Prevalence and prognostic impact of malnutrition at cancer diagnosis: A prospective cohort study

BACKGROUND: Malnutrition is a prevalent yet often under-recognized condition in oncology that could potentially compromise treatment outcomes. This study assessed its prevalence at cancer diagnosis and the prognostic implications within a large cohort of adult patients with cancer.

METHODS: In this prospective study, 2501 adults with newly diagnosed, histologically confirmed cancer (2018-2022) underwent nutritional screening within seven days preceding the initiation of cancer therapy. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form and patients were classified as well-nourished (12-14), at-risk (8-11), or malnourished (<8) points. Overall survival was analyzed using Kaplan-Meier estimates and multivariable Cox models.

RESULTS: At baseline, 47.1 % of patients were at risk of malnutrition and 12.0 % were malnourished, together comprising 59.1 % of patients with compromised nutrition. The highest burden was observed in pancreatic (74.2 %), esophageal (72.8 %), and gastric (65.3 %) cancers. Malnourished patients more frequently presented with stage IV disease (62.7 % vs. 49.5 % in well-nourished patients; P < 0.001) and with poor performance status (ECOG ≥2: 20.0 % vs. 4.8 %, respectively; P < 0.001). Three-year overall survival was 69.8 % in well-nourished patients, 51.5 % in those at risk, and 37.2 % in malnourished patients (log-rank P < 0.001). Adjusted hazard ratios (HRs) for mortality were 1.79 (95 % confidence interval [CI], 1.51-2.13) in the at-risk group and 2.74 (95 % CI, 2.20-3.42) in the malnourished group. Exploratory site-specific analyses suggested heterogeneity in the association between nutritional status and survival across tumor types.

CONCLUSION: Pre-treatment MNA-SF screening identifies patients with cancer who are at high risk of mortality. Prospective trials are needed to determine whether nutritional interventions can improve survival outcomes, particularly in patients with gastrointestinal and head and neck cancers.