Application of arm circumference to nutritional risk screening among cancer patients
HUANG Xinxin1, YING Yanping1, LU Ting1, XU Yi2
1. Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China; 2. Wuming Hospital Affiliated to Guangxi Medical University, Nanning, Guangxi 530119, China
Abstract：Objective To examine the application of arm circumference to evaluating the nutritional risk among cancer patients, so as to provide insights into nutritional risk screening among cancer patients. Methods Totally 332 cancer patients hospitalized in the Department of Oncology of The First Affiliated Hospital of Guangxi Medical University from September 2020 to March 2021 were selected as the study subjects. Subjects'demographic data and disease history were collected, and the height, body weight, arm circumference and serum nutritional indicators were measured. The indicators related to nutritional risk were identified by logistic regression models. The value of arm circumference in assessment of nutritional risk was examined among cancer patients using the receiver operating characteristic ( ROC ) curve analysis, and the Nutritional Risk Screening ( NRS 2002 ) scores were used as the gold standard. Results The subjects included 188 males ( 56.63% ) and 144 females ( 43.37% ), and had a mean age of ( 51.62±12.31 ) years. The detection rate of nutritional risk was 36.75% among the subjects according to NRS 2002, with 29.78% in males and 45.83% in females. Multivariable logistic regression analysis identified arm circumference as an independent factor affecting the nutritional risk among cancer patients ( P<0.05 ). The area under the ROC curve, cut-off, sensitivity and specificity of arm circumference in predicting nutritional risk were 0.857 ( 95%CI: 0.795-0.918, P<0.001 ), 24.4 cm, 83.3% and 78.6% among male cancer patients, and 0.727 ( 95%CI: 0.643-0.810, P<0.001 ), 23.9 cm, 78.2% and 57.6% among female cancer patients, respectively. Conclusions Arm circumference is feasible for screening nutritional risk among cancer patients. The cut-off value of nutritional risk was determined by arm circumference less than 24.4 cm in men and less than 23.9 cm in women with good accuracy.
[1] SUO J J,SUN Y,XIU W G,et al.Knowledge difference of tumor nutrition risk among thoracic cancer patients,their family members,physicians,and nurses[J/OL].J Cancer Educ(2020-08-03)[2022-02-18].https://doi.org/10.1007/s13187-020-01841-y. [2] TRESTINI I,SPERDUTI I,SPOSITO M,et al.Evaluation of nutritional status in non-small-cell lung cancer:screening,assessment and correlation with treatment outcome[J].ESMO Open,2020,5(3):1-9. [3] TSAI H J,CHANG F K.Associations between body mass index,mid-arm circumference,calf circumference,and functional ability over time in an elderly Taiwanese population[J/OL].PLoS One,2017,12(2017-04-11)[2022-02-18].https://doi.org/10.1371/journal.pone.0175062. [4] RYAN A M,POWER D G,DALY L,et al.Cancer-associated malnutrition,cachexia and sarcopenia:the skeleton in the hospital closet 40 years later[J].Proc Nutr Soc,2016,75(2):199-211. [5] WANG J,YU B,YE Y,et al.Predictive value of nutritional risk screening 2002 and prognostic nutritional index for esophageal cancer patients undergoing definitive radiochemotherapy[J].Nutr Cancer,2018,70(6):879-885. [6] 朱明炜,韦军民,陈伟,等.恶性肿瘤患者住院期间营养风险变化的动态调查[J].中华医学杂志,2018,98(14):1093-1098. ZHU M W,WEI J M,CHEN W,et al.Dynamic investigation of nutritional risk in patients with malignant tumor during hospitalization[J].Natl Med J China,2018,98(14):1093-1098. [7] KONDRUP J,RASMUSSEN H H,HAMBERG O,et al.Nutritional risk screening(NRS 2002):a new method based on an analysis of controlled clinical trials[J].Clin Nutr,2003,22(3):321-336. [8] SANSON G,BERTOCCHI L,DAL BO E,et al.Identifying reliable predictors of protein-energy malnutrition in hospitalized frail older adults:a prospective longitudinal study[J].Int J Nurs Stud,2018,82:40-48. [9] 中华人民共和国卫生部.中国成人超重和肥胖症预防控制指南[M].北京:人民卫生出版社,2006. Ministry of Health of the People's Republic of China.Guidelines for the prevention and control of overweight and obesity in adults in China[M].Beijing:People's Medical Publishing House,2006. [10] HAUNER H,KOCSIS A,JAECKEL B,et al.Prevalence of malnutrition risk in patients of cancer outpatient clinics-a cross-sectional survey[J].Dtsch Med Wochenschr,2020,145(1):1-9. [11] ZHAO X H,YANG T,MA X D,et al.Heterogeneity of nutrition care procedures in nutrition guidelines for cancer patients[J].Clin Nutr,2020,39(6):1692-1704. [12] NORAZMAN C W,ADZNAM S N A,JAMALUDDIN R.Malnutrition as key predictor of physical frailty among Malaysian older adults[J/OL].Nutrients,2020,12(6)[2022-02-18].https://doi.org/10.3390/nu12061713. [13] ORELL-KOTIKANGAS H,ÖSTERLUND P,SAARILAHTI K,et al.NRS-2002 for pre-treatment nutritional risk screening and nutritional status assessment in head and neck cancer patients[J].Support Care Cancer,2015,23(6):1495-1502. [14] SISAY B G,HASSEN H Y,GEBREYESUS S H.Diagnostic performance of mid-upper arm circumference to identify overweight and obesity in children and adolescents:a protocol for a systematic review and meta-analysis[J].BMJ Open,2021,11(3):1-5. [15] MIELE M J,SOUZA R T,CALDERON I,et al.Proposal of MUAC as a fast tool to monitor pregnancy nutritional status:results from a cohort study in Brazil[J].BMJ Open,2021,11(5):1-11. [16] DAS P,KHATUN A,BOSE K,et al.The validity of mid-upper arm circumference as an indicator of low BMI in population screening for undernutrition:a study among adult slum dwellers in eastern India[J].Public Health Nutr,2018,21(14):2575-2583. [17] SULTANA T,KARIM M N,AHMED T,et al.Assessment of under nutrition of Bangladeshi adults using anthropometry:can body mass index be replaced by mid-upper-arm-circumference?[J/OL].PLoS One,2015,10(4)[2022-02-18].https://doi.org/10.1371/journal.pone.0121456.
