Clinical usefulness of the patient-generated subjective global assessment short form© for nutritional screening in patients with head and neck cancer: a multicentric study.

Nutritional screening and assessment are considered essential steps in nutritional care for cancer patients, malnutrition remains underreported in clinical practice. The aim of this study was to analyse the clinical usefulness of the Patient-Generated Subjective Global Assessment short form (PG-SGA SF©) for nutritional screening in patients with head and neck cancer (HNC). This is a multicentre, cross-sectional study involving patients with HNC. The final score of the PG-SGA SF© was obtained and the nutritional status was diagnosed using the Patient-Generated Subjective Global Assessment (PG-SGA)®, classifying them as well-nourished or malnourished. Receiver operating characteristic curve, ordinal logistic regression, and C-statistic were used. In total, 353 patients with HNC were enrolled and the prevalence of malnutrition, according to the PG-SGA®, was 64.02% and the median final score of PG-SGA SF© was 11 points. The final score of the PG-SGA SF© had high accuracy (area under the curve = 0.915), and scores ≥9 had the best performance in diagnosing malnutrition. PG-SGA SF© final score ≥9 was associated with malnutrition (odds ratio = 28.32, 95% confidence interval= 15.98-50.17), with excellent discriminatory power (C-statistic = 0.872). In conclusion, the PG-SGA SF© demonstrated excellent performance for nutritional screening in patients with HNC. Given that it is a simple instrument that is faster to administer than the PG-SGA®, we recommend its use in clinical practice among such patients.

Evaluation of the dietary inflammatory index in children and adolescents with type 1 diabetes mellitus and its relationship with nutritional status and metabolic control.

OBJECTIVES: The aim of this study was to evaluate the association of the dietary inflammatory index (DII) with the nutritional status and metabolic control of children and adolescents with type 1 diabetes mellitus. METHODS: This was a cross-sectional study that examined data of children and adolescents ages 7 to 16 y diagnosed with type 1 diabetes mellitus. Dietary intake was assessed using a 24-h dietary recall, from which the DII was calculated. The outcomes were body mass index, lipid profiles (low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol), and glycated hemoglobin. The DII was evaluated in tertiles and in a continuous way. Multiple linear regression was adopted in the analysis, with P < 0.05 considered significant. RESULTS: Overall, 120 children and adolescents with a mean age of 11.7 (± 2.8) y were included, 53.3% (n = 64) of whom were girls. Excess weight was present in 31.7% participants (n = 38). The average DII was +0.25, ranging from -1.11 to +2.67. Higher values of selenium (P = 0.011), zinc (P = 0.001), fiber (P < 0.001), and other micronutrients were observed in the first tertile of the DII (diet with more antiinflammatory potential). The DII appeared as a predictor of body mass index (P = 0.002; ß = 0.23; 95% confidence interval [CI], 0.39-1.75) and non-high-density lipoprotein cholesterol (P = 0.034; ß = 0.19; 95% CI, -13.5 to 0.55). There was a tendency for DII to be associated with glycemic control (P = 0.09; ß = 0.19; 95% CI, -0.04 to 0.51). CONCLUSIONS: The inflammatory potential of the diet was associated with increased body mass index and aspects related to metabolic control in children and adolescents with type 1 diabetes mellitus.

Clinical usefulness of the Patient-Generated Subjective Global Assessment and modified Glasgow Prognostic Score in decision making concerning the indication of enteral nutritional therapy in patients with incurable cancer receiving palliative care.

