Skip to main content

Advertisement

SpringerLink
Log in

Prevalence of hospital malnutrition in cancer patients: a sub-analysis of the PREDyCES® study

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

In oncology patients, hospital malnutrition is associated with a greater risk of morbidity and mortality. The objective of this study was to determine the prevalence of nutritional risk and the clinical and economic consequences of hospital malnutrition in oncology patients hospitalised in Spanish centres.

Methods

This was an observational, cross-sectional, multicentre study. The prevalence of nutritional risk was determined using the Nutrition Risk Screening®-2002 (NRS®-2002).

Results

Four hundred one oncology patients were included; 33.9 % (136/401) were at nutritional risk (NRS®-2002 ≥ 3) at admission and 36.4 % (135/371) at discharge. On average, patients at nutritional risk were more elderly and had lower weights, body mass indices and arm and calf circumferences, as well as lower serum albumin levels than patients not at risk. Mean duration of hospitalisation and healthcare costs were greater in patients at nutritional risk at discharge (12.1 days; 95 % confidence interval (CI) 10.83–13.39) than in well-nourished patients (8.6 days; 95 % CI 7.86–9.40). Only a third of the patients at risk of malnutrition at discharge had received any kind of nutritional support.

Conclusions

This study shows that hospital malnutrition is a prevalent and undertreated condition in oncology patients that is associated with longer hospital stays and increased healthcare costs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Norman K, Pichard C, Lochs H, Pirlich M (2008) Prognostic impact of disease-related malnutrition. Clin Nutr 27(1):5–15

    Article  PubMed  Google Scholar 

  2. Correia MI, Hegazi RA, Higashiguchi T, Michel JP, Reddy BR, Tappenden KA, Uyar M, Muscaritoli M (2014) Evidence-based recommendations for addressing malnutrition in health care: an updated strategy from the feedM.E. Global Study Group. J Am Med Dir Assoc 15(8):544–550

    Article  PubMed  Google Scholar 

  3. Kwag SJ, Kim JG, Kang WK, Lee JK, Oh ST (2014) The nutritional risk is an independent factor for postoperative morbidity in surgery for colorectal cancer. Ann Surg Treat Res 86(4):206–211

    Article  PubMed Central  PubMed  Google Scholar 

  4. Yu K, Zhou XR, He SL (2013) A multicentre study to implement nutritional risk screening and evaluate clinical outcome and quality of life in patients with cancer. Eur J Clin Nutr 67(7):732–737

    Article  CAS  PubMed  Google Scholar 

  5. Vashi PG, Gupta D, Lammersfeld CA, Braun DP, Popiel B, Misra S, Brown KC (2013) The relationship between baseline nutritional status with subsequent parenteral nutrition and clinical outcomes in cancer patients undergoing hyperthermic intraperitoneal chemotherapy. Nutr J 12:118

    Article  PubMed Central  PubMed  Google Scholar 

  6. Nitenberg G, Raynard B (2000) Nutritional support of the cancer patient: issues and dilemmas. Crit Rev Oncol Hematol 34(3):137–168

    Article  CAS  PubMed  Google Scholar 

  7. Fiorelli A, Vicidomini G, Mazzella A, Messina G, Milione R, Di Crescenzo VG, Santini M (2014) The influence of body mass index and weight loss on outcome of elderly patients undergoing lung cancer resection. Thorac Cardiovasc Surg 62(7):578–587

    Article  PubMed  Google Scholar 

  8. Rey-Ferro M, Castaño R, Orozco O, Serna A, Moreno A (1997) Nutritional and immunologic evaluation of patients with gastric cancer before and after surgery. Nutrition 13(10):878–881

    Article  CAS  PubMed  Google Scholar 

  9. Gupta D, Lis CG, Granick J, Grutsch JF, Vashi PG, Lammersfeld CA (2006) Malnutrition was associated with poor quality of life in colorectal cancer: a retrospective analysis. J Clin Epidemiol 59(7):704–709

    Article  PubMed  Google Scholar 

  10. Jager-Wittenaar H, Dijkstra PU, Vissink A, van der Laan BF, van Oort RP, Roodenburg JL (2011) Malnutrition and quality of life in patients treated for oral or oropharyngeal cancer. Head Neck 33(4):490–496

    Article  PubMed  Google Scholar 

  11. Lis CG, Gupta D, Lammersfeld CA, Markman M, Vashi PG (2012) Role of nutritional status in predicting quality of life outcomes in cancer—a systematic review of the epidemiological literature. Nutr J 11:27

