Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer

Jingjing Cao; Hongxia Xu; Wei Li; Zengqing Guo; Yuan Lin; Yingying Shi; Wen Hu; Yi Ba; Suyi Li; Zengning Li; Kunhua Wang; Jing Wu; Ying He; Jiajun Yang; Conghua Xie; Fuxiang Zhou; Xinxia Song; Gongyan Chen; Wenjun Ma; Suxia Luo; Zihua Chen; Minghua Cong; Hu Ma; Chunling Zhou; Wei Wang; Qi Luo; Yongmei Shi; Yumei Qi; Haiping Jiang; Wenxian Guan; Junqiang Chen; Jiaxin Chen; Yu Fang; Lan Zhou; Yongdong Feng; Rongshao Tan; Junwen Ou; Qingchuan Zhao; Jianxiong Wu; Xin Lin; Liuqing Yang; Zhenming Fu; Chang Wang; Li Deng; Tao Li; Chunhua Song; Hanping Shi; Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) Group, Chinese Society of Nutritional Oncology

doi:10.1016/j.currproblcancer.2020.100638

Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer

Curr Probl Cancer. 2021 Feb;45(1):100638. doi: 10.1016/j.currproblcancer.2020.100638. Epub 2020 Aug 14.

Authors

Jingjing Cao¹, Hongxia Xu², Wei Li³, Zengqing Guo⁴, Yuan Lin⁵, Yingying Shi⁶, Wen Hu⁷, Yi Ba⁸, Suyi Li⁹, Zengning Li¹⁰, Kunhua Wang¹¹, Jing Wu¹², Ying He¹³, Jiajun Yang¹⁴, Conghua Xie¹⁵, Fuxiang Zhou¹⁵, Xinxia Song¹⁶, Gongyan Chen¹⁷, Wenjun Ma¹⁸, Suxia Luo¹⁹, Zihua Chen²⁰, Minghua Cong²¹, Hu Ma²², Chunling Zhou²³, Wei Wang²⁴, Qi Luo²⁵, Yongmei Shi²⁶, Yumei Qi²⁷, Haiping Jiang²⁸, Wenxian Guan²⁹, Junqiang Chen³⁰, Jiaxin Chen³¹, Yu Fang³², Lan Zhou³³, Yongdong Feng³⁴, Rongshao Tan³⁵, Junwen Ou³⁶, Qingchuan Zhao³⁷, Jianxiong Wu³⁸, Xin Lin², Liuqing Yang³⁹, Zhenming Fu⁴⁰, Chang Wang³, Li Deng³, Tao Li⁴¹, Chunhua Song⁴², Hanping Shi⁴³; Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) Group, Chinese Society of Nutritional Oncology

