Skip to main content

Advertisement

Springer Nature Link
Log in

NRS-2002 for pre-treatment nutritional risk screening and nutritional status assessment in head and neck cancer patients

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to assess the value of nutritional risk screening-2002 (NRS-2002) as a nutritional risk screening and status assessment method and to compare it with nutritional status assessed by subjective and objective methods in the screening of head and neck cancer patients.

Methods

Sixty-five consecutive patients (50 male), with a median age of 61 years (range, 33–77), with head and neck squamous cell carcinoma (HNSCC) were enrolled prior to cancer therapy. Nutritional status was assessed by NRS-2002, patient-generated subjective global assessment (PG-SGA), handgrip strength (HGS) and mid-arm muscle area (MAMA).

Results

Twenty-eight percent of patients were at nutritional risk based on NRS-2002, and 34 % were malnourished according to PG-SGA, while 43 % had low HGS. NRS-2002 cut-off score of ≥3 compared with the nutritional status according to PG-SGA showed 77 % specificity and 98 % sensitivity (K = 0.78). NRS-2002 was able to predict malnutrition (PG-SGA BC) both in men (p < 0.001) and in women (p < 0.05). NRS-2002 identified correctly patients with malnutrition with a score of ≥3 (p < 0.001) and risk patients with a score of ≥2 (p < 0.001).

Conclusions

These results suggest that NRS-2002 seems to be a reliable indicator of malnutrition, while NRS-2002 with the cut-off score of ≥2 seems to be more reliable for nutrition screening in head and neck cancer patients prior to oncological treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Righini C, Timi N, Junet P, Bertolo A, Reyt E, Atallah I (2013) Assessment of nutritional status at the time of diagnosis in patients treated for head and neck cancer. Eur Ann Otorhinolaryngol Head Neck Dis 130(1):8–14

    Article  PubMed  Google Scholar 

  2. Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME (2005) Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 27(8):659–668

    Article  PubMed  Google Scholar 

  3. Datema FR, Ferrier MB, Baatenburg de Jong RJ (2011) Impact of severe malnutrition on short-term mortality and overall survival in head and neck cancer. Oral Oncol 47(9):910–914

    Article  PubMed  Google Scholar 

  4. Jager-Wittenaar H, Dijkstra PU, Vissink A, Langendijk JA, van der Laan BF, Pruim J et al (2011) Changes in nutritional status and dietary intake during and after head and neck cancer treatment. Head Neck 33(6):863–870

    Article  PubMed  Google Scholar 

  5. Lees J (1999) Incidence of weight loss in head and neck cancer patients on commencing radiotherapy treatment at a regional oncology centre. Eur J Cancer Care (Engl) 8(3):133–136

    Article  CAS  Google Scholar 

  6. Matthews TW, Lampe HB, Dragosz K (1995) Nutritional status in head and neck cancer patients. J Otolaryngol 24(2):87–91

    CAS  PubMed  Google Scholar 

  7. van Bokhorst-de van der Schueren MA, van Leeuwen PA, Sauerwein HP, Kuik DJ, Snow GB, Quak JJ (1997) Assessment of malnutrition parameters in head and neck cancer and their relation to postoperative complications. Head Neck 19(5):419–425

    Article  CAS  PubMed  Google Scholar 

  8. Jager-Wittenaar H, Dijkstra PU, Vissink A, van der Laan BF, van Oort RP, Roodenburg JL (2007) Critical weight loss in head and neck cancer-prevalence and risk factors at diagnosis: an explorative study. Support Care Cancer 15(9):1045–1050

    Article  PubMed  Google Scholar 

  9. Platek ME, Reid ME, Wilding GE, Jaggernauth W, Rigual NR, Hicks WL Jr et al (2011) Pretreatment nutritional status and locoregional failure of patients with head and neck cancer undergoing definitive concurrent chemoradiation therapy. Head Neck 33(11):1561–1568

    Article  PubMed Central  PubMed  Google Scholar 

  10. van Bokhorst-De van der Schuer MA, von Blomberg-van der Flier BM, Riezebos RK, Scholten PE, Quak JJ, Snow GB et al (1998) Differences in immune status between well-nourished and malnourished head and neck cancer patients. Clin Nutr 17(3):107–111

    Article  CAS  PubMed  Google Scholar 

  11. Van Bokhorst-de Van der Schuer MA, Langendoen SI, Vondeling H, Kuik DJ, Quak JJ, Van Leeuwen PA (2000) Perioperative enteral nutrition and quality of life of severely malnourished head and neck cancer patients: a randomized clinical trial. Clin Nutr 19(6):437–444

    Article  CAS  PubMed  Google Scholar 

  12. Van Cutsem E, Arends J (2005) The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs 9(Suppl 2):S51–S63

    Article  PubMed  Google Scholar 

  13. Malone A, Hamilton C (2013) The academy of nutrition and dietetics/the american society for parenteral and enteral nutrition consensus malnutrition characteristics: application in practice. Nutr Clin Pract 28(6):639–650

    Article  PubMed  Google Scholar 

  14. Ottery FD (1996) Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition 12(1 Suppl):S15–S19 [review] [21 refs]

    Article  CAS  PubMed  Google Scholar 

  15. Bauer J, Capra S, Ferguson M (2002) Use of the scored patient-generated subjective global assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 56(8):779–785