OBJECTIVES: This study aimed to identify the clinical usefulness of assessing nutritional status using validated tools for the indication of enteral nutrition for patients with incurable cancer in palliative care. METHODS: In this prospective cohort study, patients were assessed for nutritional risk using the Patient-Generated Subjective Global Assessment and for cancer cachexia (CC) using the modified Glasgow Prognostic Score upon enrollment and after ∼30 d. The outcome was stable or improved Karnofsky Performance Status. Logistic regression models were used, providing the odds ratio (OR) and 95% confidence interval (CI). RESULTS: A total of 180 patients participated. The only nutritional status parameter that was associated with function was CC. The less severe the CC, the more likely Karnofsky Performance Status was to remain stable or improve over 30 d (non-cachectic: OR = 1.95; 95% CI, 1.01-3.47; malnourished: OR = 1.06; 95% CI, 1.01-1.42). Furthermore, white skin color (OR = 1.79; 95% CI, 1.04-2.47), higher educational level (OR = 1.39; 95% CI, 1.13-2.78), and inadequate calorie intake (OR = 1.96; 95% CI, 1.02-2.81) were also associated with the outcome. CONCLUSIONS: Using the modified Glasgow Prognostic Score to identify the existence and severity of CC, which is associated with function, has the potential to help clinical decision making concerning the indication of enteral nutrition in patients with incurable cancer receiving palliative care.

Nutritional status at hospital admission and prediction of clinical outcomes in children and adolescents with cancer: Results of the Brazilian survey on oncological nutrition in paediatrics.

BACKGROUND: Changes in nutritional status are recognised as predictors of unfavourable outcomes in children and adolescents with cancer, particularly in developing countries. There have been no studies on children and adolescents with cancer from every region of Brazil or on the impact of nutritional status on clinical outcomes. The aim of this study is to assess the association between the nutritional status of children and adolescents with cancer and the prediction of clinical outcomes. METHODS: This was a longitudinal, multicentre, hospital-based study. An anthropometric nutritional assessment was performed, and the Subjective Global Nutritional Assessment (SGNA) was administered within 48 h of admission. Seven hundred and twenty-three patients (aged 2-18 years) were included in the sample, undergoing cancer treatment. They were recruited in 13 reference centres in the five macro-regions of Brazil between March 2018 and August 2019. The outcomes evaluated were readmission within 30 days and death within 60 days of admission. To identify predictors of 60-day survival, Cox regression and log-rank statistics were used to compare Kaplan-Meier curves between the strata. RESULTS: About 36.2% (n = 262) of the samples were malnourished according to the SGNA. Severe malnutrition by the SGNA (relative risk [RR] = 8.44, 95% confidence interval [CI]: 3.35-21.3, P = 0.001) and living in the North region (RR = 11.9, 95% CI: 3.34-42.7, P = 0.001) were associated with the poorest survival. The North (RR = 5.77, 95% CI: 1.29-25.8, P = 0.021), Northeast (RR = 1.46, 95% CI: 1.01-2.11, P = 0.041), Midwest (RR = 0.43, 95% CI: 0.20-0.095, P = 0.036), age group 10-18 years (RR = 0.65, 95% CI: 0.45- 0.94, P = 0.022) and haematologic malignancy (RR = 1.52, 95% CI: 1.10-2.10, P = 0.011) were predictors of readmission within 30 days. CONCLUSIONS: The prevalence of malnutrition was high and related to death. These results highlight the need to use the SGNA in clinical practice alongside classic anthropometric methods for the diagnosis of malnutrition, and the need to standardise care across all Brazilian regions, which should include nutritional care for children and adolescents with cancer.

Body Weight, Central Adiposity, and Fasting Hyperglycemia Are Associated with Tumor Characteristics in a Brazilian Cohort of Women with Breast Cancer.

The aim of this study was to evaluate the association of overweight, obesity, excess central adiposity, hyperglycemia, and diabetes mellitus with tumor characteristics in breast cancer. In this retrospective cohort study that enrolled 2127 women with breast cancer, the independent variables collected were fasting blood glucose, body mass index, central adiposity (waist circumference and waist-to-hip circumference ratio (WHR)), and waist-to-height ratio. The tumor characteristics (infiltrating, ductal grade, hormone receptor-positive (HR+), human epidermal growth factor receptor, triple negative, size, lymph node involvement, and clinical stage) were the dependent variables. Most of the women were postmenopausal (73.5%), with an infiltrating tumor (83.0%), HR+ (82.0%), and overweight or obese (71.0%). For the premenopausal women, obesity was associated with grade 3 ductal tumor (odds ratio (OR): 1.70; 95% confidence interval (95% CI): 1.09-2.66), triple negative (OR: 1.37, 95% CI: 1.08-3.24), and size ≥ 2 cm (OR: 2.20, 95% CI: 1.36-3.56). For the postmenopausal women, obesity was associated with WHR, infiltrating tumor (OR: 1.73, 95% CI: 1.56-1.95), size ≥ 2 cm (OR: 1.38, 95% CI: 1.11-1.71), lymph node involvement (OR: 1.24, 95% CI: 1.02-1.56), and stages III-IV (OR: 1.76, 95% CI: 1.30-2.65). Excess body weight and central adiposity were associated with tumor aggressiveness characteristics in women with breast cancer, confirming the importance of nutritional status.

