Relation of Malnutrition and Nosocomical Infections in Cancer Patients in Hospital: An Observational Study

Abstract

Aim. To investigate the relation between malnutrition and nosocomial infections (NI) in hospitalized cancer patients. Methods. This observational, cross-sectional, noninterventional, descriptive study was conducted in a 500-bed university hospital in Valencia (Spain). Adult cancer patients admitted to the oncology ward were consecutively enrolled regardless of their nutritional status between November 2019 and March 2020. Patients were nutritionally assessed 24 to 48 hours after admission. Body weight, height and BMI, body composition through measurement of bioelectrical impedance analysis (BIA), and muscle strength and functionality using hand grip strength (HGS) were prospectively collected. The diagnosis of malnutrition and sarcopenia was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and the European Working Group on Sarcopenia in Older People (EWGSOP) criteria, respectively. Patients were followed up during their hospital stay or outpatient oncology visits to identify possible NI. Results. A total of 107 patients were included in this study (mean age 66 years; 66.4% were men). The most frequent reason for admission was cancer treatment (19.6%), followed by infections (18.7%) and digestive tract symptoms (18.7%). Overall, 77.5% (83/107) of the patients were malnourished at admission according to the GLIM criteria, while 52.3% (56/107) were sarcopenic. Nosocomial infections (NI) were significantly more frequent in malnourished (52.1%; 25/48) and severely malnourished (42.1%; 8/19) patients, compared with well-nourished patients without malnutrition (25%; 10/40; p = 0.035 ). The mean length of hospital stay was 13.9 days, significantly longer in patients with an NI compared to those without infections (18.6 vs. 10.8 days, p < 0.024 ). Conclusion. This study evidenced the need to implement a routine protocol for the nutritional assessment and support of cancer patients at risk of malnutrition and sarcopenia to reduce the risk of NI during their hospital stay.

Association between Controlling Nutritional Status (CONUT) Score and Body Composition, Inflammation and Frailty in Hospitalized Elderly Patients

“…The exclusion criteria were active cancer and acute infection or sepsis. Patients were divided into three groups based on CONUT scores: Normal (0-1), Mild (2)(3)(4), and Moderate/Severe (≥5) [32]. The research received approval from our Institutional Review Board at the Policlinico Foggia and was conducted in adherence to the Declaration of Helsinki.…”

“…Malnutrition, especially among hospitalized older individuals, presents a multifaceted challenge with profound implications for health outcomes [ 1 ]. Beyond its conventional association with weight loss, malnutrition is linked to heightened risks, including nosocomial infections, prolonged hospital stays, disability, and, notably, mortality [ 2 , 3 , 4 , 5 ]. This intricate scenario is further complicated by inflammaging, a pro-inflammatory status associated with aging and shared in numerous pathological states [ 6 , 7 ].…”

“…Baseline characteristics of the patients according to Normal (0-1), Mild(2)(3)(4), or Moderate/Severe (≥5) CONUT score.…”

Caloric restriction and fasting-mimicking diets in the treatment of cancer patients

“…Enrolling 107 adult patients admitted consecutively to an oncology ward, 73% were diagnosed according to GLIM criteria [40] to be malnourished, including 55% with severe malnutrition. Nosocomial infections were twice as frequent when malnutrition was present (49 vs. 25%) [41 ▪ ]. In a large international, multicenter, prospective cohort study of patients undergoing elective surgery for colorectal or gastric cancer, severe malnutrition according to GLIM [40] was present in 33% of patients and was associated with a significant increase in surgical site infections and a doubling of 30-day mortality risk [42 ▪ ].…”