The Nutritional Assessment of Gastric Cancer Outpatients and its Relation with Sarcopenia

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The purpose of this study was to assess the nutritional status of outpatient gastric cancer patients. Methods We recruited outpatient gastric cancer patients referred for chemotherapy to a tertiary hospital in Tehran and Mashhad, Iran between February and July 2023. Demographic information, malignancy and treatments characteristics were collected. We used the Patient-generated Subjective Global Assessment (PG-SGA), anthropometric parameters, clinical symptoms, hand-grip strength (HGS), and dietary intakes. For sarcopenia, we used The Sarcopenia: revised European consensus on definition and diagnosis (EWGSOP2). Results One hundred and sixteen patients were assessed. The mean age was 60.77 ± 11.95, and 70% were male. The mean PG-SGA was 14.98 ± 7.78. We found that 94% of the patients were malnourished (PG-SGA score ≥ 4), and 72.4% of the patients required urgent nutritional support (PG-SGA score ≥ 9). 73.2% were underweight. Significant weight loss was seen in 73.2%. Also, 85.3% of the patients had sarcopenia, with 16.4% having severe sarcopenia. Older age (> 65 years, p = 0.006), tumor site (p = 0.02), cancer duration (p < 0.001), weight loss in the last one month (p < 0.001), and 6 months (p < 0.001), walking velocity (p < 0.001), and sarcopenia (p < 0.001) were associated with PG-SGA score. There was a negative correlation between PG-SGA score and global quality of life (p 0.05). Conclusion Malnutrition and sarcopenia are prevalent in patients with gastric cancer during chemotherapy. Therefore, nutritional assessment and interventions should be promptly evaluated and provided as soon as possible to improve the nutritional status of outpatients with gastric cancer in Iran. Gastric cancer. Patient-generated subjective global assessment (PG-SGA). Malnutrition. Sarcopenia Introduction Cancer, as a non-communicable disease, is the second cause of death worldwide after cardiovascular diseases ( 1 ). Despite its chronic and incurable nature and the possibility of disease recurrence, cancer imposes a significant cost on different societies. According to the International Association of Cancer Registry, the global cost of cancer in 2010 was estimated at 1016 trillion dollars ( 2 ). In Iran, cancer was the third leading cause of death after cardiovascular diseases and accidents ( 3 ). In 2020, gastric cancer was the fifth most common cancer and the fourth leading cause of cancer death in the world. According to the World Health Organization, stomach cancer is the eleventh most common cancer and a leading cause of cancer-related deaths ( 4 ). The prevalence of malnutrition in cancer patients is high ( 5 ), with up to 85% of cases reported ( 6 ), and up to 90% in patients with upper gastrointestinal tract cancers ( 7 ). In addition, cancer treatments such as surgery, radiation therapy, and chemotherapy can also cause malnutrition and weight loss in these patients ( 8 ). Malnutrition can increase morbidity, mortality rate, length of hospital stay, treatment costs, and days absent from work while decreasing the quality of life and survival rate of patients ( 9 ). It also makes them susceptible to infection and reduces the effectiveness of cancer treatments, including chemotherapy, radiation therapy, and surgery, which may lead to discontinuation of anti-malignancy treatments for patients ( 8 ). Furthermore, malnutrition increases the risk of anorexia-cachexia syndrome, which is debilitating and associated with high mortality ( 10 ) Studies have shown that it increases the mortality rate of cancer patients by 20% ( 11 ). More than half of Iranian patients with cancer have malnutrition ( 5 ).In a cross-sectional study by Movahed et.al, conducted in Iran in 2012 on 166 cancer patients who referred for the first time to a radiation oncology center based on MUST, 48.8% of patients were at low risk and 38.5% of them were at high risk of malnutrition ( 12 ). In a cross-sectional study by Zarif Yegane et.al, conducted in Iran in 2006 on 71 cancer patients undergoing chemotherapy, the variables of nutritional status, weight changes, body mass index, PG-SGA and food intake were investigated in these patients. Totally, 80% of patients need nutritional interventions ( 13 ). Moreover, in another study by Davidson et al., performed in Australia in 2012 on 121 cancer patients undergoing chemotherapy, the variables of nutritional status, weight changes, body mass index and food intake were investigated. Generally, 26% of these patients were malnourished, 10% had decreased food intake due to severe nausea and vomiting, 20% had significant weight loss, and 18% needed nutritional intervention ( 14 ). In a study at 2017 by Cruz et.al on gastrointestinal cancer patients based on SGA, 21% had moderate malnutrition and 82.5% had severe malnutrition ( 15 ). In a prospective multicenter study by Karabulut et.al, demographic, oncological and nutritional data of 116 metastatic gastric cancer patients were collected. The nutritional status of patients was assessed with the Nutritional Risk Index (NRI), Body Mass Index (BMI) and weight loss percentage within 21-day period between chemotherapy cycles. Malnutrition was diagnosed in 67% of the patients and was severe in 31% of them ( 16 ). In Se et.al on gastrectomized patients under chemotherapy, based on PG-SGA 59% of the patients were malnourished, and 27.8% of the patients revealed serious malnutrition with PG-SGA score of ≥ 9 ( 17 ). According to the reviewed studies, most of the studies conducted in Iran were on hospitalized patients with gastric cancer. Additionally, a study that evaluated the nutritional status of outpatients with gastric cancer undergoing chemotherapy and the sarcopenia index did not provide data.. Considering that the type of treatment for these patients has an effect on their nutritional status