Effect of Nutrition Risk Screening 2002-guided enteral nutrition on nutritional status in gastrointestinal tumor patients

Abstract

BACKGROUND

Malnutrition exacerbates the deterioration in patients with advanced gastrointestinal tumors.

AIM

To analyze the effect of enteral nutritional support based on Nutrition Risk Screening 2002 (NRS2002) risk assessment on nutritional function in patients with gastrointestinal tumors.

METHODS

One hundred twelve patients from April 2022 to April 2024 were included for observation and were divided into a control group and an observation group by random number method, 56 each. Both groups received treatment for four consecutive weeks. The control group received routine enteral nutrition support, while the observation group received enteral nutrition support based on the NRS2002 risk assessment. Nutritional function, intestinal mucosal barrier function, quality of life, and complication rate were compared between the two groups. Statistical analysis was completed using SPSS26.0 and Excel.

RESULTS

After nutritional intervention, transferrin, albumin, hemoglobin, and diamine oxidase levels in the observation group were higher than those in the control group, while C-reactive protein, tumor necrosis factor α, and quality of life scores were lower, with significant differences (P < 0.05). There was no significant difference in complications between groups (P > 0.05), but the complication rate was lower in the observation group.

CONCLUSION

Enteral nutritional support based on NRS2002 risk assessment for patients with gastrointestinal tumors positively impacts nutritional status and promotes intestinal mucosal barrier function recovery. Patients’ quality of life improved, and the incidence of adverse reactions decreased, indicating clinical promotion and application value.

Key Words: Gastrointestinal tumors; Nutrition Risk Screening 2002; Risk assessment; Enteral nutrition support; Nutritional function

Core Tip: Effective enteral nutrition support holds utmost significance for tumor patients. In particular, those diagnosed with gastrointestinal tumors often face challenges like malabsorption due to their condition. Adequate enteral nutrition not only provides essential nutrients to maintain strength but also helps boost the immune system, enabling patients to better endure cancer treatments such as chemotherapy and radiotherapy.

INTRODUCTION

Gastrointestinal tract tumors are a common type of clinical malignant tumor. These tumors often lack typical symptoms in the early stages, leading to diagnosis at the middle or late stages, characterized by a high fatality rate. Malnutrition exacerbates the deterioration of patients with advanced cancer and negatively impacts prognosis recovery[1]. Many scholars consider enteral nutrition support the most effective, safe, and economical nutritional intervention[2]. Enteral nutrition support is a primary consideration for gastrointestinal tumor diseases where intestinal function remains normal. However, patients often experience adverse reactions such as early satiety, nausea, vomiting, pulmonary aspiration, and metabolic complications, increasing the body’s burden. Additionally, psychological and social factors lead many cancer patients to resist nasogastric tube feeding, necessitating parenteral nutrition to improve nutritional levels. The operation, immune function, prognosis, and treatment costs of patients with gastrointestinal tumors are all related to their nutritional status, making it essential to find tools to accurately evaluate this status. Nutrition Risk Screening 2002 (NRS2002) is a tool used to assess nutritional risk, enabling medical staff to evaluate nutritional status promptly and provide targeted interventions early. This study primarily discusses the mechanism of enteral nutrition support based on NRS2002 nutritional risk assessment to improve the prognosis of patients with gastrointestinal tumors.

MATERIALS AND METHODS

General information

A total of 112 patients with gastrointestinal tumors treated at Suzhou Municipal Hospital (April 2022 to April 2024) were selected for observation. The diagnostic criteria is meeting the diagnostic criteria for gastrointestinal tumors[3]. Inclusion criteria is as followed: (1) Hospitalized patients with a pathological diagnosis of gastrointestinal tumors; (2) Relatively stable and conscious patients; (3) NRS2002 assessment score of 3 points; (4) Complete clinical data; and (5) Informed consent obtained from patients and family members. Exclusion criteria is as followed: (1) Estimated survival time of less than 3 months; (2) Patients with extensive abdominal or liver metastasis during the study; (3) Patients without an accurate body mass index or inappropriate NRS2002 due to inability to stand, severe ascites, or severe edema; (4) Patients with language or hearing impairments; and (5) Patients unable to follow up after discharge. The general data of the two groups were comparable (P > 0.05) (Table 1).

Table 1 General data comparison, mean ± SD/n.

