Table 2

Nutritional status and quality of life in gastrointestinal cancer
First Author, Year, Study Place Data Collection Period Study Design Sample Size Nutritional Assessment Quality of Life Assessment Groups being compared Key results Conclusion
Tian J, 2009, China [20] January 2007 to December 2007 Cross-sectional study 233 advanced stomach cancer Daily calorie and protein intake using Food Frequency Survey Method and Food Composition Database, BMI, albumin ECOG performance status


<18 kg/m2 and > =18 kg/m2


<35 g/L and > =35 g/L

Daily Calorie intake

<2400 kcal and > =2400 kcal

Daily Protein intake

<70 g and > =70 g

The relative risk (95% confidence interval) was 1.16 (1.02–1.32) for low level

of daily calorie intake versus normal level of daily calorie intake.

Low level of daily calorie intake may be the risk factor of poor performance status of the patients with advanced stomach cancer
Tian J, 2008, China [21] January 2006 and June 2006 Cross-sectional study 113 esophagus, stomach, and colorectal Daily calorie and protein intake using Food Frequency Survey Method and Food Composition Database, BMI, albumin EORTC QLQ-C30 Calorie intake, BMI and albumin used as continuous variables After age, sex, and stage of the disease were adjusted, patients with high daily intakes of calories and protein, as well as high level of albumin, had a significantly better quality of life.

Nutrition status 1 year after being discharged

from hospitals may be associated with better QoL in patients with esophagus, stomach, and colon cancers

Correia M, 2007, Portugal [22] December 2003 to November 2004 Prospective consecutive case series 48 with a recent (< 4 weeks) diagnosis of gastric cancer

1. Percentage of weight



3. BIA for FFMI

4. Hand Grip Dynamometry


1. Weight Loss: > 10% in the previous six months or > 5% in the last month & < 10% in the previous six months or < 5% in the last month.


Well-nourished, mild malnutrition (MN) & severe MN.

3. Hand Grip Dynamometry: Below 85% & above 85%

Malnutrition identified through PG-SGA, percentage of weight loss at 1 month, FFMI or dynamometry was positively associated to a worse QoL with the worst performance in all dimensions of QoL being attributed to those patients identified as malnourished by PG-SGA. PG-SGA was correlated with the several dimensions for QoL evaluation.
Martin L, 2007, Sweden [23] 2 April 2001 to 30 October 2004 Prospective population-based cohort study

233 with esophageal or cardia cancer

Adenocarcinoma cardia: n = 102; esophageal adenocarcinoma: n = 82; Oesophageal squamous cell carcinoma: n = 49

Postoperative weight change, measured as the difference in BMI

between the time of tumor resection and 6 months later


2. QLQ-OES18

Postoperative weight change –

Six groups:

Group I: Stable or increased, Group II: decrease of 1–4%,

Group III: 5–9% decrease, Group IV: 10–14% decrease,

Group V: 15–19% decrease, Group VI: ≥ 20% decrease

Patients with a BMI decrease of at least 20 per cent experienced more appetite loss (mean score difference 26; P = 0·002), eating difficulties (mean score difference 18; P < 0·002) and odynophagia (mean score difference 12; P = 0·044) than patients without postoperative weight loss, whereas scores for dysphagia and gastro-oesophageal reflux were similar between these groups. Malnutrition is a considerable problem after oesophagectomy, and is linked to appetite loss, eating difficulties and odynophagia.
Gupta D, 2006, USA [24] March 2001 to June 2003 Retrospective 58 histologically confirmed stages III and IV colorectal cancer

1. Serum albumin,

2. Prealbumin,

3. serum Transferrin,

4. Phase angle by BIA

5. SGA


Well nourished: SGA-A (n = 34) &

Malnourished: (SGA-B&C)

(n = 24)

All others were used as continuous variables.

SGA: Well-nourished patients had significantly better QoL scores in the global, physical, role function scales and fatigue, pain, insomnia, appetite loss, and constipation symptom scales.

Serum albumin, serum transferrin, and phase angle: were significantly correlated with the physical and role function scales and fatigue and appetite loss symptom scales.

Malnutrition is associated with poor QoL, as measured by the QLQ-C30 in colorectal cancer.
Tian J, 2005, China [25] April 2004 to May 2004 Retrospective 285 surgical stomach cancer Daily calorie intake using Food Frequency Survey Method and Food Composition Database

3 QoL groups: bad (total score under

60), modest (total score within 60–80) and good (total score over 80)

Good, modest and bad quality of life For both males and females, the daily nutrition intake among three groups, except vitamin C, were statistically different, which suggested that the patients who had a better nutritional status had a higher quality of life. The nutritional status of the operated patients with stomach cancer may impact their QoL. Exercise for rehabilitation can whet the appetite of the patients and recover their body function, which in turn may improve QoL.
Andreyev HJN, 1998, UK [26] April 1990 to March 1996 Retrospective


tumors of oesophagus, stomach, pancreas,

colon or rectum

Oesophageal: n = 179; Gastric: n = 433; Pancreatic: n = 162; Colorectal: n = 781;

Weight loss at presentation EORTC-QLQ-C30 With weight loss & no weight loss Patients with weight loss at presentation had a mean quality of life score which was less than patients with no weight loss, especially in patients with gastric (P < 0.008), pancreatic and colorectal cancers (P < 0.0001) and also when all sites were combined. (P < 0.0001). Patients with weight loss had a worse quality of life score.
O’Gorman P, 1998, UK [27] NA Prospective

119 gastrointestinal cancer

Colorectal: n = 43; Esophageal: n = 27; Gastric: n = 38; Pancreatic: n = 11

Weight loss*

* defined as loss of more than 5% pre-illness weight in the previous 6 months

1. EuroQol EQ-5D


Weight-stable (< 5% weight loss) (n = 22) & Weight-losing (> 5% weight loss) (n = 97)

1. EuroQol EQ-5D –

Median (range) = 0.85 (0.03-1.00) & 0.52 (−0.26-1.00) respectively for weight-stable and weight-losing groups, p < 0.001.

2. EORTC QLQ-C30 –

The results in most subscales of the EORTC QLQ-C30 questionnaire were poorer in the weight-losing group (p < 0.01).

Weight loss and reduction of appetite are important related factors in lowering the quality of life of gastrointestinal cancer patients.

Lis et al.

Lis et al. Nutrition Journal 2012 11:27   doi:10.1186/1475-2891-11-27

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