The Challenges of Nutritional Assessment in Geriatric Cancer Patients_updated

8/8/2019 The Challenges of Nutritional Assessment in Geriatric Cancer Patients_updated

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Nutritional problems

Age-related diseases

Functional impairments

Drug-induced nutritionaldeficiencies


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Malnutrition

>DeficienciesP r o t e i n e n e r g y

V i t a m i n s

F i b r e

W a t e r

>ExcessesO b e s i t y

H y p e r v i t a m i n o s i s


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Undernutrition

Categories

>Community dwelling

>Hospitalized

>Institutionalized (nursing home)

Burden of acute and chronicdisease differs Oncology

Nutritional requirements vary


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65 +


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Aging = Loss

Muscle mass

Muscle strength

Bone mass

Hormone production

Co-occurrence suggests

>common risk factors>overlap in pathophysiology


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Weight loss is common

Poor outcomeBMI < 22

>higher 1-yr mortality

>poorer functional statusBMI < 20.5 in men > 75 y

>20% higher mortality

BMI < 18.5 in women > 75 y>40% higher mortality.

Key factor is recent weight loss

L a n d i F e t a l . J A m G e r i a t r S o c 1 9 9 9 ; 4 7 : 1 0 7 2 6

C a l l e E E , N e w E n g l J M e d 1 9 9 9 ; 3 4 1 : 1 0 9 7 1 0 5


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Age distribution in BMI class

Age distribution according to BMI

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


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Age-related loss of muscle mass

is clinically important

>diminished strength and exercisecapacity

>decline in function6 5 % o f o l d e r m e n a n d w o m e n c a n n o t l i f t

1 0 p o u n d s u s i n g t h e i r a r m s


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A r t s I e t a l , J A m G e r S o c , 2 0 0 7 : 5 5 , 1 1 5 0 - 5 2

Age-related loss of muscle mass


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Causes of skeletal muscle loss

VoluntaryInvoluntary


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Causes of skeletal muscle loss

Starvation>pure protein-energy deficiency

>reversed by replenishment of

nutrientsCachexia

>severe wasting

>accompanying disease statesSarcopenia

>age-related decline in muscle mass


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Nutritionalintake

Ageing

Cancer

In the Geriatric Oncology patient


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Nutritionalintake

Ageing

Cancer

In the Geriatric Oncology patient

Starvation

Sarcopenia

Cachexia


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Nutritional Assessment

to identify patients at risk to identify patients who could

benefit from an intervention

prognosis to evaluate the intervention

Screening should increase alertness


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Assessment

R i s k

> G e n e r a l

S N A Q : S h o r t N u t r i t i o n a l A s s e s s m e n t

N R S : N u t r i t i o n a l R i s k S c o r e

> G e r i a t r i c s

N S I : N u t r i t i o n S c r e e n i n g I n i t i a t i v e

M U S T : M a l n u t r i t i o n U n i v e r s a l S c r e e n i n g T o o l

M N A : M i n i N u t r i t i o n a l A s s e s s m e n t

A c t u a l n u t r i t i o n a l s t a t u s

P a t h o l o g y

> S w a l l o w i n g d i s o r d e r s


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SNAQ

D i d y o u l o s e w e i g h t u n i n t e n t i o n a l l y ?

> 6 k g i n t h e p a s t 6 m o n t h s

> 3 k g i n t h e p a s t m o n t h s

3

2

D i d y o u e x p e r i e n c e a d e c r e a s e d a p p e t i t e

o v e r t h e p a s t m o n t h ? 1

D i d y o u u s e s u p p l e m e n t a l d r i n k s o r t u b e

f e e d i n g o v e r t h e p a s t m o n t h ? 1

w e l l - n o u r i s h e d

m o d e r a t e l y m a l n o u r i s h e d

s e v e r e l y m a l n o u r i s h e d

1

2

3

Kruizinga et al, Am J Clin Nutr2005;82:10829.


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NRS

Kondrup et al, Clin Nutr 22, 321336, 2003


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NSI

Lipschitz, NSI, Washington DC, 1991


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MUST

BAPEN, 2008


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MNA

Antropometric measurements

Global evaluation

Diet Subjective assessment


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MNA

Screening

>6 items

>If positive (11 points or below): go toAssessment


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TOTAL SCORE(max. 30 points)

Score Risk

24 None

17 score < 24 At risk of malnutrition

< 17 Malnourished


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Problems in Geriatric patients

Validation of instrumentsnot in older people (SNAQ)

age as riskfactor (NRS)


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Validation of instrumentsAnthropometry

>Bedridden patients

>Mobility problems>Body length is not constant


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Age 75 31

Weight 56 56

Length 132 157

BMI 32.1 22.7

BMI?

BMI is doubtfulparameter in olderpeople


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Validation of instrumentsAnthropometry

Social and psychic factors

>Subjective impression>Dementia - depression


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Conclusion

Nutritional assessment should bepart ofroutine evaluation of thegeriatric oncology patient

Nutritional assessment should beframed in a larger CGA(comprehensive geriatricassessment) addressing several

functional domains


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Conclusion

Difference should be madebetween assessment ofrisk andactual nutritional status

Body weight assessment withspecific attention to unintendedweight loss is essential

BMI should be interpreted with

caution (overestimation due toshorter body length)


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Conclusion

Increased alertness

Subjective global assessment

Willingness for early intervention

Documents

The Challenges of Nutritional Assessment in Geriatric Cancer Patients_updated