and most patients with stomach cancer undergo chemotherapy, a comprehensive review of the nutritional status of outpatient cancer patients with stomach cancer during chemotherapy using PG-SGA tool, anthropometric indicators, clinical complications, and nutritional intake seems essential. Materials and methods Participants A multi-center, cross-sectional observational study was conducted from March 2023 to August 2023 at two public hospitals in Iran (Ghaem Hospital in Mashhad and Emam Khomeini Hospital in Tehran. A total of 116 gastric cancer patients were included. Inclusion criteria were as follows: ( 1 ) aged 18 to 90 years, ( 2 ) conscious, ( 3 ) no communication disorders, ( 4 ) able to cooperate with relevant inspection; ( 5 ) histologic diagnosis of gastric cancer; ( 6 ) complete medical history records and follow-up data; ( 7 ) Informed consent. Exclusion criteria were patients who refused or did not cooperate with the questionnaire. This study was approved by the Ethics Committee of Mashhad University of Medical Sciences (IR.MUMS.MEDICAL.REC.1401.507). Assessment methods All measurements were performed by trained researcher. Nutritional status was evaluated by PG-SGA developed by Ottery ( 18 ). It includes patients’ self-reported sections (body weight, eating conditions, symptoms, activities, and physical function) and a medical personnel assessment part (nutrition-related disease state, metabolic state, and physical examination) in seven domains. The sum of scores obtained in each domain is divided into three categories: scores of 0–3 (well-nourished/suspicious malnutrition), 4–8 (moderate malnutrition), and ≥ 9 (severe malnutrition). Patients scoring 4–8 points require nutritional intervention by a dietitian with a clinical symptom survey. Patients scoring ≥ 9 points are in great need of symptom management and nutrition intervention before anti-tumor treatment ( 19 ). The sarcopenia index was made using the EWGSOP2 guidelines and includes all people. Muscle strength was measured based on hand strength or a constant 709E dynamometer (made in China). The cut line of hand strength is standardized according to age and gender in Iranian society ( 15 ). It includes three tests of muscle strength, muscle volume, and walking speed. Pre-sarcopenia is diagnosed if a person has only muscle weakness. If, in addition to the decrease in muscle weakness, there is also a decrease in muscle mass, it is sarcopenia. And if all three indicators of sarcopenia are reduced, sarcopenia is severe. Height was measured using Seca model 206 (made in Germany). From the highest point of the head to the ground, a person leans against the wall without shoes, and the shoulders, hips, and backs of the legs are in contact with the wall. Then the shoulders were raised with a deep breath and the height was measured. If the patient was unable to stand, the height of each patient was obtained by measuring the length of the ulna (the distance between the styloid and the olecranon) and the conversion table of the length of the ulna to height ( 20 ). Weight was measured with a Seca model 510 scale (made in Germany). The patient stood on the scale with minimal clothes and no shoes and their weight was measured. Body composition was measured using the Inbody 270 body composition analyzer (BIA) (made in the South Korea), including the measurement of body fat mass in kilograms and percentages, and the amount of body fat-free mass in kilograms and percentages. Fat-free mass index (FFMI) was also obtained by dividing fat-free mass in kilograms by the square of height in meters. Decreased muscle mass is defined as FFMI less than 17 in men and less than 15 in women ( 21 ). A dynamometer (Camry) made in China was used to measure muscle strength. The participants were asked to holds their hands in a way that the arm and elbow make a 90-degree angle with the forearm supported on the trunk. Then, they held the device in their hands and pushed the handle back for a few moments with maximum pressure. The operation was repeated three times for each hand, and finally, the average of these three numbers was reported as the muscle strength of that hand in kilograms. The muscle strength wad then compared with the normal value according to age and gender ( 22 ). Also, clinical symptoms that affect nutritional status, such as physical condition, quality of life of the patients, 24-hours recall and the level of depression, anxiety and stress of the patients were examined. Sample size: Based on the data obtained from the study by Guo et al. ( 19 ) which reported that about 80.4% of gastric cancer patients were malnourished (based on PG-SGA), the minimum sample size was estimated to be 95 with an alpha of 5% and d = 0.1p. This calculation took into account a 10% loss of the final sample size of 105 patients. Statistical analysis Statistical analysis was carried out using SPSS version 22. Descriptive statistics, including means, standard deviations, and frequencies, were expressed. The normality distribution of data was evaluated using the Kolmogorov-Smirnov test. Proper parametric and nonparametric tests were used accordingly. Statistical significance was reported at the p < 0.05. Results A total of 116 outpatients with gastric cancer were analyzed in this study. Table 1 shows demographic characteristics, with 81 males and a mean age of 60.77 years, ranging from 18 to 81 years old. Table 2 explains cancer and treatment characteristics. Based on the PG-SGA score, 94% of patients (n = 99) needed nutrition education (score more than 3), and 72.4% of patients needed nutritional intervention and clinical symptom management (score more than 8). In addition, significant weight loss was observed in 45.6% of patients based on the Karnofsky physical performance status criterion, and 37.1% of the patients were unable to perform their daily activities (Karnofsky score less than 70). In the present study, based on the sarcopenia index, 