    Article  PubMed Central  PubMed  Google Scholar 

  12. Ma L, Wu T, Pan J, Kong X, Guo Q, Yang L, Zhang Y, Lin S, Chen C, Huang C (2014) The correlation between the comprehensive nutrition index and quality of life of patients with nasopharyngeal carcinoma treated by intensity-modulated radiotherapy. Nutr Cancer 66(1):152–158

    Article  CAS  PubMed  Google Scholar 

  13. Van Cutsem E, Arends J (2005) The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs 9(Suppl 2):S51–S63

    Article  PubMed  Google Scholar 

  14. Nicolini A, Ferrari P, Masoni MC, Fini M, Pagani S, Giampietro O, Carpi A (2013) Malnutrition, anorexia and cachexia in cancer patients: a mini-review on pathogenesis and treatment. Biomed Pharmacother 67(8):807–817

    Article  CAS  PubMed  Google Scholar 

  15. Von Haehling S, Anker SD (2010) Cachexia as a major underestimated and unmet medical need: facts and numbers. J Cachex Sarcopenia Muscle 1(1):1–5

    Article  Google Scholar 

  16. Tong H, Isenring E, Yates P (2009) The prevalence of nutrition impact symptoms and their relationship to quality of life and clinical outcomes in medical oncology patients. Support Care Cancer 17(1):83–90

    Article  CAS  PubMed  Google Scholar 

  17. Olsson U, Bosaeus I, Svedlund J, Bergbom I (2007) Patients’ subjective symptoms, quality of life and intake of food during the recovery period 3 and 12 months after upper gastrointestinal surgery. Eur J Cancer Care (Engl) 16(1):74–85

    Article  CAS  Google Scholar 

  18. Russi EG, Raber-Durlacher JE, Sonis ST (2014) Local and systemic pathogenesis and consequences of regimen-induced inflammatory responses in patients with head and neck cancer receiving chemoradiation. Mediat Inflamm 2014:518261

    Google Scholar 

  19. Silver HJ, Dietrich MS, Murphy BA (2007) Changes in body mass, energy balance, physical function, and inflammatory state in patients with locally advanced head and neck cancer treated with concurrent chemoradiation after low-dose induction chemotherapy. Head Neck 29(10):893–900

    Article  PubMed  Google Scholar 

  20. Baldwin C, McGough C, Spiro A, Thomas K, Cunningham DC, Andreyev HJN (2009) Nutritional and clinical characteristics of patients with gastrointestinal tract (GI) cancers at presentation. Proceedings of the Nutrition Society 68(OCE1)

  21. Andreyev HJ, Norman AR, Oates J, Cunningham D (1998) Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer 34(4):503–509

    Article  CAS  PubMed  Google Scholar 

  22. Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, Cohen MH, Douglass Jr HO, Engstrom PF, Ezdinli EZ, Horton J, Johnson GJ, Moertel CG, Oken MM, Perlia C, Rosenbaum C, Silverstein MN, Skeel RT, Sponzo RW, Tormey DC (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 69(4):491–497

    Article  CAS  PubMed  Google Scholar 

  23. Segura A, Pardo J, Jara C, Zugazabeitia L, Carulla J, de Las PR, García-Cabrera E, Luz Azuara M, Casadó J, Gómez-Candela C (2005) An epidemiological evaluation of the prevalence of malnutrition in Spanish patients with locally advanced or metastatic cancer. Clin Nutr 24(5):801–814

    Article  PubMed  Google Scholar 

  24. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M (2003) Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr 22(4):415–421

    Article  CAS  PubMed  Google Scholar 

  25. Álvarez-Hernández J, Planas Vila M, León-Sanz M, García de Lorenzo A, Celaya-Pérez S, García-Lorda P, Araujo K, Sarto Guerri B (2012) PREDyCES researchers. Prevalence and costs of malnutrition in hospitalized patients; the PREDyCES study. Nutr Hosp 27(4):1049–1059

    PubMed  Google Scholar 

  26. Planas Vila M, Álvarez Hernández J, García de Lorenzo A, Celaya Pérez S, León Sanz M, García-Lorda P, Brosa M (2010) The burden of hospital malnutrition in Spain: methods and development of the PREDyCES® study. Nutr Hosp 25(6):1020–1024

