Yamada; Natsumi Kagiya; Mami Takimoto; Yu Oiwa; Atsumi Matsubara; Sayaka Matsuura; Mayu Tanimura; Yoshiko Tani-Suzuki; Hideya Kashihara; Yu Saito; Masaaki Nishi; Mitsuo Shimada; Yasuhiro Hamada

doi:10.1016/j.clnesp.2021.01.023

Malnutrition by European Society for Clinical Nutrition and Metabolism criteria predicts prognosis in patients with gastrointestinal and hepatobiliary-pancreatic cancer

Clin Nutr ESPEN. 2021 Apr:42:265-271. doi: 10.1016/j.clnesp.2021.01.023. Epub 2021 Feb 11.

Authors

Affiliations

¹ Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan.
² Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan; Department of Nutrition, Tokushima University Hospital, 2-50-1, Tokushima 770-8503, Japan. Electronic address: yamada.sonoko@tokushima-u.ac.jp.
³ Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan; Department of Nutrition, Tokushima University Hospital, 2-50-1, Tokushima 770-8503, Japan.
⁴ Department of Nutrition, Tokushima University Hospital, 2-50-1, Tokushima 770-8503, Japan; Department of Digestive Surgery and Transplantation, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan.
⁵ Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan; Department of Digestive Surgery and Transplantation, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan.
⁶ Department of Digestive Surgery and Transplantation, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan.

PMID: 33745591
DOI: 10.1016/j.clnesp.2021.01.023

Abstract

Background & aims: The European Society for Clinical Nutrition and Metabolism (ESPEN) proposed the ESPEN diagnostic criteria (EDC) for malnutrition in 2015. There is no report on the association between the EDC and prognosis in patients with gastrointestinal (GI) and hepatobiliary-pancreatic (HBP) cancer. This study aimed to (1) determine the prevalence of EDC malnutrition, (2) investigate the validity of the EDC as a nutritional and prognostic indicator, and (3) examine which components of the EDC are most related to long-term prognosis in patients with GI and HBP cancers.

Methods: A total of 634 patients with primary GI and HBP cancers who underwent their first resection surgery between July 2014 and March 2018 were retrospectively recruited. According to the EDC, patients were divided into malnourished and non-malnourished groups. Clinical parameters and survival between these two groups were compared. The prognostic effects of the EDC and the EDC components were analyzed using Cox proportional hazard models.

Results: The prevalence of EDC malnutrition was 22%. Anthropometric data and biochemical data were associated with EDC malnutrition. The 5-year survival rate was lower in the malnourished group (72%) than in the non-malnourished group (73%; P = 0.007). The multivariate analysis demonstrated that the malnourished group was an independent risk factor for mortality (hazard ratio = 1.70 in the malnourished group; 95% confidence interval 1.08-2.63; P = 0.024). Among EDC components, body mass index (BMI) of <18.5 kg/m² was an independent poor prognostic factor.

Conclusions: EDC malnutrition is associated with poor postoperative long-term prognosis. Among the EDC components, BMI of <18.5 kg/m² is most associated with prognosis in patients with preoperative GI and HBP cancers.

Keywords: Body mass index; ESPEN diagnostic criteria; Fat-free mass index; Gastrointestinal cancer; Malnutrition; Prognosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Malnutrition* / epidemiology
Nutrition Assessment
Nutritional Status
Pancreatic Neoplasms* / epidemiology
Prognosis
Retrospective Studies