14.7% were in the pre-sarcopenia stage, 43.1% had sarcopenia, and 16.4% had severe sarcopenia. Table 3 . shows that most common nutritional-related complications were dry mouth (84.5%), stomach pain (81.9%) and dyspepsia (68.1%). the average pain score on the visual analogue scale was 3.28. Table 4 shows that the energy intake was 18.86 kcal/kgw/day indicating 77.6% of patients did not take enough energy intake. The protein intake was 0.82 g/kgw/day indicating that 87.9% of patients' protein intake was not enough, Table 5 . Table 1 Demographic information (116 cases). variables Frequency or mean ± SD (percent) Age (year) 60.77 ± 11.95* Gender Male Female 81 (69.8%) 25 (20.2%) Education Illiterate Literate 41(25.3%) 75 (74.7%) Living Place Rural Urban 13 (11.2%) 103 (88.8%) Occupation Housewife Farmer Worker Self-employed Employee Retired student 33 (28.4%) 12 (10.3%) 16 (13.8%) 21 (18.15%) 9 (7.8%) 24 (20.7%) 1 (0.9%) Smoking non smoker smoker second smoker 88 (75.9%) 13 (11.2%) 15 (12.9%) Addiction 7 (6%) *mean ± SD Table 2 Disease characteristics and comorbidities (116 cases). variables Frequency or mean ± SD (percent) Cancer duration (months) 6.28 ± 4.88* Malignancy awareness 106 (91.4%) Comorbidity Diabetes Heart disease Hypertension hyperlipidemia 28 (24.1%) 18 (15.5%) 45 (38.8%) 31 (26.7%) Tumor site Cardia Body Pylorus gastroesophageal 49 (42.2%) 36 (31%) 24 (20.7%) 7 (6%) Treatment Chemotherapy Chemo + surgery Chemoradiotherapy + surgery 83 (71.6%) 32 (27.6%) 1 (0.9%) Stage 1 2 3 4 13 (1.2%) 34 (29.2%) 22 (19%) 47 (40.5%) Dietician visiting 7 (6%) *mean ± SD Table 3 PG-SGA score, sarcopenia, walking velocity and anthropometric details (116 cases). Variables Numbers (percent) PG-SGA 0–1 2–3 4–8 >=9 14.98 ± 7.78* 0 (0%) 7(6%) 25 (21.6%) 84 (72.4%) Sarcopenia No sarcopenia Pre-sarcopenia Sarcopenia Severe sarcopenia 17(14.6%) 50(43.1%) 30(25.8%) 19(16.3%) walking velocity >0.8 m/min <0.8 m/min 63 (54.3%) 53 (45.6%) Hand grip (kg) (age, sex adjusted) Reduced Normal 97 (16.4%) 19 (16.4%) Fat free mass index (kg/m2) 16.64 ± 2.15 Muscle mass 1 (sex) Reduced Normal 44 (37.9%) 72 (62.1%) Body fat mass (percent) 25.1 ± 9.81 Mid-arm circumference (cm) 21.34 ± 4.15 BMI (kg/m2) 30 23.03 ± 4.46 4 (3.4%) 0 (0%) 28 (24.1%) 53 (45.7%) 24 (20.7%) 7 (6%) Weight loss 10% in 1 month or > 20% in 6 months 39 (33.6%) 0 (0%) 6 (5.2%) 33 (28.4%) 20 (17.2%) Karnofsky performance score 0–40 50–70 80–100 75.51 9 (7.8%) 34 (29.3%) 73 (62.9%) *mean ± SD Table 4 Nutrition complications in patients (116 cases). variables Number (percent) Anorexia 68 (58.6%) Dysphasia 35 (30.2%) Stomach pain 95 (81.9%) Nausea 73 (62.9%) Vomiting 42 (36.2%) Constipation 66 (56.9%) Diarrhea 26 (22.4%) Dry mouth 98 (84.5%) Dyspepsia 79 (68.1%) Dysgeusia 94 (81%) Esophagitis 66 (56.9%) Mucositis 71 (61.2%) Visual analogue scale (VAS) 3.28 ± 2.39* • Mean ± SD Table 5 Nutrition intakes (116 cases). variables Mean ± SD RDA Energy intake kcal/day kcal/kgw/day patients with intake insufficiency 1174.94 ± 579.82 18.86 ± 8.62 90 (77.6%) Protein intake(g/day) (g/kgw/day) 51.22 ± 24.22 0.82 ± 0.38 Fat (g/day) 35.20 ± 19.53 Carbohydrate (g/day) 166.48 ± 90.61 Calcium (mg/day) 433.9 ± 234.52 1000–1200 Iron (mg/day) 11.62 ± 4.99 8–18 Zinc (mg/day) 6.22 ± 2.84 8–11 Selenium (mcg/day) 0.61 ± 0.41 55 Vitamin A (mcg/day) 456.19 ± 506.29 700–900 Vitamin C (mg/day) 28.95 ± 18.94 75–90 Vitamin E (mg/day) 1.28 ± 0.86 15 Vitamin D (UI/day) 0.38 ± 0.68 600–800 Thiamin (mg/day) 1.09 ± 0.68 1.1–1.2 Riboflavin (mg/day) 1.02 ± 0.51 1.1–1.3 Niacin (mg/day) 12.73 ± 6.49 14-16j Discussion In our study, based on the PG-SGA score, 94% of patients needed nutrition education, and 72.4% of patients needed nutritional intervention and clinical symptom management. In addition, significant weight loss was observed in 45.6% of patients. Gastric cancer is a prevalent malignant tumor in Iran, and surgery and chemoradiotherapy are the primary antitumor treatments. However, these treatments can worsen the patient’s nutritional status leading to Sarcopenia, which has been linked to increased mortality ( 23 ), treatment resistance, infection risk, and postoperative complications, ( 24 ). Therefore, early identification of malnourished patients or those at risk of malnutrition is crucial for improving recovery and prognosis ( 19 ). The PG-SGA tool is a modified subjective global assessment (SGA) developed specifically for nutritional screening in cancer patients. Malnutrition incidence varies among different malignancies, in patients with head and neck cancer or digestive tract tumors at higher risk for malnutrition than those with other types of tumors ( 25 ). A cross-sectional study in China, found that 35.3% of patients had moderate malnutrition, and 45.1% had severe malnutrition based on the PG-SGA tool ( 19 ). A prospective study in Iran, found that the average of PG-SGA at the end of the treatment of gastrointestinal patients was 9.68, and mean BMI at the beginning of the treatment for female and male patients was 24.44 ± 4.2 and 22.55 ± 3.9 kg/m2. There was a significant relationship between duration of treatment and BMI ( 26 ). In the present study, the average BMI was 23.03 ± 4.46 kg/m2, which could be attributed to the long period between the onset of clinical manifestations of malignancy, especially dysphagia, and anorexia, and lack of food intake until the patients’ visit to the medical team, as well as inadequate nutritional advice. Based on the Karnofsky physical performance status, about 37.1% of the patients were unable to perform their daily activities and about 37.9% and 83.6% of the patients had decreased muscle mass and hand strength, respectively. Patients with lower physical function may require assistance with food preparation and consumption and their prognosis may be worse. In the study by Lewandowska et al., 28% of the patients were classified as normal according to the Karnofsky index, while 45% required assistance from others, 