Performance of subjective global nutritional assessment in predicting clinical outcomes: Data from the Brazilian survey of pediatric oncology nutrition.

BACKGROUND: Methods for assessing nutritional status in children and adolescents with cancer is a difficult in clinical practice. The study aimed to evaluate the performance of Subjective Global Nutritional Assessment (SGNA) in predicting clinical outcomes in children and adolescents with cancer in Brazil. METHODS: This was a prospective cohort multicenter study. It was included 723 children and adolescents with cancer aged 2-18 years between March 2018 and August 2019. Nutritional assessment was performed according to World Health Organization recommendations and using SGNA within 48h of hospitalization. Unplanned readmission, length of hospital stay, and post-discharge death were analyzed. Cohen's kappa coefficient was used to ascertain the agreement between body mass index for age (BMI/A) and SGNA. The sensitivity, specificity, positive and negative predictive values, and accuracy of SGNA were estimated. Odds ratios (ORs) with 95% confidence intervals (CIs) were evaluated using multiple logistic regression. RESULTS: The mean patient age was 9.4 ± 4.9 years. SGNA showed that 29.7% (n = 215) and 6.5% (n = 47) patients had moderate and severe malnutrition, respectively. Considering the concurrent validity criterion, SGNA had an OR (95% CI) of 6.8 (3.1-14.9) for predicting low and very low weight for age at admission, with a sensitivity and specificity of 72.4% (59%-82.1%) and 72% (64.2%-78.9%), respectively. SGNA could predict death in children with severe/moderate malnutrition, with an accuracy of 63.8% (63%-65.1%). Logistic multivariate analysis showed that the adjusted effect of death; hematological tumor; living in the northeast, southeast, and midwest regions of Brazil; and older age was associated with malnutrition according to SGNA. CONCLUSION: Based on concurrent validity between SGNA and anthropometry, SGNA performed well and had a good ability to predict death in Brazilian children with cancer.

Impact of Nutritional Status on Survival in Head and Neck Cancer Patients After Total Laryngectomy.

Malnutrition is an important prognostic indicator of laryngeal squamous cell carcinoma. Retrospective study with head and neck cancer patients who underwent total laryngectomy. 243 patients of both sex were evaluated. The univariate analyses demonstrated an increased risk of death for the patients with greater weight loss, hypoalbuminemia, radiotherapy as an initial treatment, salvage surgery, and radical neck dissection. In a Multivariate Cox regression, older age (p = 0.03, 95% confidence interval [CI] 1.003-1.06, hazard ratio [HR] 1.029), Nutritional Risk Index ≤100 (p = 0.008, 95% CI 1.18-3.12, HR 1.921) and adjuvant radiotherapy (p = 0.029, 95% CI 0.31-3.12, HR 0.544) demonstrated prognostic significance in survival. Nutritional status is a modifiable variable and these findings highlight the need to adoption of simple nutritional assessment methods routinely during the treatment of head and neck cancer patients, in order to help improve prognosis after surgery.

Relationship between Dietary Fatty Acid Intake with Nonalcoholic Fatty Liver Disease and Liver Fibrosis in People with HIV.