General information	Observation group (n = 56)	Control group (n = 56)	t/χ2	P value
Average age, years	68.80 ± 4.11	68.70 ± 4.28	0.126	0.900
Gender
Male	36	31	0.929	0.335
Female	20	25
ECOG score			0.175	0.982
1	24	26
2	18	17
3	8	7
4	6	6
Average BMI, kg/m²	20.44 ± 1.11	20.28 ± 1.35	0.685	0.495
Tumor location			0.150	0.928
Stomach	21	23
Rectum	18	17
Colon	17	16
Adjuvant therapy, radiotherapy/chemotherapy	30/26	31/25	0.036	0.850
Tumor stage			0.000	1.000
Stage I	30	27
Stage II	18	19
Stage III	6	7
Stage IV	2	3

Eastern Cooperative Oncology Group performance status score is ranging from 0 (fully active) to 4 (severely disabled). Tumor location indicates the primary site of the tumor (stomach, rectum, or colon). Adjuvant therapy indicates the additional treatment received (radiotherapy or chemotherapy). Tumor stage indicates the tumor stage according to the tumor-node-metastasis classification system. ECOG: Eastern Cooperative Oncology Group; BMI: Body mass index.

Methods

The study subjects were randomly assigned to a control or observation group. Both groups signed informed consent forms, and the ethics committee approved the study. The control group received routine enteral nutrition support. A slow infusion via the nasogastric feeding pump was used, tailored to the patient’s condition. Enteral nutritional emulsion (Huarui Pharmaceutical, National medicine approval H20040188) was administered as follows: Day 1 (200 mL), day 2 (250 mL), day 3 (500 mL) postoperatively, days 1-4 (1000 mL), and full enteral nutritional support from day 5. It was important to ensure the proper position of the gastric tube during nasal feeding and that the nutrient solution was at a suitable temperature. Careful observation was needed to prevent air from entering the stomach, with oral cleansing after nasal feeding to prevent infection by pathogenic bacteria. Patients’ nutritional status was analyzed using clinical indicators, and nutrition programs were adjusted as needed.

The observation group received enteral nutrition support based on NRS2002 risk assessment. (1) An NRS2002 nutritional risk screening team was established, including nutrition doctors, nutritionists, head nurses, attending physicians, and nursing staff. Before the study began, team members learned to apply the NRS2002 risk screening system; (2) The NRS2002 system was used to measure, screen, and evaluate the nutritional risk of patients with gastrointestinal tumors. General patient data, including age, weight, height, dietary status, and recent weight loss, were collected and organized for initial screening; (3) Personalized nutrition support plans were established based on NRS2002 evaluation results. Nutrition doctors and nutritionists accurately measured energy needs according to patient age, weight index, and condition, calculating total energy as resting state energy consumption + eating thermodynamic consumption + body activity consumption, and adjusted the carbohydrate, lipid, and protein ratios accordingly. Dietitians recorded daily nutritional support content and patients’ initial and final screening results. Nutrition and health education for patients included video explanations, graphic manuals, demonstrations, and real case analyses to help patients commit to nutritional support. Real-time nutritional support improvement measures were implemented, such as adjusting protein intake and drug ratios, in line with the control group. Dietitians and nursing staff supervised patients’ adherence to nutritional support measures, regularly monitored and evaluated anthropometric, biochemical, and nutritional indicators, corrected poor eating habits, and ensured timely and adequate nutritional supplements during ward rounds; and (4) Final screening was completed with NRS2002 risk screening, and the enteral nutrient solution ratio was adjusted for patients with significant nutritional risk or unchanged nutritional status.

Observational indicators

Nutritional functions before and after the nutritional intervention were compared between the two groups. Before and after the intervention, 2 mL of fasting venous blood was drawn from both groups. After centrifugation, serum was isolated and tested for hemoglobin, albumin, and transferrin using an automatic biochemical analyzer (Beckman, AU5800). The observational indicators were as followed: (1) Mucosal barrier function before and after nutritional intervention. Before and after the intervention, 3 mL of early morning fasting venous blood was extracted from both groups, centrifuged at 1500 r/min for 10 minutes, and the serum was isolated. Levels of diamine oxidase, plasma endotoxin, C-reactive protein, and tumor necrosis factor α (TNF-α) were measured using an automatic biochemical analyzer (Beckman, AU5800); (2) Quality of life before and after the nutritional intervention. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was used before and after the intervention. This questionnaire, developed by the European Organization for Research and Treatment of Cancer, includes physical, emotional, and other domains, as well as a total score. Scores are inversely related to patient quality of life; and (3) The incidence of adverse effects in the two groups was compared.