49% needed periodic care in health centers, and 13% needed constant care in health centers ( 27 ). In our study, based on the sarcopenia index, 14.7% of patients were in the pre-sarcopenia stage, 43.1% had sarcopenia, and and16.4% had severe sarcopenia. Also, statistical analysis revealed a significant relationship between The study by Chia et al., which investigated 20,416 patients with various cancers, found that mortality was significantly higher in patients with sarcopenia than those without sarcopenia with a ratio of 1.42 ( 23 ). Our study, highlights the inappropriate nutritional status of patients with gastric cancer, and the need for the early nutritional intervention and clinical symptom management. In our population, only seven patients were referred for nutrition counseling in our study, indicating the need for improved access to nutritional support for these patients.. In the present study, patients with gastric malignancy were old (60.77 ± 11.95 years), 35.3% (41 people) were illiterate and only 6.9% (8 people) had supplementary insurance. our study found that many patients with gastric cancer have a low socio-economic status, which may affect their access to proper nutrition and healthcare ( 28 ). These patients may benefit from counseling, social support, and continuous care to maintain proper nutritional status. It is urgent to revise, standardize, and popularize practical and feasible guidelines for nutritional support in the whole country. The strengths of our study include sampling by a trained individual and participation of patients from all over Iran through large referral hospitals. In conclusion, malnutrition is common in patients with gastric cancer and has a significant impact on sarcopenia. Early identification and timely nutritional intervention are crucial for improving recovery and prognosis in these patients. Improved access to nutritional support and healthcare may also benefit patients with low socioeconomic status. This article is extracted from the master's thesis (no. 4001661) Source of funding Mashhad University of Medical Science Declarations Compliance with ethical standards This study was approved by the Ethics Committee of each participating hospital. Ethics Declarations: This study was conducted in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its subsequent amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Funding Statement: The authors did not receive support from any organization for the submitted work. Author Contribution SM, ME, MMN, AN, HR contributed to designing the studyHRAN, GMF,ZKH contributed to provided the dataset used for analysis.FAS contributed to writing the manuscript.SM, ME, FAS contributed to designing the study and analyzing the data.FAS, HR, ME, MMN, HRAN, GMF, ZKH, AN AND SM contributed to revised the manuscript. References Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8026504","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":550140273,"identity":"c0f49a6f-576b-4717-8d8f-c991951516d7","order_by":0,"name":"Fatemeh AhangarSaryazdi","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"AhangarSaryazdi","suffix":""},{"id":550140274,"identity":"4324ab1d-cfcc-4728-adc3-183bbcd6f19e","order_by":1,"name":"Hossein Rahimi","email":"","orcid":"","institution":"Mashhad University of Medical 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19:08:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":646784,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8026504/v1/bd6b157e-e6ef-4436-a1ce-dbde79ed39d9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Nutritional Assessment of Gastric Cancer Outpatients and its Relation with Sarcopenia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCancer, as a non-communicable disease, is the second cause of death worldwide after cardiovascular diseases (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Despite its chronic and incurable nature and the possibility of disease recurrence, cancer imposes a significant cost on different societies. According to the International Association of Cancer Registry, the global cost of cancer in 2010 was estimated at 1016 trillion dollars (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In Iran, cancer was the third leading cause of death after cardiovascular diseases and accidents (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn 2020, gastric cancer was the fifth most common cancer and the fourth leading cause of cancer death in the world. According to the World Health Organization, stomach cancer is the eleventh most common cancer and a leading cause of cancer-related deaths (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe prevalence of malnutrition in cancer patients is high (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), with up to 85% of cases reported (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), and up to 90% in patients with upper gastrointestinal tract cancers (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In addition, cancer treatments such as surgery, radiation therapy, and chemotherapy can also cause malnutrition and weight loss in these patients (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMalnutrition can increase morbidity, mortality rate, length of hospital stay, treatment costs, and days absent from work while decreasing the quality of life and survival rate of patients (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). It also makes them susceptible to infection and reduces the effectiveness of cancer treatments, including chemotherapy, radiation therapy, and surgery, which may lead to discontinuation of anti-malignancy treatments for patients (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, malnutrition increases the risk of anorexia-cachexia syndrome, which is debilitating and associated with high mortality (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Studies have shown that it increases the mortality rate of