Nutritional assessment in gynecological cancers: Experience from an Indian tertiary care center

Malnutrition is highly prevalent among cancer patients and significantly impacts treatment outcomes. In India, the cancer-specific mechanisms of malnutrition are further exacerbated by the already high prevalence of malnutrition in the general population. Despite its clinical significance, nutritional screening remains underutilized in women with gynecological cancers. This study aims to assess malnutrition in Indian women with gynecological cancers using the standard Patient-Generated Subjective Global Assessment (PG-SGA) and the new Global Leadership Initiative on Malnutrition (GLIM) criteria screening tools.

A prospective observational study was conducted at a tertiary center in India, involving 130 women with newly diagnosed gynecological cancers. Nutritional status was assessed using anthropometric measures (BMI, mid-arm circumference, calf circumference), inflammatory markers (serum albumin, C-reactive protein, neutrophil-to-lymphocyte ratio), and the PG-SGA and GLIM criteria. Perioperative outcomes, including blood loss, hospital stay, and complications, were evaluated.

Malnutrition was identified in 56.1 % of patients, using both PG-SGA and GLIN criteria, with the highest prevalence observed in ovarian cancer (68.1 %). Calf circumference < 33 cm and hypoalbuminemia (<3.5 g/dL) exhibited the best diagnostic accuracy to detect malnutrition (AUC: 0.70-0.71). Weighted kappa statistic showed moderate agreement between the PG-SGA and GLIM classifications, but PG-SGA defined malnutrition significantly predicted postoperative complications (p = 0.029), whereas the GLIM criteria did not show a significant correlation.

Both PG-SGA and GLIM are effective in detecting malnutrition, though PG-SGA is a stronger predictor of postoperative outcomes. While anthropometric and biochemical markers aid in diagnosis, they cannot replace comprehensive nutritional screening. Standardized nutritional screening and multimodal prehabilitation strategies, should be integrated into gynecological cancer management to improve patient care and surgical outcomes.