Nutrition Research and Practice

The Korean Nutrition Society (한국영양학회)
권호 표지
DOI QR코드

DOI QR Code

Selection and optimization of nutritional risk screening tools for esophageal cancer patients in China

  • Dong, Wen (Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University) ;
  • Liu, Xiguang (Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University) ;
  • Zhu, Shunfang (Department of Respiratory Medicine, Nanfang Hospital, Southern Medical University) ;
  • Lu, Di (Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University) ;
  • Cai, Kaican (Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University) ;
  • Cai, Ruijun (Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University) ;
  • Li, Qing (Department of Nutrition, Nanfang Hospital, Southern Medical University) ;
  • Zeng, Jingjing (Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University) ;
  • Li, Mei (Department of Thoracic Surgery, Nanfang Hospital, Southern Medical University)
  • Received : 2019.04.23
  • Accepted : 2019.07.10
  • Published : 2020.02.01
Download PDF
⟨ Previous Next ⟩

Abstract

BACKGROUND/OBJECTIVES: Malnutrition has multiple impacts on surgical success, postoperative complications, duration of hospital stay, and costs, particularly for cancer patients. There are various nutrition risk screening tools available for clinical use. Herein, we aim to determine the most appropriate nutritional risk screening system for esophageal cancer (EC) patients in China. SUBJECTS/METHODS: In total, 138 EC patients were enrolled in this study and evaluated by experienced nurses using three different nutritional screening tools, the Nutrition Risk Screening 2002 tool (NRS2002), the Patient-generated Subjective Globe Assessment (PG-SGA), and the Nutrition Risk Index (NRI).We compared sensitivity, specificity, positive and negative likelihood ratios, and Youden index generated by each of the three screening tools. Finally, cut-off points for all three tools were re-defined to optimize and validate the best nutritional risk screening tool for assessing EC patients. RESULTS: Our data suggested that all three screening tools were 100% sensitive for EC patients, while the specificities were 44.4%, 2.96%, and 59.26% for NRS 2002, PG-SGA, and NRI, respectively. NRI had a higher positive likelihood ratio as well as a higher area under the receiver operating characteristic curve compared to those of NRS 2002 and PG-SGA; although, all three tools had null negative likelihood ratios. After adjusting the cut-off points, the specificity and accuracy for all tools were significantly improved, however, the NRI remained the most appropriate nutritional risk screening system for EC patients. CONCLUSIONS: The NRI is the most suitable (highest sensitivity and accuracy) nutritional risk screening tool for EC patients. The performance of the NRI can be significantly improved if the cut-off point is modified according to the results obtained using MedCalc software.

