- GlobalSurg Collaborative and NIHR Global Health Unit on Global Surgery. Impact of malnutrition on early outcomes after cancer surgery: an international, multicentre, prospective cohort study. Lancet Glob Health 2023; 11: e341–49.
The different degrees of malnutrition were defined according to the international criteria of the Global Leadership Initiative on Malnutrition (GLIM). According to these criteria, severe malnutrition exists if the BMI is < 18.5 kg/m2 or if there is an unintentional weight loss of more than 10% within 6 months.
The respective gross national income of the countries from which the patients came was also taken into account. These were divided into high, middle or low income countries according to the World Bank classification.
The research found that severely malnourished patients were predominantly from middle- and especially low-income countries. In poor countries, their share was 62.5%, while in rich countries it was only 22%.
At the same time, malnutrition proved to be a clear risk factor for the patients' outcome. Thus, severe malnutrition was associated with increased 30-day mortality across all country income groups. The proportion of patients with postoperative infections or other complications was also higher in severely malnourished subjects than in those who were only moderately malnourished or not malnourished at all.
Another impressive observation from the study: patients from low-income countries who were not or only slightly malnourished, had nonetheless a higher 30-day mortality than severely malnourished patients from high-income countries. In addition to the nutritional status, the country of origin thus plays a significant role in the outcome.
The authors point out that malnutrition as a risk factor can be modified in principle. Even simple and inexpensive measures such as routine screening and perioperative nutritional interventions could reduce morbidity and mortality.
A world without hunger is the declared goal of the United Nations and one of its Sustainable Development Goals. However, malnutrition is still a significant risk factor for the post-operative outcome of tumour patients, especially in poorer countries. Simple means such as screening and assessment tools like guidelines for tumour patient nutrition could significantly improve care worldwide.