The relationship between nutritional status and handgrip strength in adult cancer patients: a cross-sectional study

  • Şenay Burçin Alkan
  • Mehmet Artaç
  • Neslişah Rakıcıoğlu
Original Article

Abstract

Purpose

Malnutrition is a common complication in head, neck and lung cancer patients, particularly in cases of gastrointestinal system (GIS) cancer. Therefore, an assessment of malnutrition is crucial for early nutritional interventions. It was conducted as a cross-sectional study to evaluate nutritional status of adult cancer patients.

Methods

The nutritional status of 104 cancer patients (52 GIS and 52 non-GIS cancer cases) using a Patient-Generated Subjective Global Assessment (PG-SGA), handgrip strength, certain anthropometric measurements and food consumption in and outside of the hospital were assessed.

Results

The percentages of malnutrition were 64.6 and 64.3% in the male patients with and without GIS cancer, respectively. They were 61.9 and 45.8% in the female patients with GIS and without GIS cancer, respectively. However, no significant difference was found between these two groups according to the malnutrition classification, PG-SGA score, handgrip strength and other anthropometric measurements (p > 0.05). The daily energy and protein intakes (per body weight) of the female patients in the hospital were significantly lower than those outside (p < 0.05). In addition, there was a positive moderate and significant relationship between the handgrip strength and lean body mass (r = 0.522, p = 0.000). A negative relationship was observed between the PG-SGA score and the handgrip strength (r = − 0.117, p = 0.071), but it was not statistically significant.

Conclusions

Cancer patients could be provided with nutritional education, and arrangements could be made with hospital nutritional services in order to prevent malnutrition.