We aimed to evaluate the relationship between food intake of lipids with nonalcoholic fatty liver disease (NAFLD) and/or liver fibrosis in people living with HIV/AIDS (PLWHA). In this cross-sectional study, transient elastography was used to detect the presence of NAFLD and/or liver fibrosis. The dietary intake of fats and fatty acids (FA) were assessed by two 24 h dietary recalls (24-HDR) (n = 451). Multivariate logistic regression models were performed. Participants with higher intake of total fat were associated with higher odds for NAFLD compared to those with lower consumption [adjusted odds ratio (aOR) = 1.91 (95% confidence interval (95% CI) 1.06-3.44)]. Furthermore, participants with intermediate intake of n6-PUFA (n6-poly-unsaturated FA) and lauric FA had lower odds for NAFLD, respectively aOR = 0.54 (95% CI 0.3-0.98) and aOR = 0.42 (95% CI 0.22-0.78). Additionally, a higher intake of myristoleic FA (fourth quartile) was a significant protective factor for NAFLD [aOR = 0.56 (95% CI 0.32-0.99)]. Participants with higher intake of lauric FA [0.38 (95% CI 0.18-0.80)], myristic FA [0.38 (0.17-0.89)], palmitoleic FA [0.40 (0.19-0.82)] and oleic FA [0.35 (0.16-0.79)] had positively less odds of having liver fibrosis. On the other hand, higher intake of n-6 PUFA was significantly associated with fibrosis [aOR = 2.45 (95% CI 1.12-5.32)]. Dietary assessment of total fat and FA should be incorporated into HIV care as a tool for preventing NAFLD and fibrosis in PLWHA.

New cancer cachexia staging system for use in clinical practice.

OBJECTIVES: Previous attempts to classify cancer cachexia (CC) have demonstrated limitations regarding stages and diagnostic criteria. This study aims to develop and validate a new staging system for CC in patients with incurable cancer. METHODS: This is an analysis of a database from a prospective cohort study of 1325 patients with advanced cancer referred for palliative care between 2016 and 2020. The cohort was randomly divided into two groups: Development (882 patients) and validation (443 patients) sets. A hierarchical cluster analysis was performed to distinguish different stages of CC in the development set. Next, the optimal cutoff points and ideal combinations of the most important factors associated with the CC groups (clusters) were ascertained. Finally, the relationship between the CC stages determined using the new system and body composition, quality of life, and overall survival was verified with the validation set. RESULTS: The new system classified CC into three stages: Precachexia (10.8%), cachexia (57.8%), and refractory cachexia (31.4%), based on a combination of percentage weight loss in the past 6 mo (<15 or ≥15), body mass index (<21.0, 21.0-26.4, >26.4 kg/m2), and mid-upper-arm muscle area (≥38.0/≥35.5 or <38.0/<35.5 cm2 in men/women, respectively). The new staging system enabled a clear classification of patients into three CC groups according to the outcomes analyzed. Outcomes of patients with refractory cachexia were significantly worse than those in the other groups. CONCLUSIONS: This study presents a useful, valid system for CC staging in the clinical setting, and is also capable of predicting outcomes, including quality of life and overall survival.

Preoperative Fasting Abbreviation With Whey Protein Reduces the Occurrence of Postoperative Complications in Patients With Head and Neck Cancer: A Randomized Clinical Trial.

BACKGROUND: Surgery has become the treatment of choice for head and neck cancer (HNC) in most cases. Preoperative fasting abbreviation and nutrition screening have been suggested to reduce the occurrence of postoperative complications. This study aimed to evaluate the addition of whey protein in the preoperative fasting abbreviation and to analyze the association of nutrition status on postoperative complications in patients with HNC. METHODS: A randomized, single-blind clinical trial was performed. Patients recruited from March to November 2018 at a national cancer reference center in Brazil were divided into 2 groups: intervention group (clear fluids with carbohydrate plus whey protein [CHO-P]) and control group (clear fluids with carbohydrate only [CHO]). All patients were evaluated by the Patient-Generated Subjective Global Assessment (PG-SGA) and body mass index. Logistic regression analyses were performed to assess associations between the studied variables, generating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: A total of 49 patients met the eligibility criteria and enrolled in the study. A PG-SGA score of 4-8, indicating moderate malnutrition (OR, 10.91; 95% CI, 1.05-112.91), was an independent factor that increased the risk of postoperative complication, whereas the CHO-P group (OR, 0.04; 95% CI, 0.01-0.26) was found to be an independent factor in reducing such risk. CONCLUSION: The addition of whey protein to clear fluids (CHO-P group) was associated with a reduced risk of postoperative complications compared with the CHO group. Furthermore, moderate malnourishment was associated with an increased risk of postoperative complications for patients with HNC.