Statistical analysis

All data collected in this study were processed using SPSS 26.0 statistical software and Excel spreadsheets. Measurement data conforming to a normal distribution are presented as mean ± SD. An independent sample t-test and paired sample t-test were used for between-group and within-group comparisons, respectively. Categorical data are expressed as rates, and a χ²-test was used. A P value of less than 0.05 indicates a significant difference.

RESULTS

Nutritional function

After the nutritional intervention, the nutritional status indices of patients in both groups increased. The transferrin, albumin, and hemoglobin levels in the observation group were higher than those in the control group, with significant differences (P < 0.05) (Table 2).

Table 2 Assessment of nutritional function, mean ± SD.

Index	Time	Observation group (n = 56)	Control group (n = 56)	t	P value
Transferrin, g/L	Before	1.55 ± 0.33	1.52 ± 0.34	0.474	0.637
	After	2.96 ± 0.55	2.74 ± 0.41	2.400	0.018
t’		16.451	17.141
P value		< 0.001	< 0.001
Albumin, g/L	Before	28.34 ± 2.55	28.39 ± 2.48	0.105	0.916
	After	36.88 ± 5.21	34.28 ± 3.56	3.083	0.003
t’		11.017	10.159
P value		< 0.001	< 0.001
Hemoglobin, g/L	Before	82.33 ± 4.21	82.39 ± 4.31
	After	98.75 ± 5.41	96.33 ± 3.25	0.075	0.941
t’		17.925	19.325	2.869	0.005
P value		< 0.001	< 0.001

Intestinal mucosal barrier function

There was no difference in intestinal mucosal barrier function between the two groups before the nutritional intervention (P > 0.05). After the intervention, patients showed improved intestinal mucosal barrier function. In the observation group, C-reactive protein and TNF-α levels were lower than those in the control group, with statistical significance (P < 0.05) (Table 3).

Table 3 Index of intestinal mucosal barrier function, mean ± SD.

Index	Time	Observation group (n = 56)	Control group (n = 56)	t	P value
Diamine oxidase, U/L	Before	6.32 ± 2.11	6.28 ± 2.08	0.101	0.920
	After	13.17 ± 2.08	10.21 ± 1.89	7.882	< 0.001
t’		17.301	10.464
P value		< 0.001	< 0.001
C reactive protein, mg/L	Before	32.11 ± 4.28	31.44 ± 5.11
	After	12.28 ± 3.14	16.44 ± 2.84	0.752	0.454
t’		27.955	19.201	7.353	< 0.001
P value		< 0.001	< 0.001
TNF-α, ng/L	Before	52.44 ± 4.11	52.24 ± 5.02	0.231	0.818
	After	41.44 ± 3.54	46.11 ± 11.02	2.373	0.019
t’		15.175	3.788
P value		< 0.001	< 0.001

No difference of intestinal mucosal barrier function between the two groups before nutritional intervention (P > 0.05); after the nutritional intervention, the patients improved intestinal mucosal barrier function, the observation group, and C-reactive protein and tumor necrosis factor α were lower than the control group, statistically significant (P < 0.05). TNF-α: Tumor necrosis factor α.

Quality of life

After the nutritional intervention, the scores in all dimensions of quality of life decreased compared to before the intervention. The emotional, physical, and other field scores were lower than those of the control group. The differences were statistically significant (P < 0.05) (Table 4).

Table 4 Quality of life score, mean ± SD.

Index	Time	Observation group (n = 56)	Control group (n = 56)	t	P value
Physical domain, points	Before	17.12 ± 2.11	17.16 ± 2.02	0.102	0.919
	After	9.44 ± 1.12	11.84 ± 1.81	8.438	< 0.001
t’		24.059	14.678
P value		< 0.001	< 0.001
Emotional domain, points	Before	9.22 ± 1.34	9.18 ± 1.44	0.152	0.879
	After	5.02 ± 1.02	7.11 ± 0.81	12.008	< 0.001
t’		18.663	9.376
P value		< 0.001	< 0.001
Other areas, sub-level	Before	15.98 ± 1.66	15.92 ± 1.75	0.186	0.853
	After	8.86 ± 1.02	10.02 ± 1.44	4.919	< 0.001
t’		27.347	19.482
P value		< 0.001	< 0.001
Total score	Before	42.11 ± 5.84	42.34 ± 5.74	0.210	0.834
	After	23.44 ± 3.64	28.11 ± 2.85	7.559	< 0.001
t’		20.303	16.616
P value		< 0.001	< 0.001

Incidence of adverse reactions

Adverse reactions were not significantly different (P > 0.05) but were lower in the observation group (Table 5).