    CAS  PubMed  Google Scholar 

  27. Olivares J, Ayala L, Salas-Salvadó J, Muñiz MJ, Gamundí A, Martínez-Indart L, Masmiquel LL (2014) Assessment of risk factors and test performance on malnutrition prevalence at admission using four different screening tools. Nutr Hosp 29(3):674–680

    PubMed  Google Scholar 

  28. Mercadal-Orfila G, Lluch-Taltavull J, Campillo-Artero C, Torrent-Quetglas M (2012) Association between nutritional risk based on the NRS-2002 test and hospital morbidity and mortality. Nutr Hosp 27(4):1248–1254

    CAS  PubMed  Google Scholar 

  29. Velasco C, García E, Rodríguez V, Frias L, Garriga R, Alvarez J, García-Peris P, León M (2011) Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study. Eur J Clin Nutr 65(2):269–274

    Article  CAS  PubMed  Google Scholar 

  30. Gur AS, Atahan K, Aladag I, Durak E, Cokmez A, Tarcan E, Tavusbay C (2009) The efficacy of Nutrition Risk Screening-2002 (NRS-2002) to decide on the nutritional support in general surgery patients. Bratisl Lek Listy 110(5):290–292

    PubMed  Google Scholar 

  31. Bozzetti F, Mariani L, Lo Vullo S, SCRINIO Working Group, Amerio ML, Biffi R, Caccialanza G, Capuano G, Correja I, Cozzaglio L, Di Leo A, Di Cosmo L, Finocchiaro C, Gavazzi C, Giannoni A, Magnanini P, Mantovani G, Pellegrini M, Rovera L, Sandri G, Tinivella M, Vigevani E (2012) The nutritional risk in oncology: a study of 1,453 cancer outpatients. Support Care Cancer 20(8):1919–1928

    Article  PubMed Central  PubMed  Google Scholar 

  32. Gheorghe C, Pascu O, Iacob R, Vadan R, Iacob S, Goldis A, Tantau M, Dumitru E, Dobru D, Miutescu E, Saftoiu A, Fraticiu A, Tomescu D, Gheorghe L (2013) Nutritional risk screening and prevalence of malnutrition on admission to gastroenterology departments: a multicentric study. Chirurgia (Bucur) 108(4):535–541

    CAS  Google Scholar 

  33. Alvarez-Altamirano K, Delgadillo T, García-García A, Alatriste-Ortiz G, Fuchs-Tarlovsky V (2014) Prevalence of nutritional risk evaluated with nrs-2002 in Mexican oncology population. Nutr Hosp 30(1):173–178

    PubMed  Google Scholar 

  34. Illa P, Tomíšková M, Skřičková J (2014) Screening of malnutrition risk versus indicators of nutritional status and systemic inflammatory response in newly diagnosed lung cancer patients]. Klin Onkol 27(4):261–268

    Article  CAS  PubMed  Google Scholar 

  35. Tangvik RJ, Tell GS, Guttormsen AB, Eisman JA, Henriksen A, Nilsen RM, Ranhoff AH (2014) Nutritional risk profile in a university hospital population. Clin Nutr S0261-5614(14)00205-00202. doi:10.1016/j.clnu.2014.08.001

  36. Freijer K, Bours MJ, Nuijten MJ, Poley MJ, Meijers JM, Halfens RJ, Schols JM (2014) The economic value of enteral medical nutrition in the management of disease-related malnutrition: a systematic review. J Am Med Dir Assoc 15(1):17–29

    Article  PubMed  Google Scholar 

  37. Arends J, Bodoky G, Bozzetti F, Fearon K, Muscaritoli M, Selga G, van Bokhorst-de van der Schueren MA, von Meyenfeldt M, DGEM (German Society for Nutritional Medicine), Zürcher G, Fietkau R, Aulbert E, Frick B, Holm M, Kneba M, Mestrom HJ, Zander A (2006) ESPEN (European Society for Parenteral and Enteral Nutrition). ESPEN guidelines on enteral nutrition: non-surgical oncology. Clin Nutr 25(2):245–259

    Article  CAS  PubMed  Google Scholar 

  38. Bozzetti F, Arends J, Lundholm K, Micklewright A, Zurcher G, Muscaritoli M, ESPEN (2009) ESPEN guidelines on parenteral nutrition: non-surgical oncology. Clin Nutr 28(4):445–454