Dados do Inquérito Brasileiro de Nutrição Oncológica em Pediatria: Estudo Multicêntrico e de Base Hospitalar / Data from the Brazilian Survey of Pediatric Oncology Nutrition: Multicenter, Hospital-Based Study / Datos de Encuesta Brasileña de Nutrición en Oncología Pediátrica: Estudio Multicéntrico Hospitalario

Introdução: A desnutrição é observada em crianças com câncer e está associada a desfechos clínicos negativos. Objetivo: Descrever a prevalência de inadequação do estado nutricional de crianças e adolescentes com neoplasia maligna na admissão hospitalar em Centros de Referência do câncer infantil no Brasil. Método: Estudo transversal aninhado a um estudo de coorte, multicêntrico, de base hospitalar. A amostra probabilística foi feita em dois estágios em cada estrato por Macrorregião pelo método de probabilidade proporcional ao tamanho com um ano de coleta em cada instituição. Foram coletados em 13 instituições de referência dados clínicos, antropométricos, de composição corporal e sobre o questionário de Avaliação Nutricional Subjetiva Global Pediátrica (ANSGP), em até 48 horas da admissão hospitalar, entre março de 2018 e agosto de 2019. Resultados: O estudo totalizou 723 pacientes nas cinco regiões do Brasil. A prevalência de desnutrição moderada e grave foi de 25,9% na faixa etária de 2 a 5 anos, 40,1% de 5 a 10 anos e 39,7% de 10 a 19 anos, de acordo com ANSGP. Segundo o Índice de Massa Corporal/Idade (IMC/I), magreza e magreza acentuada totalizaram 13%, risco de sobrepeso, sobrepeso e obesidade apresentaram uma prevalência de 26,7% de 2 a 5 anos; 24,9% de 5 a 10 anos; e 25,7% de 10 a 19 anos. Conclusão: Evidenciou-se alta prevalência de inadequação nutricional pela ANSGP, sugerindo que a desnutrição pode ser subdiagnosticada quando utilizado somente o IMC/I, fortalecendo a necessidade de utilização de métodos complementares na avaliação nutricional de crianças com câncer

Introduction: Malnutrition is found in children with cancer and is associated with negative clinical outcomes. Objective: To describe the prevalence of inadequate nutritional status of children and adolescents with malignant neoplasm at hospital admission in childhood cancer reference centers in Brazil. Method: Cross-sectional study nested in a multicenter, hospital-based cohort study. The probabilistic sample was carried out in two stages in each stratum by macro-region using the probability method proportional to the size with one year of collection in each institution. Clinical, anthropometric, body composition data and the Pediatric Subjective Global Nutritional Assessment (SGNA) questionnaire were collected from 13 reference institutions within 48 hours of hospital admission, from March 2018 to August 2019. Results: The study totaled 723 patients in the 5 regions of Brazil. The prevalence of moderate and severe malnutrition was 25.9% in the age group of 2 to 5 years, 40.1% in 5 to 10 years and 39.7% in 10 to 19 years, according to the SGNA. According to the Body Mass/Age Index (BMI/I), thinness and marked thinness totaled 13%, risk of overweight, overweight and obesity showed a prevalence of 26.7% from 2 to 5 years, 24.9% from 5 to 10 years and 25.7% from 10 to 19 years. Conclusion: There was a high prevalence of nutritional inadequacy by the SGNA, suggesting that malnutrition can be underdiagnosed when using only the BMI/I, strengthening the need to use complementary methods in the nutritional assessment of children with cancer