cancer patients by 20% (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). More than half of Iranian patients with cancer have malnutrition (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).In a cross-sectional study by Movahed et.al, conducted in Iran in 2012 on 166 cancer patients who referred for the first time to a radiation oncology center based on MUST, 48.8% of patients were at low risk and 38.5% of them were at high risk of malnutrition (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn a cross-sectional study by Zarif Yegane et.al, conducted in Iran in 2006 on 71 cancer patients undergoing chemotherapy, the variables of nutritional status, weight changes, body mass index, PG-SGA and food intake were investigated in these patients. Totally, 80% of patients need nutritional interventions (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMoreover, in another study by Davidson et al., performed in Australia in 2012 on 121 cancer patients undergoing chemotherapy, the variables of nutritional status, weight changes, body mass index and food intake were investigated. Generally, 26% of these patients were malnourished, 10% had decreased food intake due to severe nausea and vomiting, 20% had significant weight loss, and 18% needed nutritional intervention (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn a study at 2017 by Cruz et.al on gastrointestinal cancer patients based on SGA, 21% had moderate malnutrition and 82.5% had severe malnutrition (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn a prospective multicenter study by Karabulut et.al, demographic, oncological and nutritional data of 116 metastatic gastric cancer patients were collected. The nutritional status of patients was assessed with the Nutritional Risk Index (NRI), Body Mass Index (BMI) and weight loss percentage within 21-day period between chemotherapy cycles. Malnutrition was diagnosed in 67% of the patients and was severe in 31% of them (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Se et.al on gastrectomized patients under chemotherapy, based on PG-SGA 59% of the patients were malnourished, and 27.8% of the patients revealed serious malnutrition with PG-SGA score of \u0026ge;\u0026thinsp;9 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to the reviewed studies, most of the studies conducted in Iran were on hospitalized patients with gastric cancer. Additionally, a study that evaluated the nutritional status of outpatients with gastric cancer undergoing chemotherapy and the sarcopenia index did not provide data.. Considering that the type of treatment for these patients has an effect on their nutritional status and most patients with stomach cancer undergo chemotherapy, a comprehensive review of the nutritional status of outpatient cancer patients with stomach cancer during chemotherapy using PG-SGA tool, anthropometric indicators, clinical complications, and nutritional intake seems essential.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eA multi-center, cross-sectional observational study was conducted from March 2023 to August 2023 at two public hospitals in Iran (Ghaem Hospital in Mashhad and Emam Khomeini Hospital in Tehran. A total of 116 gastric cancer patients were included. Inclusion criteria were as follows: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) aged 18 to 90 years, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) conscious, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) no communication disorders, (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) able to cooperate with relevant inspection; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) histologic diagnosis of gastric cancer; (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) complete medical history records and follow-up data; (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Informed consent. Exclusion criteria were patients who refused or did not cooperate with the questionnaire. This study was approved by the Ethics Committee of Mashhad University of Medical Sciences (IR.MUMS.MEDICAL.REC.1401.507).\u003c/p\u003e\u003cp\u003eAssessment methods\u003c/p\u003e\u003cp\u003eAll measurements were performed by trained researcher. Nutritional status was evaluated by PG-SGA developed by Ottery (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). It includes patients\u0026rsquo; self-reported sections (body weight, eating conditions, symptoms, activities, and physical function) and a medical personnel assessment part (nutrition-related disease state, metabolic state, and physical examination) in seven domains. The sum of scores obtained in each domain is divided into three categories: scores of 0\u0026ndash;3 (well-nourished/suspicious malnutrition), 4\u0026ndash;8 (moderate malnutrition), and \u0026ge;\u0026thinsp;9 (severe malnutrition). Patients scoring 4\u0026ndash;8 points require nutritional intervention by a dietitian with a clinical symptom survey. Patients scoring\u0026thinsp;\u0026ge;\u0026thinsp;9 points are in great need of symptom management and nutrition intervention before anti-tumor treatment (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e The sarcopenia index was made using the EWGSOP2 guidelines and includes all people. Muscle strength was measured based on hand strength or a constant 709E dynamometer (made in China). The cut line of hand strength is standardized according to age and gender in Iranian society (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). It includes three tests of muscle strength, muscle volume, and walking speed. Pre-sarcopenia is diagnosed if a person has only muscle weakness.\u003c/p\u003e\u003cp\u003eIf, in addition to the decrease in muscle weakness, there is also a decrease in muscle mass, it is sarcopenia. And if all three indicators of sarcopenia are reduced, sarcopenia is severe.