Nutritional Assessment in Cancer: Comparing the Mini-Nutritional Assessment (MNA) With the Scored Patient-Generated Subjective Global Assessment (PGSGA)

Abstract

The evaluation of nutritional status in cancer patients is often neglected in spite of the fact that poor nutritional status may adversely affect prognosis and treatment tolerance. In day-to-day oncology practice, a sensitive but simply applied nutritional assessment tool is needed to identify at-risk patients. Several tools exist; however, none has been universally accepted. The aim of this study was to compare two potential tools, the Mini-Nutritional Assessment (MNA) and the scored Patient Generated Subjective Global Assessment (PGSGA). The MNA is more simply applied and does not require a trained dietitian. The PGSGA has been previously validated in cancer patients. One hundred fifty-seven newly diagnosed cancer patients were assessed using both tools. Of these, 126 were reassessed at 4-6 wk, and 104 were reassessed at Weeks 8-12 after initial assessment. A significant negative correlation was found between the tools at all three time periods (at baseline r = -0.76; P < 0.001). Taking the PGSGA as the most accepted nutritional assessment tool, at baseline the MNA demonstrated a sensitivity of 97% and specificity of 54%. At 4-6 wk MNA sensitivity was 79% and specificity was 69%. At 8-12 wk MNA sensitivity was 93% and specificity was 82%. When comparing the tools in elderly patients alone (>65 yr), similar results were obtained. Both tools were able to correctly classify patients as malnourished, although the MNA lacks specificity. Therefore, the PGSGA should be the tool of choice for nutritional assessment in cancer patients.

A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation

“…Case series, uncontrolled studies, and articles based on expert opinion alone will receive a level of V. Rationale: There is clear evidence that nutrition screening with appropriate screening tools will identify cancer patients who are malnourished. [26][27][28][29][30][31][32] Among the developed screening tools are the patient generated subjective global assessment (PGSGA), 27,28 the subjective global assessment (SGA), 26,27,30,31 and the nutrition risk index (NRI). 30 They all have validated specificity and sensitivity in cancer patients, have been the subjects of prospective clinical trials, and share an emphasis on clinical data.…”

Nutritional screening tools in daily clinical practice: the focus on cancer

“…Both tools were able to correctly classify patients as malnourished, although the MNA® lacked specificity [49]. This indicates that the MNA® categorizes some patients as requiring nutritional support when actually they do not.…”

“…-Training is required to score the patient-generated section, as well as to complete the clinical assessment portion of the PG-SGA [49,50]; -The SGA does not allow for the categorization of mild malnutrition and focuses on chronic or established rather than on acute nutritional changes [51,52]; -The SGA more accurately identifies established malnutrition. Concerning nutritional risk, its sensitivity is suboptimal [53,54]; -The SGA may just as well represent an index of sickness rather than nutrition [55]; -The PG-SGA includes calculations of percent change in body weight and a nutrition-related physical exam, both of which are time-consuming.…”

“…Although the MNA® and the MNA-SF® tools have been used in oncology patients, there is limited evaluation in the oncology population [49,56,67]. There are a number of questions that relate to dietary intake, but none of them consider nutritional impacts specific to cancer.…”

“…Moreover, there are no intervention guidelines. Furthermore, the sensitivity of the MNA® in analyzing an unintentional weight loss of >10% over 3 months was merely 33% [56], and the positive predictive value in oncology patients was limited, at 59% [49].…”