Keywords

References

  1. Xu W, Liu Z, Bao Q, Qian Z. Viruses, other pathogenic microorganisms and esophageal cancer. Gastrointest Tumors 2015;2:2-13. https://doi.org/10.1159/000380897
  2. Gupta R, Ihmaidat H. Nutritional effects of oesophageal, gastric and pancreatic carcinoma. Eur J Surg Oncol 2003;29:634-43. https://doi.org/10.1016/S0748-7983(03)00124-0
  3. Miller KR, Bozeman MC. Nutrition therapy issues in esophageal cancer. Curr Gastroenterol Rep 2012;14:356-66. https://doi.org/10.1007/s11894-012-0272-6
  4. Sun Z, Cao Z, Ye Q, Liang E, Fu H, Qian X. Preoperative NRS 2002 assessment of nutritional risk of patients with esophagus cancer and postoperative results. Chin J Clin Thorac Cardiovasc Surg 2015;22:323-6.
  5. Li Y, Cheng Y, Xu B, Duan X, Xu J, Qi D. The effective of nutrition risk assessment and interventions in patients with esophageal cancer. Chung Hua Hu Li Tsa Chih 2015;50:166-70.
  6. Wischmeyer PE, Carli F, Evans DC, Guilbert S, Kozar R, Pryor A, Thiele RH, Everett S, Grocott M, Gan TJ, Shaw AD, Thacker JK, Miller TE, Hedrick TL, McEvoy MD, Mythen MG, Bergamaschi R, Gupta R, Holubar SD, Senagore AJ, Abola RE, Bennett-Guerrero E, Kent ML, Feldman LS, Fiore JF Jr; Perioperative Quality Initiative (POQI) 2 Workgroup. American society for enhanced recovery and perioperative quality initiative joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway. Anesth Analg 2018;126:1883-95. https://doi.org/10.1213/ane.0000000000002743
  7. Hu CL, Yu M, Yuan KT, Yu HL, Shi YY, Yang JJ, Li W, Jiang HP, Li ZN, Xu HX, Ba Y, Wang KH, Li SY, Shi HP. Determinants and nutritional assessment value of hand grip strength in patients hospitalized with cancer. Asia Pac J Clin Nutr 2018;27:777-84.
  8. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003;22:321-36. https://doi.org/10.1016/S0261-5614(02)00214-5
  9. Oh CA, Kim DH, Oh SJ, Choi MG, Noh JH, Sohn TS, Bae JM, Kim S. Nutritional risk index as a predictor of postoperative wound complications after gastrectomy. World J Gastroenterol 2012;18:673-8. https://doi.org/10.3748/wjg.v18.i7.673
  10. Robinson MK, Trujillo EB, Mogensen KM, Rounds J, McManus K, Jacobs DO. Improving nutritional screening of hospitalized patients: the role of prealbumin. JPEN J Parenter Enteral Nutr 2003;27:389-95. https://doi.org/10.1177/0148607103027006389
  11. Makhija S, Baker J. The Subjective Global Assessment: a review of its use in clinical practice. Nutr Clin Pract 2008;23:405-9. https://doi.org/10.1177/0884533608321214
  12. Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 2002;56:779-85. https://doi.org/10.1038/sj.ejcn.1601412
  13. Rasmussen HH, Kondrup J, Ladefoged K, Staun M. Clinical nutrition in danish hospitals: a questionnaire-based investigation among doctors and nurses. Clin Nutr 1999;18:153-8. https://doi.org/10.1016/S0261-5614(99)80005-3
  14. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003;22:321-36. https://doi.org/10.1016/S0261-5614(02)00214-5
  15. Chinese Medical Association. Nutrition support guidelines for clinical diagnosis and treatment. Beijing: People's medical Publishing House Co.; 2009. p. 8-9.
  16. Chen W, Jiang Z, Zhang Y, Wang X, Chen C, Shi Y. Evaluation of European nutrition risk screening method in Chinese hospitalized patients practice. Chin J Clin Nutr 2005;13:137-41. https://doi.org/10.3760/cma.j.issn.1674-635X.2005.03.002
  17. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22:415-21. https://doi.org/10.1016/S0261-5614(03)00098-0
  18. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, McCarthy MS, Davanos E, Rice TW, Cresci GA, Gervasio JM, Sacks GS, Roberts PR, Compher C; Society of Critical Care Medicine; American Society for Parenteral and Enteral Nutrition. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: society of critical care medicine (SCCM) and American society for parenteral and enteral nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 2016;40:159-211. https://doi.org/10.1177/0148607115621863
  19. Buzby GP, Knox LS, Crosby LO, Eisenberg JM, Haakenson CM, McNeal GE, Page CP, Peterson OL, Reinhardt GF, Williford WO. Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients. Am J Clin Nutr 1988;47:366-81. https://doi.org/10.1093/ajcn/47.2.366
  20. Buzby GP, Williford WO, Peterson OL, Crosby LO, Page CP, Reinhardt GF, Mullen JL. A randomized clinical trial of total parenteral nutrition in malnourished surgical patients: the rationale and impact of previous clinical trials and pilot study on protocol design. Am J Clin Nutr 1988;47:357-65. https://doi.org/10.1093/ajcn/47.2.357
  21. Hasselmann M, Alix E. Tools and procedures for screening for malnutrition and its associated in risks in hospital. Nutr Clin Metab 2003;17:218-26. https://doi.org/10.1016/j.nupar.2003.09.004
  22. Meves V, Behrens A, Pohl J. Diagnostics and early diagnosis of esophageal cancer. Viszeralmedizin 2015;31:315-8. https://doi.org/10.1159/000439473
  23. Reim D, Friess H. Feeding challenges in patients with esophageal and gastroesophageal cancers. Gastrointest Tumors 2016;2:166-77. https://doi.org/10.1159/000442907

Cited by

  1. Development and psychometric evaluation of a Chinese version of auditory hallucination risk assessment scale in patients with a diagnosis of schizophrenia vol.29, pp.17, 2020, https://doi.org/10.1111/jocn.15379
  2. Preliminary Exploration of Setting the Disease Severity Score in the Nutritional Risk Screening of Patients with Severe Novel Coronavirus Pneumonia by Applying NRS2002 vol.14, 2021, https://doi.org/10.2147/ijgm.s289655