Low body mass index demonstrates satisfactory specificity for diagnosing malnutrition and is associated with longer hospitalization in patients with gastrointestinal or head and neck cancer: a prospective cohort study

Abstract

Background: The main causes of malnutrition in patients with gastrointestinal and head and neck cancers include metabolic alterations determined by the tumour and its stage, as well as low food intake caused by the disease itself and the effects of antineoplastic treatment. In the hospital environment, nutritional markers, such as body mass index (BMI), handgrip strength (HGS) and calf circumference (CC), can be used to identify malnutrition early, ensuring individualized and specific nutritional intervention. However, few studies have evaluated the individual performance of nutritional indicators in diagnosing malnutrition in a cancer setting. We aimed to assess the ability of these nutritional indicators to accurately diagnose malnutrition and their association with length of hospital stay (LOS) in patients with cancer.

Methods: This cohort study prospectively evaluated 171 patients with gastrointestinal or head and neck cancer. Nutritional status was assessed within 48 hours of hospital admission using BMI, CC and HGS as well as two reference standards: subjective global assessment (SGA) and patient-generated SGA (PG-SGA). The accuracy of each nutritional indicator was measured by the area under the receiver operating characteristic curve (AUC) compared with the reference standards. Multiple logistic regression analysis, adjusted for confounders, was used to determine whether malnutrition was associated with LOS.

Results: Of 171 patients, 59.1% had low CC, 46.2% had low HGS and 13.5% had low BMI. The SGA and PG-SGA scores indicated malnutrition in 57.4% and 87.2% of patients, respectively. All nutritional indicators had poor accuracy in diagnosing malnutrition (AUC < 0.70). However, compared with SGA and PG-SGA, low BMI had satisfactory specificity (>80%) and was associated with 1.79 times higher odds of LOS ≥ 6 days. Malnutrition diagnosed by SGA and PG-SGA increased the odds of LOS ≥ 6 days by 3.60-fold and 2.78-fold, respectively.

Conclusion: Low BMI showed adequate specificity for diagnosing malnutrition and was associated with longer LOS in patients with gastrointestinal or head and neck cancer. Further research is needed to explore how improved screening, interventions and nutritional support could reduce malnutrition rates in cancer patients.

Keywords: anthropometry; cancer; length of hospital stay; malnutrition; nutritional status.

Figure 1.. Flowchart of patient selection.

Figure 2.. Relation between nutritional characteristics and hospitalization (≥6 days) in patients with gastrointestinal and head and neck cancer (n = 171). (a): Nutritional risk and status. (b): Nutritional indicators. PG-SGA SF, Patient-generated subjective global assessment short form; SGA, subjective global assessment; PG-SGA, patient-generated subjective global assessment; BMI, body mass index; HGS, hand grip strength; CC, calf circumference. ^a Chi-square test. ^*p < 0.001.

Figure 3.. Receiver operating characteristic (ROC) curves using nutritional indicators to diagnose malnutrition in patients with gastrointestinal and head and neck cancer (SGA and PG-SGA as reference methods). (a): SGA as a method reference. (b): PG-SGA as a method reference. AUC, area under curve; BMI, body mass index; HGS, hand grip strength; CC, calf circumference; SGA, subjective global assessment; PG-SGA, patient-generated subjective global assessment.