대한지역사회영양학회지 (Korean Journal of Community Nutrition)

대한지역사회영양학회 (The Korean Society of Community Nutrition)
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[재출판] 위암 수술 후 외래환자의 영양상태 평가: 5가지 영양검색도구의 비교연구

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

  • 조재원 (삼성서울병원 영양팀) ;
  • 윤지영 (서울대학교 생활과학대학 식품영양학과) ;
  • 최민규 (삼성서울병원 외과, 성균관대학교 의과대학) ;
  • 라미용 (삼성서울병원 영양팀) ;
  • 이정은 (서울대학교 생활과학대학 식품영양학과)
  • Cho, Jae Won (Department of Dietetic, Samsung Medical Center) ;
  • Youn, Jiyoung (Department of Food and Nutrition, College of Human Ecology, Seoul National University) ;
  • Choi, Min-Gew (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Rha, Mi Young (Department of Dietetic, Samsung Medical Center) ;
  • Lee, Jung Eun (Department of Food and Nutrition, Seoul National University)
  • 투고 : 2022.06.14
  • 심사 : 2022.06.28
  • 발행 : 2022.06.30
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초록

Objectives: This study examined the characteristics of patients according to nutritional status 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 were included. The patients were categorized into malnutrition and normal status according to five nutritional screening tools one month after surgery. The Spearman partial correlation, Cohen's Kappa coefficient, the area under the curve (AUC), sensitivity, and specificity of each two screening tools were calculated. Results: Malnutrition was observed in 86.24% of patients based on the PG-SGA and 85.82% based on the NUTRISCORE. When NRI or CONUT were applied, the proportions of malnutrition were < 30%. Patients with malnutrition had lower intakes of energy and protein than normal patients when assessed using the PG-SGA, NUTRISCORE, or NRI. Lower levels of albumin, hemoglobin, total lymphocyte count, and total cholesterol and longer postoperative hospital stays were observed among patients with malnutrition compared to normal patients when NRI, PNI, or CONUT were applied. Relatively high agreement for NUTRISCORE relative to PG-SGA was found; the sensitivity was 90.86%, and the AUC was 0.78. When NRI, PNI, and CONUT were compared, the sensitivities were 23.72% for PNI relative to NRI, 44.53% for CONUT relative to NRI, and 90.91% for CONUT relative to PNI. The AUCs were 0.95 for NRI relative to PNI and 0.91 for CONUT relative to PNI. Conclusions: NUTRISCORE had a high sensitivity compared to PG-SGA, and CONUT had a high sensitivity compared to PNI. NRI had a high specificity compared to PNI. This relatively high sensitivity and specificity resulted in 77.00% agreement between PNI and CONUT and 77.94% agreement between NRI and PNI. Further cohort studies will be needed to determine if the nutritional status assessed by PG-SGA, NUTRISCORE, NRI, PNI, and CONUT predicts the gastric cancer prognosis.

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과제정보

저자들은 본 연구에 아낌없이 협조해주신 삼성서울병원 직원들에게 감사드립니다.

