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Nutrition Risk Screening 2002 for Adult Cancer Patients: A Systematic Review and Meta-Analysis

Wang P, Tan Y, Soh KL, Soh KG, Ning C, Xue L, et al.

Nutr Cancer, 2024;76(7):573-583.
PMID: 38757365 DOI: 10.1080/01635581.2024.2352901

It is critical to screen and assess malnutrition in cancer patients early. However, there is no uniform standard for nutritional risk screening and malnutrition assessment. We aimed to analyze the effects of the Nutrition Risk Screening 2002 (NRS2002) in screening for nutritional risk among adult cancer patients, using the Patient-Generated Subjective Global Assessment (PG-SGA) as the reference standard. A systematic search was performed using PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and China Science and Technology Journal Database (VIP). Studies comparing NRS2002 with PG-SGA in adult cancer patients were included. To assess the quality of the included studies, the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used. The combined sensitivity, specificity, diagnostic odds ratio (DOR), and the area under the receiver-operating characteristic curve (AUC) were calculated. In addition, sensitivity, subgroup, and publication bias analyses were performed. Thirteen articles involving 3,373 participants were included. The combined sensitivity, specificity, DOR, and AUC were 0.62 (95% CI, 0.60-0.64), 0.86 (95% CI, 0.84-0.88), 11.23 (95% CI, 8.26-15.27), and 0.85 (95% CI, 0.82-0.88), respectively. For adult cancer patients, NRS2002 has moderate sensitivity, high specificity, and high AUC in screening for nutritional risk.
Systematic Review of Malnutrition Risk Factors to Identify Nutritionally At-Risk Patients With Head and Neck Cancer

Wang P, Lam Soh K, Geok Soh K, Xue L, Ning C, Tan Y, et al.

Clin J Oncol Nurs, 2024 Mar 15;28(2):197-208.
PMID: 38511915 DOI: 10.1188/24.CJON.197-208

BACKGROUND: Patients with head and neck cancer are prone to malnutrition, which can lead to adverse health outcomes. A review of the literature revealed a lack of systematic reviews addressing risk factors for malnutrition in this population.
OBJECTIVES: This study aimed to fill the knowledge gap by identifying risk factors for malnutrition in patients with head and neck cancer.
METHODS: A comprehensive search was conducted in PubMed®, Web of Science, Embase®, and Cochrane Library databases, spanning from their inception until June 2023. Three researchers critically evaluated the inclusion and exclusion criteria. Two investigators independently screened the literature and extracted data, resolving any discrepancies through consensus.
FINDINGS: This systematic review includes 18 studies. The results indicated that risk factors for malnutrition in patients with head and neck cancer encompass disease-related, genetic, lifestyle, nutritional health, physiologic, psychological, and treatment-related factors.
Fulltext Assessing malnutrition in patients with nasopharyngeal carcinoma: Diagnostic protocol for the development and validation of a new nutritional assessment tool

Wang P, Soh KL, Japar SB, Khazaai HB, Liao J, Ying Y, et al.

PLoS One, 2024;19(3):e0300067.
PMID: 38527072 DOI: 10.1371/journal.pone.0300067

INTRODUCTION: There is currently no gold standard or specific nutritional assessment tool to assess malnutrition in patients with nasopharyngeal carcinoma (NPC). Our study aims to develop a new nutritional assessment tool for NPC patients.
METHODS AND ANALYSIS: NPC patients will be required to complete a risk factor questionnaire after obtaining their informed consent. The risk factor questionnaire will be used to collect potential risk factors for malnutrition. Univariate and multivariate logistic regression analyses will be used to identify risk factors for malnutrition. A new nutritional assessment tool will be developed based on risk factors. The new tool's performance will be assessed by calibration and discrimination. The bootstrapping will be used for internal validation of the new tool. In addition, external validation will be performed by recruiting NPC patients from another hospital.
DISCUSSION: If the new tool is validated to be effective, it will potentially save medical staff time in assessing malnutrition and improve their work efficiency. Additionally, it may reduce the incidence of malnutrition and its adverse consequences.
STRENGTHS AND LIMITATIONS OF THIS STUDY: The study will comprehensively analyze demographic data, disease status, physical examination, and blood sampling to identify risk factors for malnutrition. Furthermore, the new tool will be systematically evaluated, and validated to determine their effectiveness. However, the restricted geographical range may limit the generalizability of the results to other ethnicities. Additionally, the study does not analyze subjective indicators such as psychology.
ETHICS AND DISSEMINATION: The ethical approval was granted by the Ethical Committee of the First Affiliated Hospital of Guangxi Medical University (NO. 2022-KT-GUI WEI-005) and the Second Affiliated Hospital of Guangxi Medical University (NO. 2022-KY-0752).
CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR2300071550.
Fulltext Characteristics associated with the consumption of malted drinks among Malaysian primary school children: findings from the MyBreakfast study

Jan Mohamed HJ, Loy SL, Mohd Taib MN, Karim NA, Tan SY, Appukutty M, et al.