    Article  CAS  PubMed  Google Scholar 

  39. Bosch R, García A, Mañas A (2008) Guía clínica multidisciplinar sobre el manejo de la nutrición en el paciente con cáncer. http://www.oncologiaynutricion.com/archivos/pubs/libroconsenso.pdf. Accessed: 18 Mar 2015

  40. Platek ME, Popp JV, Possinger CS, Denysschen CA, Horvath P, Brown JK (2011) Comparison of the prevalence of malnutrition diagnosis in head and neck, gastrointestinal, and lung cancer patients by 3 classification methods. Cancer Nurs 34(5):410–416

    Article  PubMed Central  PubMed  Google Scholar 

  41. Pressoir M, Desné S, Berchery D, Rossignol G, Poiree B, Meslier M, Traversier S, Vittot M, Simon M, Gekiere JP, Meuric J, Serot F, Falewee MN, Rodrigues I, Senesse P, Vasson MP, Chelle F, Maget B, Antoun S, Bachmann P (2010) Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer 102(6):966–971

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  42. Amaral TF, Antunes A, Cabral S, Alves P, Kent-Smith L (2008) An evaluation of three nutritional screening tools in a Portuguese oncology centre. J Hum Nutr Diet 21(6):575–583

    Article  CAS  PubMed  Google Scholar 

  43. Gavazzi C, Colatruglio S, Sironi A, Mazzaferro V, Miceli R (2011) Importance of early nutritional screening in patients with gastric cancer. Br J Nutr 106(12):1773–1778

    Article  CAS  PubMed  Google Scholar 

  44. Takahashi H, Chiba T, Tairabune T, Kimura Y, Wakabayashi G, Takahashi K, Kudo K (2014) A retrospective study on the influence of nutritional status on pain management in cancer patients using the transdermal fentanyl patch. Biol Pharm Bull 37(5):853–857

    Article  CAS  PubMed  Google Scholar 

  45. Isenring EA, Capra S, Bauer JD (2004) Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer 91(3):447–452

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  46. Moreland SS (2012) Nutrition screening and counseling in patients with lung cancer in an outpatient setting. J Adv Pract Oncol 3(3):191–193

    PubMed Central  PubMed  Google Scholar 

  47. Tan CR, Yaffee PM, Jamil LH, Lo SK, Nissen N, Pandol SJ, Tuli R, Hendifar AE (2014) Pancreatic cancer cachexia: a review of mechanisms and therapeutics. Front Physiol 5:88

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the economic support provided by Nestlé Health Science for the conduct of this study and the technical support provided by Oblikue Consulting in the analysis of results and drafting of this manuscript. The authors also thank all the investigators who participated in the PREDyCES® study for their kind collaboration.

Compliance with ethical standards

Funding

This study was sponsored by the Spanish Society for Parenteral and Enteral Nutrition (SENPE), with the technical support and funding from Nestlé Health Science.

Conflict of interest

The authors declare that the funding provider was not involved in analysing the results and preparing the conclusions of this study, and that no conflict of interest exists with the aforementioned organisations.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Author information

Authors and Affiliations

  1. Escola de Ciències de la Salut, Universitat de Vic, Avenida Mare de Deu de Montserrat, número 10, 6 piso, puerta 3, 08024, Barcelona, Spain

    Mercè Planas

  2. Hospital Universitario Príncipe de Asturias, Madrid, Spain

    Julia Álvarez-Hernández

  3. Clinical Nutrition Unit, Hospital Universitario 12 de Octubre, Madrid, Spain

    Miguel León-Sanz

  4. Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain

    Sebastián Celaya-Pérez

  5. Medical Affairs, Nestlé HealthScience, Barcelona, Spain

    Krysmarú Araujo

  6. Hospital Universitario La Paz, Madrid, Spain

    Abelardo García de Lorenzo

Authors
  1. Mercè Planas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julia Álvarez-Hernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miguel León-Sanz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sebastián Celaya-Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Krysmarú Araujo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Abelardo García de Lorenzo
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the PREDyCES® researchers

Corresponding author

Correspondence to Mercè Planas.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Planas, M., Álvarez-Hernández, J., León-Sanz, M. et al. Prevalence of hospital malnutrition in cancer patients: a sub-analysis of the PREDyCES® study. Support Care Cancer 24, 429–435 (2016). https://doi.org/10.1007/s00520-015-2813-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-015-2813-7

Keywords

Search

Navigation