Table 5 Incidence of adverse reactions, n (%).

Group	Case	Early satiety	Nausea and vomiting	Lung inhalation	Metabolic complications	Prevalence of adverse reactions
Observation	56	1 (1.79)	1 (1.79)	0 (0.00)	0 (0.00)	2 (3.57)
Control	56	1 (1.79)	2 (3.57)	1 (1.79)	1 (1.79)	5 (8.93)
χ2						0.610
P value						0.435

DISCUSSION

Nutritional function is an important indicator for evaluating patients’ nutritional and dietary status. Patients with gastrointestinal tumors are affected by cancer cells, drugs, immobility, and other factors, leading to metabolic disorders and poor nutrient absorption, which can result in malnutrition[4]. The results of this study show that after nutritional intervention, the levels of transferrin, albumin, and hemoglobin in the observation group were higher than those in the control group, with significant differences (P < 0.05). This suggests that enteral nutrition support based on NRS2002 risk assessment can effectively improve the nutritional status of patients with gastrointestinal tumors. The reasons are as follows: Through NRS2002 risk screening, medical staff can develop targeted nutritional interventions based on individual patient differences and adjust the dosage and ratio of enteral nutritional emulsion, significantly improving patients’ nutritional function.

Malnutrition in patients with gastrointestinal tumors can lead to intestinal mucosa atrophy, decreased protein synthesis, and low immune function. Dysfunction of the intestinal barrier increases permeability, causing bacteria and toxins to translocate and pro-inflammatory factors to be massively released[5]. The study results showed that the intestinal mucosal barrier function improved in both groups after nutritional intervention[6,7]. The observation group had higher diamine oxidase levels and lower C-reactive protein and TNF-α levels than the control group (P < 0.05). This suggests that NRS2002 risk screening can adjust the intestinal mucosal barrier function in patients with gastrointestinal tumors. The reasons may include nutritional support based on NRS2002 risk assessment, allowing medical staff to adjust growth hormone and dietary fiber to promote intestinal mucosal metabolism, improve intestinal nutrition supply, and emphasize the importance of intestinal nutrition support for prognosis[8-10]. This promotes the proliferation and repair of intestinal mucosal cells, prevents the circulation of bacteria, toxins, and allergens, and improves intestinal mucosal barrier indicators[11-14].

After nutritional intervention, quality of life scores decreased in both groups, with the observation group showing lower scores in emotional, physical, and other fields compared to the control group (P < 0.05). Although adverse reactions were not significantly different (P > 0.05), their incidence was lower in the observation group, suggesting that enteral nutrition support based on NRS2002 risk screening ensures patient safety and reduces the incidence of adverse reactions. By using NRS2002 risk screening, medical staff provide patients with dynamic nutrition support measures. These measures help patients understand the role and significance of enteral nutrition support[15]. For patients with gastrointestinal tumors, personalized nutrient ratios are designed to ensure sufficient postoperative decomposition and metabolism, reasonably adjust gastrointestinal function and nutritional status, and promote the recovery of body function[16]. This measure not only improves nutrition supply but also significantly reduces body inflammation, thereby avoiding the risk of adverse reactions due to intestinal dysfunction[17,18]. However, because the study sample size is small and the duration is short, the difference in adverse reactions between the two groups is not meaningful and can be addressed in follow-up studies. Furthermore, further validation using larger and more diverse datasets is needed to determine the robustness and generalizability of the findings.

CONCLUSION

Implementing enteral nutritional support based on the NRS2002 risk assessment for patients with gastrointestinal tumors positively improves their nutritional status and promotes the recovery of intestinal mucosal barrier function. It also enhances their quality of life. Although there was no significant difference in the incidence of complications between the two groups, the study demonstrated that NRS2002-based enteral nutritional support does not increase the incidence of complications in patients with gastrointestinal tumors. This approach holds important clinical application value.