Low BMI Demonstrates Satisfactory Specificity for Diagnosing Malnutrition and is Associated with Longer Hospitalization in Patients with Gastrointestinal or Head and Neck Cancer: A Prospective Cohort Study

Abstract

Purpose Few studies have evaluated the individual performance of the nutritional indicators body mass index (BMI), calf circumference (CC), and handgrip strength (HGS) for the diagnosis of malnutrition in the cancer setting. We aimed to evaluate the ability of these nutritional indicators to accurately diagnose malnutrition and their association with hospital length of stay (LOS) in patients with cancer. Methods This cohort study prospectively evaluated 171 patients with gastrointestinal or head and neck cancer. Nutritional status was assessed within 48 hours of hospital admission using BMI, CC, and HGS as well as 2 reference standards: Subjective Global Assessment (SGA) and Patient-Generated SGA (PG-SGA). The accuracy of each nutritional indicator was measured by the area under the receiver operating characteristic curve (AUC), compared with the reference standards. Multiple logistic regression analysis, adjusted for confounders, was used to determine whether malnutrition was associated with LOS. Results Of 171 patients, 59.1% had low CC, 46.2% had low HGS, and 13.5% had low BMI. The SGA and PG-SGA scores indicated malnutrition in 57.3% and 87.1% of patients, respectively. All nutritional indicators had poor accuracy in diagnosing malnutrition (AUC < 0.70). However, compared with SGA and PG-SGA, low BMI had satisfactory specificity (> 80%) and was associated with 1.79 times higher odds of LOS ≥ 6 days. Malnutrition diagnosed by SGA and PG-SGA increased the odds of LOS ≥ 6 days by 3.60-fold and 2.78-fold, respectively. Conclusion Low BMI showed adequate specificity for diagnosing malnutrition and was associated with longer LOS in patients with gastrointestinal or head and neck cancer.