Nutritional assesment instrument based on risk factors for malnutrition among Chinese patients with Nasopharyngeal carcinoma

Malnutrition is common among nasopharyngeal carcinoma (NPC) patients, and it can lead to poor clinical outcomes. However, there is no accepted gold standard for assessing malnutrition. Moreover, commonly used malnutrition assessment tools have their limitations. Therefore, a study was conducted to address these gaps. The study was conducted in multiple stages. (i) 668 NPC patients were enrolled and randomly divided into a training set and a test set. Univariate and multivariate logistic regression analyses were performed in the training set to identify risk factors for malnutrition. Based on these risk factors, a new instrument was developed. The new instrument was divided into two forms based on prealbumin (PA) inclusion: the initial nutritional assessment tool (INA) and the final nutritional assessment tool (FNA). The new instrument was evaluated in the training set and internally validated in the test set. (ii) An external validation of the new instrument was conducted with 262 NPC patients from another hospital. (iii) The new instrument was compared with existing tools, including the Patient-Generated Subjective Global Assessment (PG-SGA), the Mini Nutritional Assessment (MNA), and the Global Leadership Initiative on Malnutrition (GLIM). (iv) To validate the clinical application effectiveness of the new instrument, 195 NPC patients were recruited and randomized into three groups: the FNA group, the PG-SGA group, and the GLIM group. Each tool was applied to each group for 7 weeks. The results revealed that (i) older age, tumour stage IV, the number of completed chemotherapy cycles ≥1, the number of radiation treatments completed ≥1, low body mass index (BMI), loss of appetite, and PA ≤ 250 mg/l were risk factors for malnutrition. After the evaluation, the areas under the receiver operating characteristic curve (AUC) were 0.910 for INA and 0.918 for FNA. Both tools showed good calibration. After internal validation, the results indicated that the AUC were 0.899 for INA and 0.906 for FNA. Calibration for both tools remained robust in the test set. (ii) After external validation, the results revealed AUC of 0.836 for INA and 0.849 for FNA. Furthermore, both tools demonstrated reliable calibration. (iii) After comparison with other tools, the results showed that the assessment times of both INA and FNA were shorter than those of the PG-SGA and MNA, and not longer than that of the GLIM. Additionally, the INA and FNA had higher AUC, sensitivity, and specificity than those of the MNA and GLIM. (iv) After clinical application, the results indicated no significant statistical differences in outcomes between the FNA and PG-SGA groups. However, BMI, weight, calf circumference, handgrip strength, and haemoglobin were higher in both the FNA and the PG-SGA groups than in the GLIM group. Additionally, PG-SGA scores and the prevalence of severe malnutrition were higher in the GLIM group than in the FNA and PG-SGA groups. In conclusion, the new instrument has good discrimination and calibration, high efficiency and accuracy, and good clinical application effectiveness, but further validation is needed before it can be used as a tool for assessing malnutrition in NPC patients.

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