{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T03:49:59Z","timestamp":1793764199458,"version":"4.6.1"},"reference-count":37,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T00:00:00Z","timestamp":1632441600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010886","name":"Nestl\u00e9 Health Science","doi-asserted-by":"publisher","award":["NA- small project grant"],"award-info":[{"award-number":["NA- small project grant"]}],"id":[{"id":"10.13039\/100010886","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Identification and treatment of malnutrition are essential in upper gastrointestinal (UGI) cancer. However, there is limited understanding of the nutritional status of UGI cancer patients at the time of curative surgery. This prospective point prevalence study involving 27 Australian tertiary hospitals investigated nutritional status at the time of curative UGI cancer resection, as well as presence of preoperative nutrition impact symptoms, and associations with length of stay (LOS) and surgical complications. Methods: Subjective global assessment, hand grip strength (HGS) and weight were performed within 7 days of admission. Data on preoperative weight changes, nutrition impact symptoms, and dietary intake were collected using a purpose-built data collection tool. Surgical LOS and complications were also recorded. Multivariate regression models were developed for nutritional status, unintentional weight loss, LOS and complications. Results: This study included 200 patients undergoing oesophageal, gastric and pancreatic surgery. Malnutrition prevalence was 42% (95% confidence interval (CI) 35%, 49%), 49% lost \u22655% weight in 6 months, and 47% of those who completed HGS assessment had low muscle strength with no differences between surgical procedures (p = 0.864, p = 0.943, p = 0.075, respectively). The overall prevalence of reporting at least one preoperative nutrition impact symptom was 55%, with poor appetite (37%) and early satiety (23%) the most frequently reported. Age (odds ratio (OR) 4.1, 95% CI 1.5, 11.5, p = 0.008), unintentional weight loss of \u22655% in 6 months (OR 28.7, 95% CI 10.5, 78.6, p &lt; 0.001), vomiting (OR 17.1, 95% CI 1.4, 207.8, 0.025), reduced food intake lasting 2\u20134 weeks (OR 7.4, 95% CI 1.3, 43.5, p = 0.026) and \u22651 month (OR 7.7, 95% CI 2.7, 22.0, p &lt; 0.001) were independently associated with preoperative malnutrition. Factors independently associated with unintentional weight loss were poor appetite (OR 3.7, 95% CI 1.6, 8.4, p = 0.002) and degree of solid food reduction of &lt;75% (OR 3.3, 95% CI 1.2, 9.2, p = 0.02) and &lt;50% (OR 4.9, 95% CI 1.5, 15.6, p = 0.008) of usual intake. Malnutrition (regression coefficient 3.6, 95% CI 0.1, 7.2, p = 0.048) and unintentional weight loss (regression coefficient 4.1, 95% CI 0.5, 7.6, p = 0.026) were independently associated with LOS, but no associations were found for complications. Conclusions: Despite increasing recognition of the importance of preoperative nutritional intervention, a high proportion of patients present with malnutrition or clinically significant weight loss, which are associated with increased LOS. Factors associated with malnutrition and weight loss should be incorporated into routine preoperative screening. Further investigation is required of current practice for dietetics interventions received prior to UGI surgery and if this mitigates the impact on clinical outcomes.<\/jats:p>","DOI":"10.3390\/nu13103349","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T21:40:30Z","timestamp":1632778830000},"page":"3349","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["Assessment of Nutritional Status and Nutrition Impact Symptoms in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3822-147X","authenticated-orcid":false,"given":"Irene","family":"Deftereos","sequence":"first","affiliation":[{"name":"Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia"},{"name":"Department of Nutrition and Dietetics, Western Health, Footscray, VIC 3011, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7230-149X","authenticated-orcid":false,"given":"Justin M. C.","family":"Yeung","sequence":"additional","affiliation":[{"name":"Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia"},{"name":"Department of Colorectal Surgery, Western Health, Footscray, VIC 3011, Australia"},{"name":"Western Health Chronic Disease Alliance, Western Health, Footscray, VIC 3011, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2683-3775","authenticated-orcid":false,"given":"Janan","family":"Arslan","sequence":"additional","affiliation":[{"name":"Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa M.","family":"Carter","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Western Health, Footscray, VIC 3011, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Isenring","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia"},{"name":"Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6476-9834","authenticated-orcid":false,"given":"Nicole","family":"Kiss","sequence":"additional","affiliation":[{"name":"Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia"},{"name":"Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of The NOURISH Point Prevalence Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"Bray","year":"2018","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.1002\/bjs.9902","article-title":"Comparison of outcomes after laparoscopy-assisted and open total gastrectomy for early gastric cancer","volume":"102","author":"Lee","year":"2015","journal-title":"BJS"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4846","DOI":"10.3748\/wjg.v24.i43.4846","article-title":"Pancreatic cancer: A review of clinical diagnosis, epidemiology, treatment and outcomes","volume":"24","author":"McGuigan","year":"2018","journal-title":"World J. Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S845","DOI":"10.21037\/jtd.2018.12.09","article-title":"Effects of improving outcomes after esophagectomy on the short- and long-term: A review of literature","volume":"11","author":"Fransen","year":"2019","journal-title":"J. Thorac. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.clnu.2017.02.013","article-title":"ESPEN guideline: Clinical nutrition in surgery","volume":"36","author":"Weimann","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3211","DOI":"10.1016\/j.clnu.2020.03.038","article-title":"Perioperative nutrition: Recommendations from the ESPEN expert group","volume":"39","author":"Lobo","year":"2020","journal-title":"Clin. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1016\/j.clnu.2017.06.017","article-title":"ESPEN expert group recommendations for action against cancer-related malnutrition","volume":"36","author":"Arends","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/1758835919880084","article-title":"From guidelines to clinical practice: A roadmap for oncologists for nutrition therapy for cancer patients","volume":"11","author":"Muscaritoli","year":"2019","journal-title":"Ther. Adv. Med. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1111\/j.1747-0080.2010.01466.x","article-title":"Nutritional management of patients undergoing major upper gastrointestinal surgery: A survey of current practice in Australia","volume":"67","author":"Carey","year":"2010","journal-title":"Nutr. Diet."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1016\/j.amjsurg.2016.10.008","article-title":"Assessment of perioperative nutrition practices and attitudes\u2014A national survey of colorectal and GI surgical oncology programs","volume":"213","author":"Williams","year":"2017","journal-title":"Am. J. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1016\/j.ejso.2020.04.008","article-title":"A systematic review of the effect of preoperative nutrition support on nutritional status and treatment outcomes in upper gastrointestinal cancer resection","volume":"46","author":"Deftereos","year":"2020","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1177\/0884533614532501","article-title":"Translating Evidence-Based Practice Guidelines into a Summary of Recommendations for the Nutrition Management of Upper Gastrointestinal Cancers","volume":"29","author":"Lu","year":"2014","journal-title":"Nutr. Clin. Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1007\/s00520-012-1387-x","article-title":"The nutritional risk in oncology: A study of 1453 cancer outpatients","volume":"20","author":"Bozzetti","year":"2012","journal-title":"Support. Care Cancer"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1016\/j.clnu.2018.04.007","article-title":"Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points","volume":"38","author":"Marshall","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1177\/0148607113502674","article-title":"Prevalence of Malnutrition and Current Use of Nutrition Support in Patients with Cancer","volume":"38","author":"Michallet","year":"2014","journal-title":"J. Parenter. Enter. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Findlay, M., Bauer, J.D., Dhaliwal, R., De Van Der Schueren, M., Laviano, A., Widaman, A., Martin, L., Day, A.G., and Gramlich, L.M. (2020). Translating Evidence-Based Guidelines into Practice\u2014Are We Getting It Right? A Multi-Centre Prospective International Audit of Nutrition Care in Patients with Foregut Tumors (INFORM). Nutrients, 12.","DOI":"10.3390\/nu12123808"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e035824","DOI":"10.1136\/bmjopen-2019-035824","article-title":"Nutritional Outcomes of patients Undergoing Resection for upper gastroIntestinal cancer in AuStralian Hospitals (NOURISH): Protocol for a multicentre point prevalence study","volume":"10","author":"Deftereos","year":"2020","journal-title":"BMJ Open"},{"key":"ref_18","unstructured":"Brody, T. (2011). Clinical Trials: Study Design, Endpoints and Biomarkers, Drug Safety, and FDA and ICH Guidelines, Elsevier Science & Technology."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1177\/014860718701100108","article-title":"What is subjective global assessment of nutritional status?","volume":"11","author":"Detsky","year":"1987","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/jpen.1440","article-title":"GLIM Criteria for the Diagnosis of Malnutrition: A Consensus Report from the Global Clinical Nutrition Community","volume":"43","author":"Jensen","year":"2019","journal-title":"JPEN J. Parenter. Enter. