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The validity of three malnutrition screening markers among older patients with cancer
  1. Xiaotao Zhang1,2,
  2. Linda Pang3,
  3. Shreela V Sharma4,
  4. Ruosha Li5,
  5. Alan G Nyitray4,6 and
  6. Beatrice J Edwards7
  1. 1 Dan L Duncan Comprehensive Cancer Center, Epidemiology & Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
  2. 2 Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3 General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  4. 4 Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
  5. 5 Biostatistics and Data Science, University of Texas Health Science Center, Houston, Texas, USA
  6. 6 Department of Psychiatry and Behavioral Medicine Center for AIDS Intervention Research (CAIR) MCW Cancer Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  7. 7 Central Texas Veterans Healthcare System, Temple, Texas, USA
  1. Correspondence to Dr Beatrice J Edwards, Central Texas Veterans Healthcare System, Temple, TX 76501, USA; Beatrice.Edwards{at}


Background Malnutrition is common in older adults with cancer and is associated with adverse clinical outcomes. We assessed and compared the validity of three tools commonly used to screen for malnutrition: The Mini Nutritional Assessment (MNA), weight loss and body mass index (BMI).

Methods In this retrospective study, we reviewed patients over age 65 with a diagnosis of cancer who were treated at the MD Anderson Cancer Center between 1 January 2013 and 31 March 2017. All patients in this study were evaluated by a trained geriatrician as part of a comprehensive geriatric assessment (CGA). Malnutrition was diagnosed by both CGA and clinical examination. The sensitivity, specificity and Cohen’s κ of each tool was also compared with the clinical diagnosis.

Results A total of 454 older patients with cancer who had malnutrition information available were included in the analyses. The median age was 78%, and 42% (n=190) were clinically diagnosed with malnutrition at baseline. When the MNA was performed, 105 out of 352 patients (30%) were malnourished, and 122 (35%) at risk of malnutrition. Weight loss >3 kg was seen in 183 out of 359 (51%) patients, and BMI <20 kg/m2 was found in 30 of the 454 (7%) patients. MNA had the highest validity (area under curve (AUC)=0.83) and reliability (κ=0.67), weight loss had moderate validity (AUC=0.73) and reliability (κ=0.46), while BMI had the lowest validity (AUC=0.55) and reliability (κ=0.55).

Conclusions For clinical practice, MNA should be incorporated for standard assessment/screening for these older patients with cancer.

  • malnutrition
  • CGA
  • weight loss
  • MNA
  • BMI
  • older patients with cancer

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  • Contributors BJE: conceptualisation, funding acquisition, investigation, methodology, supervision, validation, writing, review and editing. Developed the study concept, designed the study, monitored the study and revised the manuscript. XZ: methodology, investigation, data curation, formal analysis, writing, original draft. Collected the data, cleaned the data, analysed the data, interpreted the data, drafted the manuscript and revised the manuscript. All other coauthors (LP, SVS, RL and AGN) review and editing; reviewed the manuscript and gave comments and suggestions.

  • Funding This work was funded (in part) by a Research Training Award for Cancer Prevention Post-Graduate Training Program in Integrative Epidemiology from the Cancer Prevention & Research Institute of Texas, grant number RP160097 (PI: M. Spitz).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval University of Texas, MD Anderson Cancer Center Institutional Review Board, protocol number: PA14-0460.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data may be obtained from a third party and are not publicly available.