Keywords

Cancer Oncology Malnutrition Handgrip strength 

Notes

Acknowledgments

The authors thank the patients who participate voluntarily in this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Kumar N (2012) Nutritional management of cancer treatment effects, 1st edn. Springer, Verlag Berlin Heidelberg.  https://doi.org/10.1007/978-3-642-27233-2 CrossRefGoogle Scholar
  2. 2.
    Santarpia L, Contaldo F, Pasanisi F (2011) Nutritional screening and early treatment of malnutrition in cancer patients. J Cachexia Sarcopenia Muscle 2(1):27–35.  https://doi.org/10.1007/s13539-011-0022-Z CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Nicolini A, Ferrari P, Masoni MC, Fini M, Pagani S, Giampietro O, Carpi A (2013) Malnutrition, anorexia and cachexia in cancer patients: a mini-review on pathogenesis and treatment. Biomed Pharmacother 62(8):807–817.  https://doi.org/10.1016/j.biopha.2013.08.005 CrossRefGoogle Scholar
  4. 4.
    Isenring E, Cross G, Kellett E, Koczwara B, Daniels L (2010) Nutritional status and information needs of medical oncology patients receiving treatment at an Australian public hospital. Nutr Cancer 62(2):220–228.  https://doi.org/10.1080/01635580903305276 CrossRefPubMedGoogle Scholar
  5. 5.
    Wie GA, Cho YA, Kim SY, Kim SM, Bae JM, Joung H (2010) Prevalence and risk factors of malnutrition among cancer patients according to tumor location and stage in the National Cancer Center in Korea. Nutrition 26(3):263–268.  https://doi.org/10.1016/j.nut.2009.04.013 CrossRefPubMedGoogle Scholar
  6. 6.
    Muscaritoli M, Lucia S, Farcomeni A, Lorusso V, Saracino V, Barone C, Plastino F, Gori S, Magarotto R, Carteni G, Chiurazzi B, Pavese I, Marchetti L, Zagonel V, Bergo E, Tonini G, Imperatori M, Iacono C, Maiorana L, Pinto C, Rubino D, Cavanna L, Di Cicilia R, Gamucci T, Quadrini S, Palazzo S, Minardi S, Merlano M, Colucci G, Marchetti P, on behalf of the PreMi OSG (2017) Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study. Oncotarget 8(45):79884–79896.  https://doi.org/10.18632/oncotarget.20168 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Leuenberger M, Kurmann S, Stanga Z (2010) Nutritional screening tools in daily clinical practice: the focus on cancer. Support Care Cancer 18(2):17–27.  https://doi.org/10.1007/s00520-009-0805-1 CrossRefGoogle Scholar
  8. 8.
    Cunningham R (2013) Nutritional issues in patients with hematologic malignancies. In: Hoffman R, Benz E, Silberstein L, Heslop H, Weitz J, Anastasi J (eds) Hematology: basic principles and practice. Churchill Livingstone, Philadelphia, pp 1405–1417Google Scholar
  9. 9.
    Davies M (2005) Nutritional screening and assessment in cancer-associated malnutrition. Eur J Oncol Nurs 9(2):64–73.  https://doi.org/10.1016/j.ejon.2005.09.005 CrossRefGoogle Scholar
  10. 10.
    Bauer J, Capra S, Ferguson M (2002) Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 56(8):779–785.  https://doi.org/10.1038/sj.ejcn.1601412 CrossRefPubMedGoogle Scholar
  11. 11.
    Marin Caro MM, Gomez Candela C, Castillo Rabaneda R, Lourenco Nogueira T, Garcia Huerta M, Loria Kohen V, Villarino Sanz M, Zamora Aunon P, Luengo Perez L, Robledo Saenz P, Lopez-Portabella C, Zarazaga Monzon A, Espinosa Rojas J, Nogues Boqueras R, Rodriguez Suarez L, Celaya Perez S, Pardo Masferrer J (2008) Nutritional risk evaluation and establishment of nutritional support in oncology patients according to the protocol of the Spanish Nutrition and Cancer Group. Nutr Hosp 23(5):458–468PubMedGoogle Scholar
  12. 12.
    White JV, Guenter P, Jensen G, Malone A, Schofield M (2012) Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet 112(5):730–738.  https://doi.org/10.1016/j.jand.2012.03.012 CrossRefPubMedGoogle Scholar
  13. 13.
    Norman K, Stobaus N, Gonzalez MC, Schulzke JD, Pirlich M (2011) Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr 30(2):135–142.  https://doi.org/10.1016/j.clnu.2010.09.010 CrossRefPubMedGoogle Scholar
  14. 14.
    Hebuterne X, Lemarie E, Michallet M, de Montreuil CB, Schneider SM, Goldwasser F (2014) Prevalence of malnutrition and current use of nutrition support in patients with cancer. J Parenter Enter Nutr 38(2):196–204.  https://doi.org/10.1177/0148607113502674 CrossRefGoogle Scholar
  15. 15.
    Hintze J (2008) PASS 2008. NCSS, LLC, Kaysville, Utah, USA.Google Scholar
  16. 16.
    Hintze J (2007) NCSS 2007 Kaysville. NCSS, LLC, Utah, USAGoogle Scholar
  17. 17.