참고문헌

  1. International Agency for Research on Cancer. Incidence, mortality and prevalence by cancer site [Internet]. Globocan; 2020 [cited 2022 Jun 02]. Available from: https://gco.iarc.fr/today/data/factsheets/populations/900-world-fact-sheets.pdf.
  2. International Agency for Research on Cancer. Cancer incidence and mortality statistics worldwide and by region [Internet]. Globocan; 2020 [cited 2022 Jun 02]. Available from: https://gco.iarc.fr/today/data/factsheets/cancers/7-Stomach-fact-sheet.pdf.
  3. National Cancer Information Center. Incidence status by cancer type for Korea in 2019 [Internet]. National Cancer Information Center Korea; 2022 [cited 2022 Jun 02]. Avalable from: https://cancer.go.kr/lay1/S1T639C641/contents.do.
  4. National Cancer Information Center. Mortality by major cancer type for Korea in 2020 [Internet]. National Cancer Information Center Korea; 2022 [cited 2022 Jun 02]. Avalable from: https://cancer.go.kr/lay1/S1T645C646/contents.do.
  5. Song Z, Wu Y, Yang J, Yang D, Fang X. Progress in the treatment of advanced gastric cancer. Tumour Biol 2017; 39(7): 1010428317714626.
  6. Lee HO, Han SR, Choi SI, Lee JJ, Kim SH, Ahn HS et al. Effects of intensive nutrition education on nutritional status and quality of life among postgastrectomy patients. Ann Surg Treat Res 2016; 90(2): 79-88. https://doi.org/10.4174/astr.2016.90.2.79
  7. Sakurai K, Ohira M, Tamura T, Toyokawa T, Amano R, Kubo N et al. Predictive potential of preoperative nutritional status in long-term outcome projections for patients with gastric cancer. Ann Surg Oncol 2016; 23(2): 525-533. https://doi.org/10.1245/s10434-015-4814-7
  8. Oh CA, Kim DH, Oh SJ, Choi MG, Noh JH, Sohn TS et al. Nutritional risk index as a predictor of postoperative wound complications after gastrectomy. World J Gastroenterol 2012; 18(7): 673-678. https://doi.org/10.3748/wjg.v18.i7.673
  9. Klute KA, Brouwer J, Jhawer M, Sachs H, Gangadin A, Ocean A et al. Chemotherapy dose intensity predicted by baseline nutrition assessment in gastrointestinal malignancies: A multicentre analysis. Eur J Cancer 2016; 63: 189-200. https://doi.org/10.1016/j.ejca.2016.05.011
  10. Tegels JJ, De Maat MF, Hulsewe KW, Hoofwijk AG, Stoot JH. Improving the outcomes in gastric cancer surgery. World J Gastroenterol 2014; 20(38): 13692-13704. https://doi.org/10.3748/wjg.v20.i38.13692
  11. Rodrigues CS, Lacerda MS, Chaves GV. Patient generated subjective global assessment as a prognosis tool in women with gynecologic cancer. Nutrition 2015; 31(11-12): 1372-1378. https://doi.org/10.1016/j.nut.2015.06.001
  12. Jager-Wittenaar H, Ottery FD. Assessing nutritional status in cancer: Role of the Patient-Generated Subjective Global Assessment. Curr Opin Clin Nutr Metab Care 2017; 20(5): 322-329. https://doi.org/10.1097/MCO.0000000000000389
  13. Wiegert EVM, Padilha PC, Peres WAF. Performance of Patient-Generated Subjective Global Assessment (PG-SGA) in patients with advanced cancer in palliative care. Nutr Clin Pract 2017; 32(5): 675-681. https://doi.org/10.1177/0884533617725071
  14. Um MH, Choi MY, Lee SM, Lee IJ, Lee CG, Park YK. Intensive nutritional counseling improves PG-SGA scores and nutritional symptoms during and after radiotherapy in Korean cancer patients. Support Care Cancer 2014; 22(11): 2997-3005. https://doi.org/10.1007/s00520-014-2304-2
  15. Arribas L, Hurtos L, Sendros MJ, Peiro I, Salleras N, Fort E et al. NUTRISCORE: A new nutritional screening tool for oncological outpatients. Nutrition 2017; 33: 297-303. https://doi.org/10.1016/j.nut.2016.07.015
