title: Evaluation of nutritional status in advanced metastatic cancer.
abstract: Consecutive cancer referrals to a palliative medicine program were evaluated to assess nutritional status using a standard protocol. The study included 352 patients (180 men, 172 women; median age 61 years, range 22-94 years). The most common diagnosis was lung cancer. All had metastatic disease, 139 with gastrointestinal involvement. The most common gastrointestinal symptoms were weight loss ( n=307), anorexia ( n=285), and early satiety ( n=243). Of those with any weight loss, 71% had lost >or0% of their pre-illness weight. The most common factor identified which might have contributed to weight loss was hypophagia ( n=275/307). Men had lost weight more often and to a greater extent than women. Triceps skinfold (TSF) was measured in 337: 51% had values that suggested severe fat deficiency. Upper mid-arm muscle area (AMA) was measured in 349: 30% had evidence of significant muscle mass reduction. The body mass index (BMI) was normal or increased in most patients. Calculated resting energy expenditure (REE) ( n=324) was high in 41%. C-reactive protein was elevated in 74% of those measured ( n=50). We conclude that: (1).most of this group of cancer patients referred to palliative medicine had severe weight loss; (2).there was a gender difference in the severity and type of weight loss; (3).males lost more weight overall and more muscle than females; (4).males with any degree of weight loss had a higher REE than females; (5).a significant correlation existed between the time from diagnosis to death and the severity of weight loss in the prior month; (6).BMI was normal in most patients, suggesting precancer diagnosis obesity; and (7).both TSF and AMA correlated well with body composition of both fat and protein as determined by bioelectrical impedance.
authors.affiliation: The Harry R Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio, USA.
authors.forename: N
authors.initials: N
authors.lastname: Sarhill
authors.forename: F
authors.initials: F
authors.lastname: Mahmoud
authors.forename: D
authors.initials: D
authors.lastname: Walsh
authors.forename: K A
authors.initials: KA
authors.lastname: Nelson
authors.forename: S
authors.initials: S
authors.lastname: Komurcu
authors.forename: M
authors.initials: M
authors.lastname: Davis
authors.forename: S
authors.initials: S
authors.lastname: LeGrand
authors.forename: O
authors.initials: O
authors.lastname: Abdullah
authors.forename: L
authors.initials: L
authors.lastname: Rybicki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000378:metabolism*; D009748:Nutrition Disorders / Q000175:diagnosis* / Q000209:etiology*; D009752:Nutritional Status; D010166:Palliative Care; D015431:Weight Loss