Skeletal muscle function was studied in 10 malnourished patients with various gastrointestinal disorders and in 22 normal subjects. The function of the adductor pollicis muscle was assessed by electrical stimulation of the ulnar nerve. The objective parameters of muscle function measured were: 1) Force of contraction expressed as a percentage of the maximal force obtained with electrical stimulation at 10, 20, 30, 50 and 100 Hz. 2) Maximal relaxation rate expressed as percentage force loss/!10 ms. 3) Endurance expressed as percentage force loss/30 s. The force of contraction at 10 Hz was higher in malnourished patients compared with normal subjects, with a mean +/- SEM (n) of 43.0 +/- 4.2% (n = 10) and 28.8 +/- 1.2% (n = 22), respectively, (p less than 0.001). The maximal relaxation rate was slower in patients compared with normals with a mean +/- SEM (n) of 7.2 +/- 0.4% (n = 9) ad 9.6 +/- 0.2% (n = 22), respectively, (p less than 0.001). Muscle endurance testing showed an increased force loss with prolonged tetanic stimulation in patients compared with normals, with a mean +/- SEM (n) of 29.1 +/- 4.0% (n = 7) and 3.5 +/- 0.8% (n = 22), respectively, (p less than 0.001). Four patients were restudied after a 4-wk period of total parenteral nutrition, with a significant improvement in muscle function parameters. Malnutrition results in both increased muscle fatiguability and an altered pattern of muscle contraction and relaxation which are reversible by nutritional supplementation. This technique promises to be valuable in assessing the functional effects of malnutrition and the response to nutritional support.

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In addition to evaluating nutritional status, the PG-SGA is directly related with survival in terminal cancer patients. The use of this tool in the studied population is of paramount importance to provide individualised and adequate support for these patients.

Context and objective: Palliative care aims at promoting quality of life, symptoms management and alleviating suffering. Nutrition plays an important role in the early identification of these symptoms by the use of tools such as Patient-Generated Subjective Global Assessment (PG-SGA). The objective of the study is to describe the nutritional status and the prevalence of symptoms using PG-SGA on palliative care patients. We also correlate PG-SGA with clinical characteristics and functional status. Method: A cross-sectional study was conducted in patients followed at the palliative care outpatient clinic from May 2009 through May 2015. On admission, the PG-SGA was filled out and the Karnofsky Performance Scale (KPS) was obtained. Correlation between PG-SGA and KPS was performed by statistical inference and analysis of variance. Results: 104 patients were included in the analysis. Most of the patients were classified as moderately or severely malnourished and had a score greater than or equal to 9. Tumor sites with the highest frequency of severe malnutrition were pulmonary and colorectal. The most prevalent nutritional symptoms were hyporexia, constipation, nausea, pain, and early satiety. The KPS had a statistically significant association with the PG-SGA. Most patients with KPS≤40% were classified as PG-SGA-C (p=0.002) and patients with KPS≥70% were PG-SGA A or B (90%). Patients with a numerical score greater than or equal to 9 had a lower KPS mean (p <0.001). Conclusion: PG-SGA should be used to evaluate the nutritional status of patients in palliative care. We could strongly correlate the PG-SGA with KPS. Such information helps to guide the best intervention on symptom management, considering that the primary goal of palliative care is to promote quality of life.

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