Introducción: La desnutrición se observa en niños con cáncer y se asocia con resultados clínicos negativos. Objetivo: Describir la prevalencia del estado nutricional inadecuado de niños y adolescentes con neoplasia maligna al ingreso hospitalario en centros de referencia de cáncer infantil en Brasil. Método: Estudio transversal anidado en un estudio de cohorte hospitalario multicéntrico. La muestra probabilística se realizó en dos etapas en cada estrato por macrorregión utilizando el método de probabilidad proporcional al tamaño con un año de recolección en cada institución. Se recopilaron datos clínicos, antropométricos, de composición corporal y el cuestionario Global Pediatric Subjective Nutritional Assessment (ANSGP) de 13 instituciones de referencia dentro de las 48 horas posteriores al ingreso hospitalario, desde marzo de 2018 hasta agosto de 2019. Resultados: El estudio totalizó 723 pacientes en las 5 regiones de Brasil. La prevalencia de desnutrición moderada y severa fue de 25,9% en el grupo de edad de 2 a 5 años, 40,1% de 5 a 10 años y 39,7% de 10 a 19 años, según la ANSGP. Según el Índice de Masa Corporal/ Edad (IMC/I), la delgadez y la delgadez marcada totalizaron 13%, el riesgo de sobrepeso, sobrepeso y obesidad mostró una prevalencia de 26,7% de 2 a 5 años, 24,9% de 5 a 10 años y 25,7% de 10 a 19 años. Conclusión: Hubo una alta prevalencia de insuficiencia nutricional por parte de la ANSGP, lo que sugiere que la desnutrición puede ser infradiagnosticada cuando se utiliza solo el IMC/I, fortaleciendo la necesidad de utilizar métodos complementarios en la evaluación nutricional de los niños con cáncer

Impact of Long-Term Supplementation with Fish Oil in Individuals with Non-Alcoholic Fatty Liver Disease: A Double Blind Randomized Placebo Controlled Clinical Trial.

Non-alcoholic fatty liver disease (NAFLD) is a chronic disease affecting up to 25% of the population worldwide. n-3 long-chain polyunsaturated fatty acids (n-3 PUFA) have been associated with improved clinical parameters of NAFLD. Our purpose was to conduct a pilot study to evaluate the effects of n-3 PUFA supplementation in a randomized, double-blind, placebo-controlled clinical study performed on NAFLD individuals diagnosed by ultrasound. Patients received n-3 PUFA (n = 13) or placebo (n = 11) supplementation for six months. Circulating miR-122 expression (determined by quantitative real time-polymerase chain reaction (qRT-PCR), liver fibrosis (FibroScan®), red blood cells (RBC) fatty acids (gas chromatography), and biochemical tests were performed at baseline and after intervention. After the intervention, in the n-3 PUFA group, docosahexaenoic acid (DHA) and omega index increased significantly in RBC (p = 0.022 and p = 0.012, respectively), in addition to a significant reduction in alkaline phosphatase (ALP) (p = 0.002) and liver fibrosis (p = 0.039). However, there was no change in the expression of circulating miR-122 in both groups. Our results showed that omega-3 PUFA were incorporated in erythrocytes after six months of fish oil supplementary intake, and that n-3 PUFA were effective in reducing ALP and liver fibrosis without altering the expression of circulating miR-122 in individuals with NAFLD.

Cancer cachexia: Comparing diagnostic criteria in patients with incurable cancer.

OBJECTIVES: Cancer cachexia (CC) is a multifactorial syndrome that is associated with worse outcomes. Several criteria for its diagnosis have been suggested, but notable disparities exist. This study compared different diagnostic criteria for CC in patients with incurable cancer who are in palliative care. METHODS: A prospective cohort study was conducted at the National Cancer Institute in Brazil. Patients were classified by three CC diagnostic criteria, and comparisons between clinical, nutritional, and functional variables were verified according to the CC stage identified. Kaplan-Meier survival curves and Cox regression were used for the survival analysis. Concordance statistics were used to test the prognostic predictive accuracy of the criteria. RESULTS: The prevalence of cachexia in the 1384 patients included in the study varied from 13.8% to 53.9% according to the classification criteria used. All criteria distinguished noncachectic patients from other categories according to the majority of the domains studied. However, the results were inconsistent in distinguishing patients with intermediate cachexia (mainly precachexia) from noncachectic and cachectic patients. Patients with cachexia or refractory cachexia faced a higher risk of 90-d mortality. The criteria described by Vigano et al. were found to be better at distinguishing the stages of CC regarding overall survival (hazard ratio increases according to CC severity: 1.87 to 2.87; concordance statistic: 0.74). CONCLUSIONS: Our results demonstrate the disparities in existing CC diagnostic criteria and their inability to discriminate intermediate stages. Vigano et al.'s criteria is/was the most effective in predicting the prognosis. The development of new diagnostic criteria to improve CC classification requires future exploration.

