title: Subjective versus objective nutritional assessment study in women with gynecological cancer: a prospective cohort trial.
abstract: OBJECTIVE
  Nutritional evaluation of cancer patients may lead to treatment intervention that reduces morbidity and mortality. This evaluation can be done subjectively or objectively. We studied the correlation between subjective and objective nutritional assessment in gynecological oncology patients.
  
  
  METHODS
  Sixty-seven consecutive patients admitted to the gynecological oncology service were prospectively evaluated by laboratory criteria using a standardized formula. The prognostic nutritional index (PNI) consists of tests measuring albumin, transferrin, triceps skin fold, and skin sensitivity reaction to common antigens. The patients were also subjectively evaluated using a standardized questionnaire and physical examination, known as the subjective global assessment, by two clinicians who were blinded from the PNI results. Both scores were categorized as normal, mild malnutrition, or severe malnutrition. Reproducibility of the subjective testers and consistency between the subjective and the objective evaluations were assessed with a weighted kappa statistic.
  
  
  RESULTS
  Cancer distribution consisted of 39 (58%) cervical, 16 (24%) endometrial, 11 (16%) ovarian, and one (2%) vulvar carcinomas. There was a high level of agreement between the two subjective raters (weighted kappa = 0.797; 95% CI 0.67-0.92). Furthermore, there were no cases in which the ratings differed by two points on the three-point ordered scale of nutritional status. Agreement between the two evaluation methods was only fair to moderate (weighted kappa = 0.435; 95% CI 0.28-0.59). Agreement was exact in 38 of 67 patients (57%). There were eight patients (12%) where the difference in ratings differed by two points on the ordinal scale, all with the subjective scored as normal, but the objective rated as severe malnourishment.
  
  
  CONCLUSIONS
  In assessing nutritional status of gynecological patients, subjective assessment differs with objective/laboratory measurement.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Tennessee Cancer Institute, 1331 Union Avenue, Suite 800, Memphis, TN 38104, USA. jsantoso@utcancer.com
authors.forename: J T
authors.initials: JT
authors.lastname: Santoso
authors.forename: T
authors.initials: T
authors.lastname: Cannada
authors.forename: B
authors.initials: B
authors.lastname: O'Farrel
authors.forename: K
authors.initials: K
authors.lastname: Alladi
authors.forename: R L
authors.initials: RL
authors.lastname: Coleman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D015596:Nutrition Assessment; D009748:Nutrition Disorders / Q000150:complications / Q000175:diagnosis*; D009752:Nutritional Status; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012885:Skinfold Thickness