BMC Public Health, 2015;15:1322.
PMID: 26718818 DOI: 10.1186/s12889-015-2666-5

The consumption of beverages contributes to diet quality and overall nutrition. Studies on malted drinks, one of the widely consumed beverage choices among children in Asia, however, have received limited attention. This study aimed to examine the prevalence of malted drink consumption and explored associations of sociodemographic characteristics, nutrient intakes, weight status and physical activity levels with malted drink consumption among primary school children in Malaysia.
Fulltext Whole Grain Intakes in the Diets Of Malaysian Children and Adolescents--Findings from the MyBreakfast Study

Ak N, Koo HC, Hamid Jan JM, Mohd Nasir MT, Tan SY, Appukutty M, et al.

PLoS One, 2015;10(10):e0138247.
PMID: 26473369 DOI: 10.1371/journal.pone.0138247

Diets rich in whole grain are associated with several health benefits. Little is known however, about whole grain consumption patterns in Malaysia. The aim of this study was to assess whole grain intakes and dietary source in Malaysian children and adolescents.
Fulltext Erratum to: 'Characteristics associated with the consumption of malted drinks among Malaysian primary school children: findings from the MyBreakfast study'

Jan Mohamed HJ, Loy SL, Taib MN, Karim NA, Tan SY, Appukutty M, et al.

BMC Public Health, 2016;16:162.
PMID: 26883422 DOI: 10.1186/s12889-016-2745-2
Fulltext Consumption of ready-to-eat cereals (RTEC) among Malaysian children and association with socio-demographics and nutrient intakes - findings from the MyBreakfast study

Mohd Nasir MT, Nurliyana AR, Norimah AK, Jan Mohamed HJB, Tan SY, Appukutty M, et al.

Food Nutr Res, 2017;61(1):1304692.
PMID: 28469545 DOI: 10.1080/16546628.2017.1304692

Background: The association between different types of breakfast meals and nutrient intakes has been studied to a lesser extent. Objective: This study compared nutrient intakes at breakfast and throughout the day between Malaysian children who consumed ready-to-eat cereals (RTEC) and those who did not. Methods: Anthropometric and dietary data for 1955 children aged 6-12 years from the MyBreakfast study were used in the analysis. Results: Overall, 18% of the children consumed RTEC at breakfast on at least one of the recall days. RTEC consumption was associated with younger age, urban areas, higher income and education level of parents. Among consumers, RTEC contributed 10% and 15% to daily intakes of calcium and iron respectively and ≥20% to daily intakes of vitamin C, thiamin, riboflavin and niacin. RTEC consumers had significantly higher mean intakes of vitamin C, thiamin, riboflavin, niacin, calcium, iron and sugar but lower intakes of fat and sodium than non-RTEC consumers at breakfast and for the total day. Conclusion: Consumption of fortified RTEC at breakfast was associated with lower fat and sodium intakes and higher intakes of several micronutrients both at breakfast and for the total day. However, total sugar intakes appeared to be higher.
Fulltext Breakfast consumption among Malaysian primary and secondary school children and relationship with body weight status - Findings from the MyBreakfast Study

Tee ES, Nurliyana AR, Norimah AK, Mohamed HJBJ, Tan SY, Appukutty M, et al.

Asia Pac J Clin Nutr, 2018 2 1;27(2):421-432.
PMID: 29384332 DOI: 10.6133/apjcn.062017.12

BACKGROUND AND OBJECTIVES: This study aimed to determine the relationship between breakfast consumption and body weight status among primary and secondary school children in Malaysia.
METHODS AND STUDY DESIGN: This nationwide cross-sectional study involved 5,332 primary school children aged 6 to 12 years and 3,000 secondary school children aged 13 to 17 years. Height and weight were measured and BMI-for-age was determined. Socio-demographic backgrounds, breakfast habits and physical activity levels were assessed using questionnaires. Breakfast frequency was defined as follows: breakfast skippers (ate breakfast 0-2 days/week), irregular breakfast eaters (ate breakfast 3-4 days/week) and regular breakfast eaters (ate breakfast ≥5 days/week).
RESULTS: The overall prevalence of breakfast skippers and irregular breakfast eaters was 11.7% and 12.7% respectively. Breakfast skipping was related to age, sex, ethnicity, income and physical activity level. Among primary school boys and secondary school girls, the proportion of overweight/obesity was higher among breakfast skippers (boys: 43.9%, girls: 30.5%) than regular breakfast eaters (boys: 31.2%, girls: 22.7%). Among primary school children, only boys who skipped breakfast had a higher mean BMI-for-age z-score than regular breakfast eaters. Among secondary school boys and girls, BMI-for-age z-score was higher among breakfast skippers than regular breakfast eaters. Compared to regular breakfast eaters, primary school boys who skipped breakfast were 1.71 times (95% CI=1.26-2.32, p=0.001) more likely to be overweight/obese, while the risk was lower in primary school girls (OR=1.36, 95% CI=1.02-1.81, p=0.039) and secondary school girls (OR=1.38, 95% CI=1.01-1.90, p=0.044).
CONCLUSION: Regular breakfast consumption was associated with a healthier body weight status and is a dietary behaviour which should be encouraged.