Association between low muscle mass and survival in incurable cancer patients: A systematic review.

Current data suggest that low skeletal muscle mass provides prognostic information in patients with cancer and may even be considered a biomarker in research and clinical evaluations. The aim of this systematic review was to explore whether low muscle mass is associated with overall survival (OS) in patients with incurable cancer. A systematic search was conducted for published literature using PubMed/MEDLINE, Scopus, LILACS, and the Cochrane Library, with no restrictions on language or publication date, to examine whether low muscle mass is associated with OS in patients with incurable cancer. Eligible studies included low muscle mass evaluated using gold standard techniques (dual energy x-ray absorptiometry or computed tomography). The studies quality assessment was performed using the Newcastle-Ottawa Scale. Thirteen studies were included. The studies reported on 1959 patients between 54.3 (median) and 72.9 (mean) y of age; pancreatic cancer was the most common type of tumor. According to the survival curves and most of the multivariate analyses, there was no statistically significant association between loss of muscle mass and reduced OS. Four studies reported that overweight or obese patients with muscle mass depletion had significantly shorter OS. These results indicate that there is insufficient evidence to associate low muscle mass with OS in patients with incurable cancer. Further studies deploying other muscle measurement methods suggest that use of low muscle mass cutoff alone is still necessary in the pursuit of OS prediction in this population.

Advanced Stage of Disease and Systemic Inflammation as Factors Associated With Referral of Patients With Colorectal Cancer to a Palliative Care Unit.

OBJECTIVE: To identify factors associated with referral to an exclusive palliative care unit (PCU) in patients with colorectal cancer (CRC). METHODS: Retrospective cohort study with patients having CRC of both sexes treated at a hospital unit, aged ≥20 years. Data were extracted from the medical records of pretreatment patients between January 2008 and August 2014. The outcome was referral to the PCU within 5 years. Logistic regression analyses were performed to assess whether sociodemographic, clinical, nutritional, and biochemistry data were associated to referral, generating odds ratios (OR), and 95% confidence intervals (CI). RESULTS: Four hundred fifteen patients were evaluated. The Patient-Generated Subjective Global Assessment demonstrated a prevalence of malnutrition of 57.3%. One hundred one (24.3%) patients were referred to the PCU after 16.3 months (interquartile range: 7.2-33.5). These patients were more likely to be at an advanced stage of the disease and have malnutrition and exacerbated systemic inflammation. Tumor stage III and IV (OR: 2.05; 95% CI: 1.12-3.76) and neutrophil-to-lymphocyte ratio (NLR) ≥3 (OR: 1.89; 95% CI: 1.12-3.17) were predictors of an increased chance of referral to the PCU. CONCLUSION: Advanced disease stage and NLR were associated with referral of patients with CCR to a PCU.

Evaluation of the prognostic significance of the malnutrition inflammation score in hemodialysis patients.

BACKGROUND & AIMS: To verify the performance of Malnutrition Inflammation Score (MIS) in the evaluation of nutritional status and its relation with clinical outcomes. METHODS: Nutritional status was evaluated by MIS. The Mann Whitney and chi-square tests were used to compare the dependent variables MIS, death, and hospitalization. We used the forward stepwise multivariate regression model to evaluate the relationship between age, dialysis time, albumin, total iron binding capacity, C-reactive protein (CRP), and ferritin and the outcome variables. The Kaplan-Meier curve was constructed to evaluate the influence of MIS on survival in the two groups of patients, and log rank tests were used to ascertain the equality of survival distributions in these groups. ROC curves were fitted to measure the area under the curve and the significance of MIS in predicting mortality. RESULTS: A total of 47 patients on hemodialysis with a median age of 62 (48.5-72) took part in this study. The median total MIS was 9 (5.5-10). The MIS of 51% of the patients indicated they were malnourished. After 29 months' follow-up, 27.7% of the patients had died and survival was significantly lower in the high MIS group. The score from Part B of the MIS form and ferritin were higher for the patients who deceased during the follow-up period. Patients with an MIS >9 presented a significantly shorter survival time than those with an MIS ≤9. CONCLUSION: MIS is effective in evaluating the nutritional status of patients on hemodialysis and has a predictive capacity for negative clinical outcomes.

