Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study

Maurizio Muscaritoli, Simone Lucia, Alessio Farcomeni, Vito Lorusso, Valeria Saracino, Carlo Barone, Francesca Plastino, Stefania Gori, Roberto Magarotto, Giacomo Carteni, Bruno Chiurazzi, Ida Pavese, Luca Marchetti, Vittorina Zagonel, Eleonora Bergo, Giuseppe Tonini, Marco Imperatori, Carmelo Iacono, Luigi Maiorana, Carmine Pinto, Daniela Rubino, Luigi Cavanna, Roberto Di Cicilia, Teresa Gamucci, Silvia Quadrini, Salvatore Palazzo, Stefano Minardi, Marco Merlano, Giuseppe Colucci, Paolo Marchetti, PreMiO Study Group, Maurizio Muscaritoli, Simone Lucia, Alessio Farcomeni, Vito Lorusso, Valeria Saracino, Carlo Barone, Francesca Plastino, Stefania Gori, Roberto Magarotto, Giacomo Carteni, Bruno Chiurazzi, Ida Pavese, Luca Marchetti, Vittorina Zagonel, Eleonora Bergo, Giuseppe Tonini, Marco Imperatori, Carmelo Iacono, Luigi Maiorana, Carmine Pinto, Daniela Rubino, Luigi Cavanna, Roberto Di Cicilia, Teresa Gamucci, Silvia Quadrini, Salvatore Palazzo, Stefano Minardi, Marco Merlano, Giuseppe Colucci, Paolo Marchetti, PreMiO Study Group

Abstract

Background: In cancer patients, malnutrition is associated with treatment toxicity, complications, reduced physical functioning, and decreased survival. The Prevalence of Malnutrition in Oncology (PreMiO) study identified malnutrition or its risk among cancer patients making their first medical oncology visit. Innovatively, oncologists, not nutritionists, evaluated the nutritional status of the patients in this study.

Methods: PreMiO was a prospective, observational study conducted at 22 medical oncology centers across Italy. For inclusion, adult patients (>18 years) had a solid tumor diagnosis, were treatment-naive, and had a life expectancy >3 months. Malnutrition was identified by the Mini Nutritional Assessment (MNA), appetite status with a visual analog scale (VAS), and appetite loss with a modified version of Anorexia-Cachexia Subscale (AC/S-12) of the Functional Assessment of Anorexia-Cachexia Therapy (FAACT).

Findings: Of patients enrolled (N=1,952), 51% had nutritional impairment; 9% were overtly malnourished, and 43% were at risk for malnutrition. Severity of malnutrition was positively correlated with the stage of cancer. Over 40% of patients were experiencing anorexia, as reported in the VAS and FAACT questionnaire. During the prior six months, 64% of patients lost weight (1-10 kg).

Interpretation: Malnutrition, anorexia, and weight loss are common in cancer patients, even at their first visit to a medical oncology center.

Keywords: cachexia; cancer; malnutrition; oncology; sarcopenia.

Conflict of interest statement

CONFLICTS OF INTEREST None of the authors declares any conflict of interest which might have interfered with conducting the present study and with the interpretation of the results.

Figures

Figure 1. Causes and consequences of malnutrition…
Figure 1. Causes and consequences of malnutrition in cancer: anorexia, cachexia, and sarcopenia
Figure 2
Figure 2
PreMiO patients with malnutrition or malnutrition risk using MNA scoring with results shown by tumor stage and for all tumors (A) as well as classified in M0 and M1 groups (B) (N=1925). P<0.001 among cancer stage groups. Malnutrition was defined as MNA score <17, while risk of malnutrition was represented by MNA scores of 17 to 23.5. M0 = stage I-III, M1 = stage IV.
Figure 3. Prevalence of overt malnutrition by…
Figure 3. Prevalence of overt malnutrition by cancer site (% of patients with specified tumor type), with malnutrition defined as MNA score N=1925)
M0 = stage I-III, M1 = stage IV. P<0.001 among cancer site groups.
Figure 4. Prevalence of cachexia by primary…
Figure 4. Prevalence of cachexia by primary tumor type in the study population (N=1952)
Cachexia is defined by weight loss >5% or by the dual criteria of BMI P<0.001 among cancer site groups.
Figure 5. Prevalence of pre-cachexia by cancer…
Figure 5. Prevalence of pre-cachexia by cancer site, as determined by percent of patients with unintentional weight loss up to 5% during prior 6 months, along with chronic systemic inflammation and anorexia-related symptoms (N=1085)
M0 = stage I-III, M1 = stage IV. P<0.05 among cancer site groups.
Figure 6. Prevalence of systemic inflammation by…
Figure 6. Prevalence of systemic inflammation by cancer site, as determined by % patients with elevated blood levels of C-reactive protein (N=1087)
M0 = stage I-III, M1 = stage IV. P<0.001 among cancer site groups.

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