Malnutrition defined by Global Leadership Initiative on Malnutrition criteria, cachexia, and dietary intake among adult patients with cancer undergoing chemotherapy

Abstract

Background and aims

Malnutrition is associated with high morbidity and mortality among patients with cancer. In Malawi, there is limited data on the prevalence of malnutrition and cachexia and associated factors among adult out-patients with cancer. We therefore assessed factors associated with malnutrition, cachexia, and dietary intake in adult outpatients with cancer undergoing chemotherapy.

Methods

A cross-sectional study was conducted at the National Cancer Centre in Malawi, targeting adult outpatients with different types of cancer. Data collected included socio-demographic characteristics, anthropometrics, health-related information, inflammatory biomarkers, and dietary intakes. We screened for malnutrition risk using the Malnutrition Screening Tool and assessed for malnutrition and cachexia using the Global Leadership Initiative on Malnutrition and Fearon criteria, respectively. Multivariate logistic and linear regressions examined the factors associated with malnutrition, cachexia, and dietary intake at p<0.05, using SPSS.

Results

Our study included 97 patients with a mean age of 49.24 ± 13.9 years, and 68.0% were female. The common types of cancer were cervical (47.4%) and gastrointestinal (20.6%). Approximately 51.5% of the patients were at risk of malnutrition, 33.0% were malnourished, and 24.7% had cachexia. The estimated median [Interquartile range: IQR] protein (0.99 g/kg/day [0.76; 1.42]; p=0.028) and dietary fiber (19.40 g/day [12.85; 29.50]) intakes were lower than the recommendations. The risk of malnutrition increased with anorexia (p=0.011) and reduced with normal handgrip strength (p=0.037). Gastrointestinal cancer (p=0.016) and high C-reactive protein (p=0.002) were associated with malnutrition. Having gastrointestinal cancer (p=0.040), living with HIV (p=0.030), anorexia (p=0.029), and inadequate energy intake (p=0.012) were associated with cachexia. Furthermore, gastrointestinal cancer was negatively associated with energy (p<0.0001) and protein (p=0.010) intakes.

Conclusions

Malnutrition, cachexia, and inadequate dietary intake are of concern in Malawian patients with cancer. Therefore, tailored dietetic/nutrition interventions are urgently needed in this population.