Neutrophil-lymphocyte ratio and nutritional status are clinically useful in predicting prognosis in colorectal cancer patients.

Background: Neutrophil-lymphocyte ratio (NLR) and nutritional status may provide a prognostic value in colorectal cancer (CRC). Thus, aim of this study was to evaluate the prognostic value of nutritional status and NLR in CRC patients.Methods: A retrospective analysis was conducted in CRC patients. The independent variables were body mass index (BMI), weight loss (WL) and NLR. Logistic regression was used to estimate the odds chance of low NLR. Kaplan-Meier curves and Cox regression were used to evaluate the overall survival at 5 years old.Results: In the 148 patients evaluated, the most prevalent nutritional status was overweight/obesity (43.2%) and 27.0% had severe WL. Sixty-seven subjects (45.3%) had NLR ≥ 3 that was associated with the lower OS (P < 0.001). There was a higher OS for overweight/obese patients (P = 0.002) and a lower among subjects with severe WL (P = 0.009). The NLR ≥3 (HR: 3.639; 95% CI, 1.708-7.771) was an independent poor prognostic factor for OS. Patients without WL (HR: 0.367, 95% CI, 0.141-0.954) and classified as overweight/obesity (HR: 0.260; 95% CI, 0.106-0.639) presented better prognostic.Conclusion: NLR, WL, BMI assessments are promising prognostic indicators in the CRC.

Phase angle assessment in critically ill cancer patients: Relationship with the nutritional status, prognostic factors and death.

PURPOSE: To evaluate the relationship between phase angle (PA) and nutritional status and the prognostic significance of PA in critically ill cancer patients. METHODS: 31 patients that had been admitted to the intensive care unit (ICU) of a center on oncology were evaluated. Their PA was obtained from their bioelectrical impedance within 48 h of the ICU admission. The logistic regression analysis of Cox was used in order to identify the independent predictors of the outcomes. RESULTS: Negative and significant correlations were observed between the PA and the following variables: the length of hospital ward stay, the length of ICU stay, the total time of hospital stay, the mechanical ventilation time, and the acute physiology and chronic health evaluation II (APACHE II) scores. A positive correlation was ascertained between the PA and albumin. PA was significantly associated with death. Patients with a PA ≤3.8° presented a significantly shorter survival time than those with a PA >3.8°. CONCLUSION: PA was a prognostic marker in this population, independently of previously established prognostic factors. PA can represent a clinically feasible approach for the initial identification of critically ill cancer patients who require an early and specialized nutritional intervention.

Performance of Patient-Generated Subjective Global Assessment (PG-SGA) in Patients With Advanced Cancer in Palliative Care.

BACKGROUND: The purpose of this study was to evaluate the prognostic significance of the Patient-Generated Subjective Global Assessment (PG-SGA) in patients receiving palliative care for advanced cancer. METHODS: The PG-SGA was used to assess nutrition status of 120 patients admitted to the Palliative Care Unit at the National Cancer Institute in Brazil. RESULTS: According to the PG-SGA, 94.2% (n = 113) of the patients were evaluated as malnourished. The PG-SGA evaluated that xerostomia was the only symptom associated with a short survival (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.2-5.38; P = .014). Survival was found to be significantly higher in well-nourished (PG-SGA A) than malnourished (PG-SGA B [ P = .021] or C [ P = .013]) patients. Total PG-SGA score (hazard ratio [HR], 1.06; 95% CI, 1.001-1.09; P = .045) and Karnofsky Performance Status of 20%-30% (HR, 15.4; 95% CI, 1.63-92.9; P = .001) and 40%-50% (HR, 10.0; 95% CI, 1.22-64.9; P = .031) were found to be independent prognostic survival factors. CONCLUSION: The scored PG-SGA is an independent prognostic factor of survival and thus can be a useful tool for nutrition evaluation in palliative care.