\u003c/p\u003e\u003cp\u003eHeight was measured using Seca model 206 (made in Germany). From the highest point of the head to the ground, a person leans against the wall without shoes, and the shoulders, hips, and backs of the legs are in contact with the wall. Then the shoulders were raised with a deep breath and the height was measured. If the patient was unable to stand, the height of each patient was obtained by measuring the length of the ulna (the distance between the styloid and the olecranon) and the conversion table of the length of the ulna to height (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Weight was measured with a Seca model 510 scale (made in Germany). The patient stood on the scale with minimal clothes and no shoes and their weight was measured.\u003c/p\u003e\u003cp\u003eBody composition was measured using the Inbody 270 body composition analyzer (BIA) (made in the South Korea), including the measurement of body fat mass in kilograms and percentages, and the amount of body fat-free mass in kilograms and percentages. Fat-free mass index (FFMI) was also obtained by dividing fat-free mass in kilograms by the square of height in meters. Decreased muscle mass is defined as FFMI less than 17 in men and less than 15 in women (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA dynamometer (Camry) made in China was used to measure muscle strength. The participants were asked to holds their hands in a way that the arm and elbow make a 90-degree angle with the forearm supported on the trunk. Then, they held the device in their hands and pushed the handle back for a few moments with maximum pressure. The operation was repeated three times for each hand, and finally, the average of these three numbers was reported as the muscle strength of that hand in kilograms. The muscle strength wad then compared with the normal value according to age and gender (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Also, clinical symptoms that affect nutritional status, such as physical condition, quality of life of the patients, 24-hours recall and the level of depression, anxiety and stress of the patients were examined.\u003c/p\u003e\u003cp\u003eSample size:\u003c/p\u003e\u003cp\u003eBased on the data obtained from the study by Guo et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) which reported that about 80.4% of gastric cancer patients were malnourished (based on PG-SGA), the minimum sample size was estimated to be 95 with an alpha of 5% and d\u0026thinsp;=\u0026thinsp;0.1p. This calculation took into account a 10% loss of the final sample size of 105 patients.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical analysis was carried out using SPSS version 22. Descriptive statistics, including means, standard deviations, and frequencies, were expressed. The normality distribution of data was evaluated using the Kolmogorov-Smirnov test. Proper parametric and nonparametric tests were used accordingly. Statistical significance was reported at the p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 116 outpatients with gastric cancer were analyzed in this study. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows demographic characteristics, with 81 males and a mean age of 60.77 years, ranging from 18 to 81 years old. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e explains cancer and treatment characteristics. Based on the PG-SGA score, 94% of patients (n\u0026thinsp;=\u0026thinsp;99) needed nutrition education (score more than 3), and 72.4% of patients needed nutritional intervention and clinical symptom management (score more than 8). In addition, significant weight loss was observed in 45.6% of patients based on the Karnofsky physical performance status criterion, and 37.1% of the patients were unable to perform their daily activities (Karnofsky score less than 70). In the present study, based on the sarcopenia index, 14.7% were in the pre-sarcopenia stage, 43.1% had sarcopenia, and 16.4% had severe sarcopenia.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. shows that most common nutritional-related complications were dry mouth (84.5%), stomach pain (81.9%) and dyspepsia (68.1%). the average pain score on the visual analogue scale was 3.28. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows that the energy intake was 18.86 kcal/kgw/day indicating 77.6% of patients did not take enough energy intake. The protein intake was 0.82 g/kgw/day indicating that 87.9% of patients' protein intake was not enough, Table\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic information (116 cases).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003evariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (percent)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60.77\u0026thinsp;\u0026plusmn;\u0026thinsp;11.95*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003cp\u003eMale\u003c/p\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81 (69.8%)\u003c/p\u003e\u003cp\u003e25 (20.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003cp\u003eLiterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41(25.3%)\u003c/p\u003e\u003cp\u003e75 (74.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiving Place\u003c/p\u003e\u003cp\u003eRural\u003c/p\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (11.2%)\u003c/p\u003e\u003cp\u003e103 (88.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOccupation\u003c/p\u003e\u003cp\u003eHousewife\u003c/p\u003e\u003cp\u003eFarmer\u003c/p\u003e\u003cp\u003eWorker\u003c/p\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003cp\u003eEmployee\u003c/p\u003e\u003cp\u003eRetired\u003c/p\u003e\u003cp\u003estudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33 (28.4%)\u003c/p\u003e\u003cp\u003e12 (10.3%)\u003c/p\u003e\u003cp\u003e16 (13.8%)\u003c/p\u003e\u003cp\u003e21 (18.15%)\u003c/p\u003e\u003cp\u003e9 (7.8%)\u003c/p\u003e\u003cp\u003e24 (20.7%)\u003c/p\u003e\u003cp\u003e1 (0.