Korean J Community Nutr.  2021 Aug;26(4):280-295. 10.5720/kjcn.2021.26.4.280.

Assessing Nutritional Status in Outpatients after Gastric Cancer Surgery : A Comparative Study of Five Nutritional Screening Tools

Affiliations
  • 1Unit manager, Department of Dietetic, Samsung Medical Center, Seoul, Korea
  • 2Student, Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Korea
  • 3Professor, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 4Team leader, Department of Dietetic, Samsung Medical Center Seoul, Korea
  • 5Professor, Department of Food and Nutrition, Seoul National University, Seoul, Korea
  • 6Professor, Research Institute of Human Ecology, Seoul National University, Seoul, Korea

Abstract


Objectives
This study aimed to examine the characteristics of patients according to their nutritional status as assessed by five nutritional screening tools: Patient-Generated Subjective Global Assessment (PG-SGA), NUTRISCORE, Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) and to compare the agreement, sensitivity, and specificity of these tools.
Methods
A total of 952 gastric cancer patients who underwent gastrectomy and chemotherapy from January 2009 to December 2012 at the Samsung Medical Center were included. We categorized patients into malnourished and normal according to the five nutritional screening tools 1 month after surgery and compared their characteristics. We also calculated the Spearman partial correlation, Cohen’s Kappa coefficient, the area under the curve (AUC), sensitivity, and specificity of each pair of screening tools.
Results
We observed 86.24% malnutrition based on the PG-SGA and 85.82% based on the NUTRISCORE among gastric cancer patients in our study. When we applied NRI or CONUT, however, the malnutrition levels were less than 30%. Patients with malnutrition as assessed by the PG-SGA, NUTRISCORE, or NRI had lower intakes of energy and protein compared to normal patients. When NRI, PNI, or CONUT were used to identify malnutrition, lower levels of albumin, hemoglobin, total lymphocyte count, total cholesterol, and longer postoperative hospital stays were observed among patients with malnutrition compared to those without malnutrition. We found relatively high agreement between PG-SGA and NUTRISCORE; sensitivity was 90.86% and AUC was 0.78. When we compared NRI and PNI, sensitivity was 99.64% and AUC was 0.97. AUC ranged from 0.50 to 0.67 for comparisons between CONUT and each of the other nutritional screening tools.
Conclusions
Our study suggests that PG-SGA and NRI have a relatively high agreement with the NUTRISCORE and PNI, respectively. Further cohort studies are needed to examine whether the nutritional status assessed by PG-SGA, NUTRISCORE, NRI, PNI, and CONUT predicts the gastric cancer prognosis.

Keyword

gastric cancer; gastrectomy; malnutrition; nutritional screening tool; comparison
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