  16. Yim GW, Eoh KJ, Kim SW, Nam EJ, Kim YT. Malnutrition identified by the nutritional risk index and poor prognosis in advanced epithelial ovarian carcinoma. Nutr Cancer 2016; 68(5): 772-779. https://doi.org/10.1080/01635581.2016.1159702
  17. Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg 2011; 98(2): 268-274. https://doi.org/10.1002/bjs.7305
  18. Ryo S, Kanda M, Ito S, Mochizuki Y, Teramoto H, Ishigure K et al. The controlling nutritional status score serves as a predictor of shortand long-term outcomes for patients with stage 2 or 3 gastric cancer: Analysis of a multi-institutional data set. Ann Surg Oncol 2019; 26(2): 456-464. https://doi.org/10.1245/s10434-018-07121-w
  19. Schiesser M, Kirchhoff P, Muller MK, Schafer M, Clavien PA. The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery. Surgery 2009; 145(5): 519-526. https://doi.org/10.1016/j.surg.2009.02.001
  20. Bao X, Liu F, Lin J, Chen Q, Chen L, Chen F et al. Nutritional assessment and prognosis of oral cancer patients: A large-scale prospective study. BMC Cancer 2020; 20(1): 146. https://doi.org/10.1186/s12885-020-6604-2
  21. Vicente M, Barao K, Silva TD, Forones NM. What are the most effective methods for assessment of nutritional status in outpatients with gastric and colorectal cancer? Nutr Hosp 2013; 28(3): 585-591.
  22. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK et al. AJCC Cancer Staging Manual. 8th ed. New York (NY). 2016.
  23. Pasricha SR, Colman K, Centeno-Tablante E, Garcia-Casal MN, Pena-Rosas JP. Revisiting WHO haemoglobin thresholds to define anaemia in clinical medicine and public health. Lancet Haematol 2018; 5(2): e60-e62. https://doi.org/10.1016/s2352-3026(18)30004-8
  24. Zini G. Abnormalities in leukocyte morphology and number. In: Porwit A, McCullough J, Erber W, editors. Blood and bone marrow pathology. 2nd ed. Philadelphia: Churchill Livingstone; 2011. p. 247-261.
  25. Elmehdawi R. Hypolipidemia: A word of caution. Libyan J Med 2008; 3(2): 84-90. https://doi.org/10.3402/ljm.v3i2.4764
  26. WHO/IASO/IOTF. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: 0-9577082-1-1Health Communications Australia, Melbourne; 2000. p. 15-21.
  27. Elliot L, Molseed L, McCallum PD. The clinical guide to oncology nutrition. Chicago: American Dietetic Association; 2006. p. 54-71.
  28. Ottery FD. Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition 1996; 12(1): S15-S19. https://doi.org/10.1016/0899-9007(95)00067-4
  29. Buzby GP, Knox LS, Crosby LO, Eisenberg JM, Haakenson CM, McNeal GE et al. Study protocol: A randomized clinical trial of total parenteral nutrition in malnourished surgical patients. Am J Clin Nutr 1988; 47(2): 366-381. https://doi.org/10.1093/ajcn/47.2.366
  30. Sun J, Wang D, Mei Y, Jin H, Zhu K, Liu X et al. Value of the prognostic nutritional index in advanced gastric cancer treated with preoperative chemotherapy. J Surg Res 2017; 209: 37-44. https://doi.org/10.1016/j.jss.2016.09.050
  31. de Ulibarri JI, Gonzalez-Madrono A, de Villar NG, Gonzalez P, Gonzalez B, Mancha A et al. CONUT: A tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp 2005; 20(1): 38-45.
  32. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33(1): 159-174. https://doi.org/10.2307/2529310
  33. Muller MP, Tomlinson G, Marrie TJ, Tang P, McGeer A, Low DE et al. Can routine laboratory tests discriminate between severe acute respiratory syndrome and other causes of community-acquired pneumonia? Clin Infect Dis 2005; 40(8): 1079-1086. https://doi.org/10.1086/428577
  34. Lee JY, Kim HI, Kim YN, Hong JH, Alshomimi S, An JY et al. Clinical significance of the prognostic nutritional index for predicting short- and long-term surgical outcomes after gastrectomy: A retrospective analysis of 7781 gastric cancer patients. Medicine 2016; 95(18): e3539. https://doi.org/10.1097/md.0000000000003539