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoking\u003c/p\u003e\u003cp\u003enon smoker\u003c/p\u003e\u003cp\u003esmoker\u003c/p\u003e\u003cp\u003esecond smoker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e88 (75.9%)\u003c/p\u003e\u003cp\u003e13 (11.2%)\u003c/p\u003e\u003cp\u003e15 (12.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAddiction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e*mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDisease characteristics and comorbidities (116 cases).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003evariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (percent)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCancer duration (months)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.28\u0026thinsp;\u0026plusmn;\u0026thinsp;4.88*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMalignancy awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e106 (91.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComorbidity\u003c/p\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003cp\u003eHeart disease\u003c/p\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003cp\u003ehyperlipidemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (24.1%)\u003c/p\u003e\u003cp\u003e18 (15.5%)\u003c/p\u003e\u003cp\u003e45 (38.8%)\u003c/p\u003e\u003cp\u003e31 (26.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTumor site\u003c/p\u003e\u003cp\u003eCardia\u003c/p\u003e\u003cp\u003eBody\u003c/p\u003e\u003cp\u003ePylorus\u003c/p\u003e\u003cp\u003egastroesophageal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49 (42.2%)\u003c/p\u003e\u003cp\u003e36 (31%)\u003c/p\u003e\u003cp\u003e24 (20.7%)\u003c/p\u003e\u003cp\u003e7 (6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTreatment\u003c/p\u003e\u003cp\u003eChemotherapy\u003c/p\u003e\u003cp\u003eChemo\u0026thinsp;+\u0026thinsp;surgery\u003c/p\u003e\u003cp\u003eChemoradiotherapy\u0026thinsp;+\u0026thinsp;surgery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83 (71.6%)\u003c/p\u003e\u003cp\u003e32 (27.6%)\u003c/p\u003e\u003cp\u003e1 (0.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStage\u003c/p\u003e\u003cp\u003e1\u003c/p\u003e\u003cp\u003e2\u003c/p\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (1.2%)\u003c/p\u003e\u003cp\u003e34 (29.2%)\u003c/p\u003e\u003cp\u003e22 (19%)\u003c/p\u003e\u003cp\u003e47 (40.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDietician visiting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e*mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePG-SGA score, sarcopenia, walking velocity and anthropometric details (116 cases).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumbers (percent)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePG-SGA\u003c/p\u003e\u003cp\u003e0\u0026ndash;1\u003c/p\u003e\u003cp\u003e2\u0026ndash;3\u003c/p\u003e\u003cp\u003e4\u0026ndash;8\u003c/p\u003e\u003cp\u003e\u0026gt;=9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.98\u0026thinsp;\u0026plusmn;\u0026thinsp;7.78*\u003c/p\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003cp\u003e7(6%)\u003c/p\u003e\u003cp\u003e25 (21.6%)\u003c/p\u003e\u003cp\u003e84 (72.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSarcopenia\u003c/p\u003e\u003cp\u003eNo sarcopenia\u003c/p\u003e\u003cp\u003ePre-sarcopenia\u003c/p\u003e\u003cp\u003eSarcopenia\u003c/p\u003e\u003cp\u003eSevere sarcopenia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17(14.6%)\u003c/p\u003e\u003cp\u003e50(43.1%)\u003c/p\u003e\u003cp\u003e30(25.8%)\u003c/p\u003e\u003cp\u003e19(16.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ewalking velocity\u003c/p\u003e\u003cp\u003e\u0026gt;0.8 m/min\u003c/p\u003e\u003cp\u003e\u0026lt;0.8 m/min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63 (54.3%)\u003c/p\u003e\u003cp\u003e53 (45.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHand grip (kg) (age, sex adjusted)\u003c/p\u003e\u003cp\u003eReduced\u003c/p\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e97 (16.4%)\u003c/p\u003e\u003cp\u003e19 (16.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFat free mass index (kg/m2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMuscle mass \u003csup\u003e1\u003c/sup\u003e(sex)\u003c/p\u003e\u003cp\u003eReduced\u003c/p\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44 (37.9%)\u003c/p\u003e\u003cp\u003e72 (62.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody fat mass (percent)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMid-arm circumference (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m2)\u003c/p\u003e\u003cp\u003e\u0026lt;15\u003c/p\u003e\u003cp\u003e15-15.9\u003c/p\u003e\u003cp\u003e16-18.4\u003c/p\u003e\u003cp\u003e18.5\u0026ndash;24.9\u003c/p\u003e\u003cp\u003e25-29.9\u003c/p\u003e\u003cp\u003e\u0026gt;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.46\u003c/p\u003e\u003cp\u003e4 (3.4%)\u003c/p\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003cp\u003e28 (24.1%)\u003c/p\u003e\u003cp\u003e53 (45.7%)\u003c/p\u003e\u003cp\u003e24 (20.7%)\u003c/p\u003e\u003cp\u003e7 (6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight loss\u003c/p\u003e\u003cp\u003e\u0026lt;2%\u003c/p\u003e\u003cp\u003e2\u0026ndash;3% in 1 month or 2\u0026ndash;6% in 6 months\u003c/p\u003e\u003cp\u003e3\u0026ndash;5% in 1 month or 6\u0026ndash;10% in 6 months\u003c/p\u003e\u003cp\u003e5\u0026ndash;10% in 1 month or 10\u0026ndash;20% in 6 months\u003c/p\u003e\u003cp\u003e\u0026gt;10% in 1 month or \u0026gt;\u0026thinsp;20% in 6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (33.6%)\u003c/p\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003cp\u003e6 (5.2%)\u003c/p\u003e\u003cp\u003e33 (28.4%)\u003c/p\u003e\u003cp\u003e20 (17.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKarnofsky performance score\u003c/p\u003e\u003cp\u003e0\u0026ndash;40\u003c/p\u003e\u003cp\u003e50\u0026ndash;70\u003c/p\u003e\u003cp\u003e80\u0026ndash;100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75.51\u003c/p\u003e\u003cp\u003e9 (7.8%)\u003c/p\u003e\u003cp\u003e34 (29.3%)\u003c/p\u003e\u003cp\u003e73 (62.