Validation of a Nutrition Alert Form (NAF) against Patient-Generated Subjective Global Assessment (PG-SGA) in Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma
Keywords:Cancer, Nutrition screening, Nutrition assessment, Malnutrition, Head and Neck cancer
Malnutrition is an under-recognized problem among oncological patients. However, there are no nutritional assessment tools that are easy to use and provide accurate results in time-limited settings. This study aimed to validate a Nutrition Alert Form (NAF) versus the Patient-Generated Subjective Global Assessment (PG-SGA) among patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC), as well as to determine the relationships between nutritional status and clinical outcomes. We prospectively enrolled 110 LA-HNSCC patients (77.3% males) who underwent chemoradiotherapy in the nutrition clinic at our institution. Nutritional status was assessed using both PG-SGA and NAF at the same timepoints. Body composition was determined by multifrequency bioelectrical impedance analysis. A total of 92.7% and 91.8% of patients were malnourished according to PG-SGA and NAF, respectively. NAF had a sensitivity of 97% and specificity of 75% versus PG-SGA. The agreement between the two assessment tools was moderate but significant (kappa = 0.59, P < 0.001). Dietitians completed NAF significantly faster than PG-SGA (3.6±1.3 vs. 16.4±3.3 min, P < 0.001). The NAF score correlated highly with the PG-SGA score (r = 0.80, P < 0.001). The NAF score and PG-SGA score were negatively associated with fat mass and skeletal muscle mass (P < 0.03 for all parameters). The NAF score correlated significantly with the PG-SGA score in terms of assessing nutritional status among oncological patients with high sensitivity and specificity. Given the simplicity and convenience of NAF compared to PG-SGA, the NAF tool should be an alternative nutrition assessment tool among oncological patients during routine clinical practice, particularly in time-limited settings.
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