Affiliations

¹ Department of Preventive Medicine, Heze Medical College, Heze, Shandong 274000, China.
² Department of Nutrition, Daping Hospital & Research Institute of Surgery, Third Military Medical University, Chongqing 400042, China.
³ Cancer Center of the First Hospital of Jilin University, Changchun, Jilin 130021 China.
⁴ Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, Fujian 350014, China.
⁵ Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China.
⁶ Department of Surgery, The First Affiliated Hospital of SunYat-sen University, Guangzhou, Guangdong 510080, China.
⁷ Department of Clinical Nutrition, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China.
⁸ Department of Gastrointestinal Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
⁹ Department of Nutrition and Metabolism of Oncology, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui 230031, China.
¹⁰ Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050031, China.
¹¹ Department of Gastrointestinal Surgery, Institute of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
¹² Zhongshan Chenxinghai Hospital (Affiliated Zhongshan Chenxinghai Hospital of Guangdong Medical University), Zhongshan, Guangdong 528400, China; Department of Clinical Nutrition, The First People's Hospital of Kashi, Xinjiang 844000, China.
¹³ Department of Clinical Nutrition, Chongqing General Hospital, Chongqing 400014, China.
¹⁴ Department of Colorectal and Anal Surgery, Huizhou Municipal Central Hospital, Huizhou, Guangdong 516001, China.
¹⁵ Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China.
¹⁶ Department of Oncology, Xingtai People's Hospital, Hebei Medical University, Xingtai, Hebei 054031, China.
¹⁷ The First Department of the Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang 150085, China.
¹⁸ Department of Nutrition, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China.
¹⁹ Department of Oncology, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, Henan 450008, China.
²⁰ Department of General Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
²¹ Comprehensive Oncology Department, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China.
²² Department of Oncology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China.
²³ The Fourth Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150001, China.
²⁴ Cancer Center, The First People's Hospital of Foshan, Foshan, Guangdong 528000, China.
²⁵ Department of Gastrointestinal Tumor Surgery, The First Affiliated Hospital, Xiamen University, Xiamen, Fujian 361003, China.
²⁶ Department of Nutrition, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
²⁷ Department of Nutrition, Tianjin Third Central Hospital, Tianjin 300170, China.
²⁸ Department of Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China.
²⁹ Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China.
³⁰ Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China.
³¹ Department of Radiation and Medical Oncology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China.
³² Department of Clinical Nutrition, Peking University Cancer Hospital and Institute, Beijing 100142, China.
³³ Department of Nutrition, Third Affiliated Hospital of Kunming Medical College, Tumor Hospital of Yunnan Province, Kunming, Yunnan 650118, China.
³⁴ Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
³⁵ Department of Nutrition, Guangzhou Red Cross Hospital, Guangzhou, Guangdong 510220, China.
³⁶ Department of Clinical Nutrition, Clifford Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510632, China.
³⁷ Department of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi 710032, China.
³⁸ Department of Hepatobiliary Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
³⁹ Department of Gastrointestinal Surgery/Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, The 9th Clinical College, PKU. No.10 Tieyi Road, Haidian Dist, Beijing 100038, China.
⁴⁰ Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.
⁴¹ Department of Radiotherapy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610041, China. Electronic address: litaoxmf@126.com.
⁴² Department of Epidemiology and Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, PR China. Electronic address: sch16@zzu.edu.cn.
⁴³ Department of Gastrointestinal Surgery/Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, The 9th Clinical College, PKU. No. 10 Tieyi Road, Haidian Dist, Beijing 100038, China. Electronic address: shihp@ccmu.edu.cn.

PMID: 32829957
DOI: 10.1016/j.currproblcancer.2020.100638

Abstract

Introduction: Esophageal cancer is the fourth most common cause of cancer death in China. Patients with esophageal cancer are more likely to suffer from malnutrition. The purpose of this study is to assess nutritional status of patients with esophageal cancer from multiple perspectives and analyze the risk factors.

Methods: A total of 1482 esophageal cancer patients were enrolled in the study. We investigated the Scored Patient Generated Subjective Global Assessment (PG-SGA) scores, NRS-2002 scores, Karnofsky performance status scores, anthropometric, and laboratory indicators of patients. Unconditional logistic regression analysis was applied to identify the risk factors of nutritional status.

Results: PG-SGA (≥4) and NRS-2002 (≥3) showed the incidence of malnutrition were 76% and 50%, respectively. In the patients with PG-SGA score ≥4, the proportion of patients who did not receive any nutritional support was 60%. The incidence of malnutrition in females was significantly higher than that in males. Besides, abnormality rates of Red blood cell (P < 0.001), MAC (P = 0.037), and MAMC (P < 0.001) in males was significantly higher than that in females, while abnormality rates of TSF (P < 0.001) was lower than that in females. After adjusted with the other potential risk factors listed, unconditional logistic regression analysis indicated smoking (odds ratio: 2.868, 95% confidence interval: 1.660-4.954), drinking (OR: 1.726, 95% CI: 1.099-2.712), family history (OR: 1.840, 95% CI: 1.132-2.992), radiotherapy or chemotherapy (OR: 1.594, 95% CI: 1.065-2.387), and pathological stage (OR: 2.263, 95% CI: 1.084-4.726) might be the risk factors of nutritional status, while nutritional support can reduce the risk of malnutrition.

Conclusion: Effective nutritional risk assessment methods and nutritional intervention measures can be adopted according to the research data to improve quality of life of esophageal cancer patients.

Keywords: Esophageal cancer; Nutrition status; Nutritional support; PG-SGA; Risk factor.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't
Review

MeSH terms

Adult
Aged
China / epidemiology
Cross-Sectional Studies
Esophageal Neoplasms / blood
Esophageal Neoplasms / complications*
Female
Humans
Male
Malnutrition / blood
Malnutrition / complications*
Malnutrition / epidemiology*
Middle Aged
Nutrition Assessment
Risk Factors