Relationship Between Nutritional Status And Clinical Outcomes In Patients With Cancer

Part 1 Investigation of nutritional status and nutritional intervention during hospitalization in patients with cancerOBJECTIVE: Through studying the nutritional status of patients with malignant tumors and the status of nutritional intervention during hospitalization,the existing problems were found to provide reference for strengthening the nutritional intervention of such patients.METHODS: From September 2016 to October 2017,184 patients diagnosed with malignant tumors in a top-three hospital were targeted.They were used with nutritional risk screening 2002(NRS 2002)and patient-generated subjective global assessment(PG-SGA)to conduct nutritional risk screening and nutritional status assessment within 48 h of admission.The patients were also recorded for nutritional intervention during their hospitalization.RESULTS: 1.In 184 patients,NRS 2002 score ?3(with nutritional risk)was classified as 120 cases,and the overall nutritional risk was 64.40%.PG-SGA assessment,127 was evaluated with malnutrition(PG-SGA B+C),the overall malnutrition rate was 69.02%.2.The incidence of nutritional risk and malnutrition in patients with different tumor stages were statistically different(P<0.05).The incidence of malnutrition among patients of different age groups was statistically significant(P<0.05).The incidence of nutritional risk and malnutrition in digestive system tumors and non-digestive system tumors was not statistically different(P>0.05).3.In addition to the lymphocyte counts,the differences in age,BMI,MAC,TSF,MAMC,albumin,and hemoglobin between the NRS 2002 ?3 groups and the <3 group were statistically significant(P<0.05).The differences in age,BMI,MAC,TSF,MAMC,albumin,hemoglobin and lymphocyte counts between the well-nourished group and the malnourished group were statistically significant(P<0.05).4.NRS 2002 scores were significantly correlated with age,BMI,MAC,TSF,MAMC,albumin and hemoglobin(P<0.05),and had no correlation with lymphocyte count(P>0.05).The PG-SGA scores were significantly correlated with the objective indicators(P<0.05).There was also a significant correlation between NRS 2002 and PG-SGA scores(rs=0.703,P<0.05).5.NRS 2002 and PG-SGA showed a consistency of Kappa=0.545(95%CI 0.416-0.674,P<0.001)and the consistency was moderate.Using NRS 2002 as the standard,the sensitivity of PG-SGA was 87.50%(105/120),the specificity was 65.63%(42/64),the positive predictive value was 82.68%(105/127),and the negative predictive value was 73.68%(42/57).6.Of the 184 patients,only 44 received nutritional intervention,and the overall intervention rate was 23.91%,which was dominated by parenteral nutrition.Among them,the intervention rate of patients with nutritional risk was only 34.17%(41/120),and the intervention rate of patients with malnutrition was 31.50%(40/127).Conclusion: 1.In patients with malignant tumors,the incidence of nutritional risk and malnutrition is high.The proportion of urgently needed nutritional interventions on admission was more than one-third.2.Clinical nutrition interventions are obviously inadequate and the application rate of enteral nutrition support is low.3.NRS 2002(except lymphocyte count)and PG-SGA score were negatively correlated with various anthropometric indexes and laboratory indicators.4.Combined with NRS 2002 and PG-SGA two tools,the nutritional status of patients can be evaluated comprehensively,so that the assessment results are more perfect.Part 2 Effect of perioperative nutritional intervention on clinical outcomes in patients with digestive system malignant tumorsOBJECTIVE: In this study,preoperative nutritional risk screening for patients with digestive system malignancy was performed with NRS 2002 to investigate the effect of nutritional support on clinical outcomes of nutritionally risky patients and provide the basis for clinically reasonable nutritional support.METHODS: From January 2017 to October 2017,the patients with digestive system malignancy who met the inclusion criteria in the gastrointestinal surgical department of a top-threel hospital were prospectively observed.NRS 2002 was used for nutritional risk screening within 24 h after admission.NRS 2002?3 points patients were divided into standard nutritional support group and non-standard nutritional support group according to the nutritional support program.The effects of nutritional support on postoperative nutritional indicators,gastrointestinal function recovery,postoperative hospital stay and postoperative complications were analyzed.RESULTS: 1.Among the 84 patients,NRS 2002 ? 3 points with 63 cases,and the incidence of nutritional risk was 75.00%.There were statistically significant differences in age,BMI,and tumor sites between patients with nutritional risk and those without nutritional risk(P<0.05),and the gender was not statistically significant(P>0.05).2.In patients with nutritional risk,there was no significant difference(P>0.05)in terms of age,gender,and BMI between the two groups of standard nutritional support group and non-standard nutritional support group.3.There were no statistically significant differences in nutritional indicators between the two groups before and after the 7th day(P>0.05).On the 7th day after operation,all indicators in the two groups were reduced.Except for the hemoglobin in the standard nutritional support group,the remaining indicators were significantly different from the preoperative ones(P<0.05).4.The postoperative hospital stay in the standard nutritional support group was significantly shorter than that of the non-standard nutritional support group,and the difference was statistically significant(P<0.05).There was no significant difference in the time of first postoperative discharge and defecation between the two groups(P>0.05).5.The total complications,infectious complications and peritoneal effusion in the standard nutritional support group were significantly higher than those in the non-standard nutritional support group,and the difference was statistically significant(P<0.05).The complications of pleural effusion,anastomotic fistula,gastroparesis,diarrhea,and hemorrhage were not statistically different between the two groups(P>0.05).Conclusion: 1.The nutritional status of patients with digestive system malignancy was mostly poor at the time of admission,and the incidence of nutritional risk was high.2.In the nutritional risk patients,given standardized nutritional support can significantly shorten the postoperative hospital stay,reduce the incidence of total complications and the incidence of infectious complications.