    Article  CAS  PubMed  Google Scholar 

  16. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, ESPEN Ad Hoc Working G. (2003) Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 22(3):321–336

    Article  PubMed  Google Scholar 

  17. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M (2003) Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr 22(4):415–421 [see comment]

    Article  CAS  PubMed  Google Scholar 

  18. Isenring E, Bauer J, Capra S (2003) The scored patient-generated subjective global assessment (PG-SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. Eur J Clin Nutr 57(2):305–309

    Article  CAS  PubMed  Google Scholar 

  19. Ottery FD (1994) Rethinking nutritional support of the cancer patient: the new field of nutritional oncology. Semin Oncol 21(6):770–778 [review] [103 refs]

    CAS  PubMed  Google Scholar 

  20. Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME (2003) Nutritional deterioration in cancer: the role of disease and diet. Clin Oncol (R Coll Radiol) 15(8):443–450

    Article  CAS  Google Scholar 

  21. Frisancho AR (2008) Anthropometric standards. an interactive nutritional reference of body size and body composition for children and adults, 2nd edn. The University of Michigan Press, United States of America

    Google Scholar 

  22. Gurney JM, Jelliffe DB (1973) Arm anthropometry in nutritional assessment: nomogram for rapid calculation of muscle circumference and cross-sectional muscle and fat areas. Am J Clin Nutr 26(9):912–915

    CAS  PubMed  Google Scholar 

  23. Frisancho AR (1974) Triceps skin fold and upper arm muscle size norms for assessment of nutrition status. Am J Clin Nutr 27(10):1052–1058

    CAS  PubMed  Google Scholar 

  24. Peters MJ, van Nes SI, Vanhoutte EK, Bakkers M, van Doorn PA, Merkies IS et al (2011) Revised normative values for grip strength with the Jamar dynamometer. J Peripher Nerv Syst 16(1):47–50

    Article  PubMed  Google Scholar 

  25. Taylor R (1990) Interpretation of the correlation: coefficient: a basic review. JDMS 1:35–39

    Google Scholar 

  26. Altman DG, Machin D, Bryant TN, Gardner MJ (eds) (2000) Statistics with confidence. BMJ Books, London

    Google Scholar 

  27. Bozzetti F, Mariani L, Lo Vullo S, SCRINIO Working Group, Amerio ML, Biffi R et al (2012) The nutritional risk in oncology: a study of 1,453 cancer outpatients. Support Care Cancer 20(8):1919–1928

    Article  PubMed Central  PubMed  Google Scholar 

  28. Almeida AI, Correia M, Camilo M, Ravasco P (2012) Nutritional risk screening in surgery: valid, feasible, easy! Clin Nutr 31(2):206–211

    Article  PubMed  Google Scholar 

  29. Ryu SW, Kim IH (2010) Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients. World J Gastroenterol 16(26):3310–3317

    Article  PubMed Central  PubMed  Google Scholar 

  30. Raslan M, Gonzalez MC, Torrinhas RS, Ravacci GR, Pereira JC, Waitzberg DL (2011) Complementarity of subjective global assessment (SGA) and nutritional risk screening 2002 (NRS 2002) for predicting poor clinical outcomes in hospitalized patients. Clin Nutr 30(1):49–53

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was financially supported by grants from the Finnish Cultural Foundation and the Helsinki University Central Hospital Research Funds, Helsinki, Finland. The study sponsors did not have any involvement in the study design, data collection, analysis and interpretation of data, the writing of the manuscript and in the decision to submit the manuscript for publication.

Statement of authorship

HOK, AM, US and KS designed the study. HOK was the main author of the manuscript, performed all the assessments of nutritional status, and analysed and interpreted data. AM supervised the project and assisted with the statistical analysis, writing the manuscript and interpretation of the results. PÖ, PR and US assisted in the interpretation of the results and writing the manuscript.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Clinical Nutrition Therapy, Ravioli, Helsinki University Central Hospital, P.O. Box 100, 00029, Helsinki, Finland

    Helena Orell-Kotikangas

  2. Department of Oncology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland

    Pia Österlund & Kauko Saarilahti

  3. Laboratório de Nutrição e Unidade de Nutrição e Metabolismo do Instituto de Medicina Molecular da Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal

    Paula Ravasco

  4. Department of Clinical Nutrition, University of Eastern Finland and Institute of Internal Medicine, Kuopio University Hospital, Kuopio, Finland

    Ursula Schwab

  5. Department of Otolaryngology - Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland

    Antti A. Mäkitie

Authors
  1. Helena Orell-Kotikangas
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Pia Österlund
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Kauko Saarilahti
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Paula Ravasco
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Ursula Schwab
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Antti A. Mäkitie
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Helena Orell-Kotikangas.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Orell-Kotikangas, H., Österlund, P., Saarilahti, K. et al. NRS-2002 for pre-treatment nutritional risk screening and nutritional status assessment in head and neck cancer patients. Support Care Cancer 23, 1495–1502 (2015). https://doi.org/10.1007/s00520-014-2500-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-014-2500-0

Keywords