Malnutrition Among Patients With Cancer Admitted to the Hospital May Increase the Risk for Infection

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Upon hospital admission for cancer, many patients already demonstrated a high prevalence of malnutrition per Global Leadership Initiative on Malnutrition (GLIM) criteria, which was associated with the risk of developing a nosocomial infection, according to findings presented by Nuñez Abad et al at the ESMO Virtual Congress 2020 (Abstract 1810O).

Researchers investigated the nutritional status in patients hospitalized for cancer to determine the prevalence of malnutrition according to GLIM criteria, as well as to determine the association between malnutrition and the risk of nosocomial infection and length of hospital stay.

Observational Study Methods

This prospective observational study was carried out among patients admitted to the Oncology Department of the General University Hospital of Valencia from November 2019 to March 2020. Nutritional status was evaluated within the first 48 hours after admission.

The body mass criteria used included the fat-free mass index and phase angle, as measured using a bioelectrical impedance. Muscle function was evaluated using a handgrip. The extent of sarcopenia was measured using the cutoff values established by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2).

The study included 107 patients with a mean age of 66 years; 66.4% of patients were male, and 70.1% patients had advanced cancer.


The investigators found that, on admission, 48 (44.9%) patients presented with severe malnutrition and 19 (17.8%) patients had moderate malnutrition per GLIM criteria. In addition, 77 (72%) patients also presented with dynapenia and 18 (16.8%) patients had sarcopenia.

Regarding other parameters of nutritional status, the mean weight was 67.8 kg (149.5 lb), mean body mass index was 24 kg/m2, mean fat-free mass index was 18.6 kg/m2, and mean phase angle was 4.5º in these patients overall.

During a mean hospital stay of 13.9 days, 43 (40.2%) patients developed a nosocomial infection, which were primarily respiratory tract infections (26 patients). Patients who developed infection had significantly lower weight, body mass index, and fat-free mass index than the overall patient cohort (P < .05 all comparisons), but phase angle was not lower.

Nosocomial infection occurred in 8 of 19 (42.1%) patients with moderate malnutrition and 25 of 48 (52.1%) patients with severe malnutrition, compared with 10 infections in 40 (25%) patients without signs of malnutrition (P = .035). The incidence of nosocomial infection was highest in patients with sarcopenia (61.1%), as compared with 36% in the hospitalized patients overall (P = .044).

The length of hospital stay was prolonged in patients with nosocomial infection compared to patients overall. The mean length of stay was 18.6 vs 10.8 days (P < .024). Length of hospital stay was not found to be related to nutritional status.

According to the authors, the prevalence of malnutrition in patients hospitalized for cancer is high. Malnutrition per GLIM criteria and sarcopenia are associated with a high risk of nosocomial infection.

The investigators advise that an adequate nutritional evaluation is essential for timely implementation of nutritional support to avoid malnutrition and sarcopenia and to decrease chance of developing infection.

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