Comparison of Nutritional Screening Tools in Patients Undergoing Surgery for Gastric Cancer


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Yildirim R., Candaş Altınbaş B. , Usta M. A. , Erkul O. , Türkyılmaz S. , Güner A.

HASEKI TIP BULTENI-MEDICAL BULLETIN OF HASEKI, vol.58, no.2, pp.153-161, 2020 (Journal Indexed in ESCI) identifier identifier

  • Publication Type: Article / Article
  • Volume: 58 Issue: 2
  • Publication Date: 2020
  • Doi Number: 10.4274/haseki.galenos.2020.5779
  • Title of Journal : HASEKI TIP BULTENI-MEDICAL BULLETIN OF HASEKI
  • Page Numbers: pp.153-161
  • Keywords: Nutritional assessment, nutritional screening tools, malnutrition, stomach neoplasms, surgical procedure, SUBJECTIVE GLOBAL ASSESSMENT, NRS 2002, RISK, NRS-2002, MALNUTRITION, GUIDELINES, VALIDITY, OUTCOMES, SUPPORT

Abstract

Aim: Nutritional screening tools are mainly used to identify patients at risk of malnutrition. We aimed to compare commonly used nutritional tools in assessing the nutritional status of patients undergoing surgery for gastric cancer Methods: Consecutive patients undergoing surgery for gastric cancer between January 2017 and May 2019 were retrospectively evaluated from the comprehensive database. Nutritional Risk Screening-2002 (NRS), Malnutrition Universal Screening Tool, Subjective Global Assessment, Mini Nutritional AssessmentShort Form (MNA-SF), Malnutrition Screening Tool, and Short Nutritional Assessment Questionnaire scores were calculated for all patients. The assessment capabilities of these tools were compared using the European Society for Clinical Nutrition and Metabolism (ESPEN) diagnostic criteria for malnutrition as the reference standard. The distinctive abilities of the tool risk groups were also evaluated using parameters reflecting nutritional status, including albumin, lymphocyte count, and fat-free mass index. Results: One hundred forty patients with the mean age of 64.2±11.8 years were analyzed, and 29 (20.71%) of whom were diagnosed as malnourished based on the ESPEN criteria. The strongest association (phi=0.62, large effect) and the highest agreement (kappa=0.59, moderate agreement) between tools and malnutrition were found for MNA-SF. This exhibited the highest specificity (0.84, 95% CI: 0.76 to 0.90), positive predictive value (0.58, 95% CI: 0.42 to 0.73), accuracy (0.84, 95% CI: 0.77 to 0.90), area under curve (0.850, 95% CI: 0.777 to 0.923), and diagnostic odds ratio (32.29, 95% CI: 10.02 to 104.04). Statistically significant decreases in all three parameters were observed only for the NRS risk groups. Additionally, MNASF exhibited a statistically significant decrease in the fat-free mass index (-1.60, 95% CI: -2.49 to -0.71) between low- and high-risk groups. Conclusion: Although all the tools analyzed were effective to a certain extent, MNA-SF, designed as a screening and assessment tool, was the most effective tool for assessing nutritional status based on the ESPEN malnutrition criteria in patients undergoing surgery for gastric cancer. Keywords: Nutritional assessment, nutritional screening tools, malnutrition, stomach neoplasms, surgical procedure