    Pekcan G (2008) Beslenme durumunun saptanması. In: Baysal A, Aksoy M, Besler T (eds) Diyet El Kitabı, 9th edn. Hatipoğlu Yayınevi, Ankara, pp 67–141Google Scholar
  18. 18.
    Rakıcıoğlu N, Acar-Tek N, Ayaz A, Pekcan G (2014) Photograph catalog of food and dishes: portion sizes and amounts, 4th edn. Ata Ofset Pub, AnkaraGoogle Scholar
  19. 19.
    Nutrition Data Base Software (2007) Data base: the German Food Code and Nutrient Data Base (BLS II.3, 1999) With additions from USDA-SR and other sources. IstanbulGoogle Scholar
  20. 20.
    IBMCorp (2013) SPSS Statistics for Windows, Version 22.0. Armonk, NYGoogle Scholar
  21. 21.
    Alpar R (2010) Spor, Sağlık ve Eğitim Bilimlerinden Örneklerle Uygulamalı İstatistik ve Geçerlik-Güvenirlik. Detay Yayıncılık, AnkaraGoogle Scholar
  22. 22.
    Caccialanza R, Pedrazzoli P, Cereda E, Gavazzi C, Pinto C, Paccagnella A, Beretta GD, Nardi M, Laviano A, Zagonel V (2016) Nutritional support in cancer patients: a position paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE). J Cancer 7(2):131–135.  https://doi.org/10.7150/jca.13818 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Pereira Borges N, D’Alegria Silva B, Cohen C, Portari Filho PE, Medeiros FJ (2009) Comparison of the nutritional diagnosis, obtained through different methods and indicators, in patients with cancer. Nutr Hosp 24(1):51–55PubMedGoogle Scholar
  24. 24.
    Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, Davis M, Muscaritoli M, Ottery F, Radbruch L, Ravasco P, Walsh D, Wilcock A, Kaasa S, Baracos VE (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12(5):489–495.  https://doi.org/10.1016/s1470-2045(10)70218-7 CrossRefPubMedGoogle Scholar
  25. 25.
    Braun TP, Marks DL (2010) Pathophysiology and treatment of inflammatory anorexia in chronic disease. J Cachexia Sarcopenia Muscle 1(2):135–145.  https://doi.org/10.1007/s13539-010-0015-1 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    MacDonald N (2011) Chronic inflammatory states: their relationship to cancer prognosis and symptoms. J R Coll Physicians Edinb 41(3):246–453.  https://doi.org/10.4997/jrcpe.2011.315 CrossRefPubMedGoogle Scholar
  27. 27.
    Khoshnevis N, Ahmadizar F, Alizadeh M, Akbari ME (2012) Nutritional assessment of cancer patients in Tehran, Iran. Asian Pac J Cancer Prev 13(4):1621–1626.  https://doi.org/10.7314/APJCP.2012.13.4.1621 CrossRefPubMedGoogle Scholar
  28. 28.
    Pressoir M, Desné S, Berchery D, Rossignol G, Poiree B, Meslier M, Traversier S, Vittot M, Simon M, Gekiere JP, Meuric J, Serot F, Falewee MN, Rodrigues I, Senesse P, Vasson MP, Chelle F, Maget B, Antoun S, Bachmann P (2010) Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer 102(6):966–971.  https://doi.org/10.1038/sj.bjc.6605578 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Halpern-Silveira D, Susin LR, Borges LR, Paiva SI, Assuncao MC, Gonzalez MC (2010) Body weight and fat-free mass changes in a cohort of patients receiving chemotherapy. Support Care Cancer 18(5):617–625.  https://doi.org/10.1007/s00520-009-0703-6 CrossRefPubMedGoogle Scholar
  30. 30.
    Guerra RS, Fonseca I, Pichel F, Restivo MT, Amaral TF (2015) Handgrip strength and associated factors in hospitalized patients. JPEN J Parenter Enteral Nutr 39(3):322–330.  https://doi.org/10.1177/0148607113514113 CrossRefPubMedGoogle Scholar
  31. 31.
    Araujo dos Santos C, de Oliveira Barbosa Rosa C, Queiroz Ribeiro A, Lanes Ribeiro Rde C (2015) Patient-generated subjective global assessment and classic anthropometry: comparison between the methods in detection of malnutrition among elderly with cancer. Nutr Hosp 31(1):384–392.  https://doi.org/10.3305/nh.2015.31.1.7543 PubMedGoogle Scholar
  32. 32.
    Wu B-W, Yin T, Cao W-X, Gu Z-D, Wang X-J, Yan M, Liu B-Y (2009) Clinical application of subjective global assessment in Chinese patients with gastrointestinal cancer. World J Gastroenterol 15(28):3542–3549.  https://doi.org/10.3748/wjg.15.3542 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Alberici Pastore C, Paiva Orlandi S, Gonzalez MC (2013) Association between an inflammatory-nutritional index and nutritional status in cancer patients. Nutr Hosp 28(1):188–193.  https://doi.org/10.3305/nh.2013.28.1.6167 PubMedGoogle Scholar
  34. 34.
    da Silva TL, Pretto ADB, Gonzalez MC, Pastore CA (2015) Association between nutritional subjective global assessment and manual dynamometry in cancer patients of a chemotherapy service in Southern Brazil. Revista Brasileira de Oncologia Clínica 11(40):66–70Google Scholar