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/ageing\/afr051","article-title":"A review of the measurement of grip strength in clinical and epidemiological studies: Towards a standardised approach","volume":"40","author":"Roberts","year":"2011","journal-title":"Age Ageing"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1111\/jhn.12763","article-title":"Impact of nutritional status\/risk and post-operative nutritional management on clinical outcomes in patients undergoing gastrointestinal surgery: A prospective observational study","volume":"33","author":"Narendra","year":"2020","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1111\/j.1365-277X.2010.01058.x","article-title":"Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer","volume":"23","author":"Garth","year":"2010","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.clnu.2010.07.015","article-title":"Associations between nutritional status, weight loss, radiotherapy treatment toxicity and treatment outcomes in gastrointestinal cancer patients","volume":"30","author":"Hill","year":"2011","journal-title":"Clin. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1080\/01635581.2012.670743","article-title":"Malnutrition Is High and Underestimated During Chemotherapy in Gastrointestinal Cancer: An AGEO Prospective Cross-Sectional Multicenter Study","volume":"64","author":"Attar","year":"2012","journal-title":"Nutr. Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"100638","DOI":"10.1016\/j.currproblcancer.2020.100638","article-title":"Nutritional assessment and risk factors associated to malnutrition in patients with esophageal cancer","volume":"45","author":"Cao","year":"2021","journal-title":"Curr. Probl. Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s00520-019-04803-3","article-title":"Survey and analysis of the nutritional status in hospitalized patients with malignant gastric tumors and its influence on the quality of life","volume":"28","author":"Guo","year":"2020","journal-title":"Support. Care Cancer"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/1758835919875568","article-title":"An update on treatment options for pancreatic adenocarcinoma","volume":"11","author":"Lambert","year":"2019","journal-title":"Ther. Adv. Med. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1111\/1747-0080.12422","article-title":"Use of hand grip strength in nutrition risk screening of older patients admitted to general surgical wards","volume":"75","author":"Byrnes","year":"2018","journal-title":"Nutr. Diet."},{"key":"ref_30","first-page":"539","article-title":"Understanding pancreatic exocrine insufficiency and replacement therapy in pancreatic cancer","volume":"47","author":"Carino","year":"2020","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Movahed, S., Tabrizi, F.V., Pahlavani, N., Toussi, M.S., Motlagh, A.G., Eslami, S., Ghayour-Mobarhan, M., Nematy, M., Ferns, G.A., and Emadzadeh, M. (2021). Comprehensive assessment of nutritional status and nutritional-related complications in newly diagnosed esophageal cancer patients: A cross-sectional study. Clin. Nutr., in press.","DOI":"10.1016\/j.clnu.2021.01.003"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1111\/jhn.12588","article-title":"Nutritional status, the development and persistence of malnutrition and dietary intake in oesophago-gastric cancer: A longitudinal cohort study","volume":"31","author":"Grace","year":"2018","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3161","DOI":"10.1245\/s10434-009-0630-2","article-title":"Nutritional Support with Endoluminal Stenting During Neoadjuvant Therapy for Esophageal Malignancy","volume":"16","author":"Bower","year":"2009","journal-title":"Ann. Surg. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1016\/j.clnu.2018.05.010","article-title":"Malnutrition associated with nutrition impact symptoms and localization of the disease: Results of a multicentric research on oncological nutrition","volume":"38","author":"Martucci","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"5147","DOI":"10.1002\/cncr.33122","article-title":"Association of malnutrition with geriatric assessment impairments and health-related quality of life among older adults with gastrointestinal malignancies","volume":"126","author":"Williams","year":"2020","journal-title":"Cancer"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.clnu.2016.07.015","article-title":"ESPEN guidelines on nutrition in cancer patients","volume":"36","author":"Arends","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/10\/3349\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:04:38Z","timestamp":1760166278000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/10\/3349"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,24]]},"references-count":37,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["nu13103349"],"URL":"https:\/\/doi.org\/10.3390\/nu13103349","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,24]]}}}