  35. Hsueh SW, Liu KH, Hung CY, Tsai CY, Hsu JT, Tsang NM et al. Predicting postoperative events in patients with gastric cancer: A comparison of five nutrition assessment tools. In Vivo 2020; 34(5): 2803-2809. https://doi.org/10.21873/invivo.12106
  36. Kuroda D, Sawayama H, Kurashige J, Iwatsuki M, Eto T, Tokunaga R et al. Controlling Nutritional Status (CONUT) score is a prognostic marker for gastric cancer patients after curative resection. Gastric Cancer 2018; 21(2): 204-212. https://doi.org/10.1007/s10120-017-0744-3
  37. Sanz EA, Siles MG, Fernandez LR, Roldan RV, Dominguez AR, Abiles J. Nutritional risk and malnutrition rates at diagnosis of cancer in patients treated in outpatient settings: Early intervention protocol. Nutrition 2019; 57: 148-153. https://doi.org/10.1016/j.nut.2018.05.021
  38. Sanz EA, Abiles J, Siles MG, Ruiz FR, Goitia BT, Dominguez AR. Evaluation of a protocol to detect malnutrition and provide nutritional care for cancer patients undergoing chemotherapy. Sci Rep 2020; 10(1): 21186. https://doi.org/10.1038/s41598-020-78246-w
  39. Kim Y, Kim WG, Lee HJ, Park MS, Lee YH, Kong SH et al. Comparison of the impact of malnutrition by nutritional assessment and screening tools on operative morbidity after gastric cancer surgery. J Korean Soc Parenter Enter Nutr 2011; 4(1): 7-15.
  40. Pablo AM, Izaga MA, Alday LA. Assessment of nutritional status on hospital admission: Nutritional scores. Eur J Clin Nutr 2003; 57(7): 824-831. https://doi.org/10.1038/sj.ejcn.1601616
  41. Kyle UG, Kossovsky MP, Karsegard VL, Pichard C. Comparison of tools for nutritional assessment and screening at hospital admission: A population study. Clin Nutr 2006; 25(3): 409-417. https://doi.org/10.1016/j.clnu.2005.11.001
  42. Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M et al. Malnutrition in hospital outpatients and inpatients: Prevalence, concurrent validity and ease of use of the 'malnutrition universal screening tool' ('MUST') for adults. Br J Nutr 2004; 92(5): 799-808. https://doi.org/10.1079/BJN20041258
  43. Braga M, Zuliani W, Foppa L, Di Carlo V, Cristallo M. Food intake and nutritional status after total gastrectomy: Results of a nutritional follow-up. Br J Surg 1988; 75(5): 477-480.
  44. Park YO, Yoon SY, Kang SS, Han SM, Kang EH. Nutritional status and dietary change after gastrectomy of gastric cancer patients. Korean J Community Nutr 2012; 17(1): 101-108. https://doi.org/10.5720/kjcn.2012.17.1.101
  45. James WP, Hay AM. Albumin metabolism: Effect of the nutritional state and the dietary protein intake. J Clin Investig 1968; 47(9): 1958-1972. https://doi.org/10.1172/JCI105885
  46. Thalacker-Mercer AE, Campbell WW. Dietary protein intake affects albumin fractional synthesis rate in younger and older adults equally. Nutr Rev 2008; 66(2): 91-95. https://doi.org/10.1111/j.1753-4887.2007.00012.x
  47. Kim WG, Park MS, Lee YH, Heo DS. Nutritional risk in oncology outpatients receiving chemotherapy. Korean J Community Nutr 2008; 13(4): 573-581.
  48. Yu EJ, Kang JH, Yoon S, Chung HK. Changes in nutritional status according to biochemical assay, body weight, and nutrient intake levels in gastrectomy patients. J Korean Diet Assoc 2012; 18(1): 16-29. https://doi.org/10.14373/JKDA.2012.18.1.016
  49. Kanda M, Mizuno A, Tanaka C, Kobayashi D, Fujiwara M, Iwata N et al. Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer. Medicine 2016; 95(24): e3781. https://doi.org/10.1097/MD.0000000000003781
  50. Ryu SW, Kim IH. Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients. World J Gastroenterol 2010; 16(26): 3310-3317. https://doi.org/10.3748/wjg.v16.i26.3310