  35. 35.
    Flood A, Chung A, Parker H, Kearns V, O’Sullivan TA (2014) The use of hand grip strength as a predictor of nutrition status in hospital patients. Clin Nutr 33(1):106–114.  https://doi.org/10.1016/j.clnu.2013.03.003 CrossRefPubMedGoogle Scholar
  36. 36.
    Lammel Ricardi J, Marcadenti A, Perocchin de Souza S, Siviero Ribeiro A (2013) Oral nutritional supplements intake and nutritional status among inpatients admitted in a tertiary hospital. Nutr Hosp 28(4):1357–1360.  https://doi.org/10.3305/nh.2013.28.4.6499 PubMedGoogle Scholar
  37. 37.
    Dupertuis YM, Kossovsky MP, Kyle UG, Raguso CA, Genton L, Pichard C (2003) Food intake in 1707 hospitalised patients: a prospective comprehensive hospital survey. Clin Nutr 22(2):115–123.  https://doi.org/10.1054/clnu.2002.0623 CrossRefPubMedGoogle Scholar
  38. 38.
    Bozzetti F, Arends J, Lundholm K, Micklewright A, Zurcher G, Muscaritoli M (2009) ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology. Clin Nutr 28(4):445–454.  https://doi.org/10.1016/j.clnu.2009.04.011 CrossRefPubMedGoogle Scholar
  39. 39.
    Çehreli R (2014) HIV ve kanser. In: Besler T, İnanç N (eds) Diyetisyen el kitabı: Enteral ve parenteral nütrisyon. Nobel Tıp Kitabevi, İstanbul, pp 199–216Google Scholar
  40. 40.
    Planas M, Alvarez-Hernandez J, Leon-Sanz M, Celaya-Perez S, Araujo K, Garcia de Lorenzo A (2016) Prevalence of hospital malnutrition in cancer patients: a sub-analysis of the PREDyCES® study. Support Care Cancer 24(1):429–435.  https://doi.org/10.1007/s00520-015-2813-7 CrossRefPubMedGoogle Scholar
  41. 41.
    World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. AICR, Washington DCGoogle Scholar
  42. 42.
    Anonymous (2015) Hacettepe Üniversitesi Sağlık Bilimleri Fakültesi Beslenme ve Diyetetik Bölümü: Türkiye’ye Özgü Besin ve Beslenme Rehberi, AnkaraGoogle Scholar
  43. 43.
    Robien K, Demark-Wahnefried W, Rock CL (2011) Evidence-based nutrition guidelines for cancer survivors: current guidelines, knowledge gaps, and future research directions. J Acad Nutr Diet 111(3):368–375.  https://doi.org/10.1016/j.jada.2010.11.014 Google Scholar
  44. 44.
    Meyerhardt JA, Niedzwiecki D, Hollis D, Saltz LB, Hu FB, Mayer RJ, Nelson H, Whittom R, Hantel A, Thomas J, Fuchs CS (2007) Association of dietary patterns with cancer recurrence and survival in patients with stage III colon cancer. JAMA 298(7):754–764.  https://doi.org/10.1001/jama.298.7.754 CrossRefPubMedGoogle Scholar
  45. 45.
    Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, Gapstur S, Patel AV, Andrews K, Gansler T (2012) American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 62(1):30–67.  https://doi.org/10.3322/caac.20140 CrossRefPubMedGoogle Scholar
  46. 46.
  47. 47.
    Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, Bandera EV, Hamilton KK, Grant B, McCullough M, Byers T, Gansler T (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62(4):242–274.  https://doi.org/10.3322/caac.21142 CrossRefGoogle Scholar
  48. 48.
    Okkels SL, Bredie WLP, Klausen TW, Beck AM (2016) An investigation into between-meal food desires among hospitalised haematological cancer patients. Clinl Nutr 35(2):440–445.  https://doi.org/10.1016/j.clnu.2015.03.010 CrossRefGoogle Scholar
  49. 49.
    Strohle A, Zanker K, Hahn A (2010) Nutrition in oncology: the case of micronutrients (review). Oncol Rep 24(4):815–828CrossRefPubMedGoogle Scholar
  50. 50.
    Gröber U, Holzhauer P, Kisters K, Holick MF, Adamietz IA (2016) Micronutrients in oncological intervention. Nutrients 8(3):163.  https://doi.org/10.3390/nu8030163 CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    August DA, Huhmann MB (2009) A.S.P.E.N. clinical guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation. JPEN J Parenter Enteral Nutr 33(5):472–500.  https://doi.org/10.1177/0148607109341804 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Şenay Burçin Alkan
    • 1
  • Mehmet Artaç
    • 2
  • Neslişah Rakıcıoğlu
    • 3
  1. 1.Faculty of Health Sciences, Department of Nutrition and DieteticsNecmettin Erbakan UniversitySelçukluTurkey
  2. 2.Faculty of MedicineNecmettin Erbakan UniversityMeramTurkey
  3. 3.Faculty of Health Sciences, Department of Nutrition and DieteticsHacettepe UniversityAnkaraTurkey

Personalised recommendations