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e*mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNutrition complications in patients (116 cases).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003evariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber (percent)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnorexia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68 (58.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDysphasia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 (30.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStomach pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95 (81.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNausea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e73 (62.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVomiting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42 (36.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConstipation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66 (56.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiarrhea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (22.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDry mouth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98 (84.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDyspepsia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79 (68.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDysgeusia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e94 (81%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEsophagitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66 (56.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMucositis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71 (61.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVisual analogue scale (VAS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.28\u0026thinsp;\u0026plusmn;\u0026thinsp;2.39*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u0026bull; Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNutrition intakes (116 cases).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003evariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRDA\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEnergy intake\u003c/p\u003e\u003cp\u003ekcal/day\u003c/p\u003e\u003cp\u003ekcal/kgw/day\u003c/p\u003e\u003cp\u003epatients with intake insufficiency\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1174.94\u0026thinsp;\u0026plusmn;\u0026thinsp;579.82\u003c/p\u003e\u003cp\u003e18.86\u0026thinsp;\u0026plusmn;\u0026thinsp;8.62\u003c/p\u003e\u003cp\u003e90 (77.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProtein intake(g/day)\u003c/p\u003e\u003cp\u003e(g/kgw/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51.22\u0026thinsp;\u0026plusmn;\u0026thinsp;24.22\u003c/p\u003e\u003cp\u003e0.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFat (g/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35.20\u0026thinsp;\u0026plusmn;\u0026thinsp;19.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCarbohydrate (g/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e166.48\u0026thinsp;\u0026plusmn;\u0026thinsp;90.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCalcium (mg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e433.9\u0026thinsp;\u0026plusmn;\u0026thinsp;234.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1000\u0026ndash;1200\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIron (mg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.62\u0026thinsp;\u0026plusmn;\u0026thinsp;4.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u0026ndash;18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZinc (mg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.22\u0026thinsp;\u0026plusmn;\u0026thinsp;2.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u0026ndash;11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelenium (mcg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitamin A (mcg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e456.19\u0026thinsp;\u0026plusmn;\u0026thinsp;506.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e700\u0026ndash;900\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitamin C (mg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28.95\u0026thinsp;\u0026plusmn;\u0026thinsp;18.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75\u0026ndash;90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitamin E (mg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVitamin D (UI/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e600\u0026ndash;800\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThiamin (mg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.1\u0026ndash;1.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRiboflavin (mg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.1\u0026ndash;1.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNiacin (mg/day)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.73\u0026thinsp;\u0026plusmn;\u0026thinsp;6.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14-16j\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, based on the PG-SGA score, 94% of patients needed nutrition education, and 72.4% of patients needed nutritional intervention and clinical symptom management. In addition, significant weight loss was observed in 45.6% of patients. Gastric cancer is a prevalent malignant tumor in Iran, and surgery and chemoradiotherapy are the primary antitumor treatments.\u003c/p\u003e\u003cp\u003eHowever, these treatments can worsen the patient\u0026rsquo;s nutritional status leading to Sarcopenia, which has been linked to increased mortality (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), treatment resistance, infection risk, and postoperative complications, (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTherefore, early identification of malnourished patients or those at risk of malnutrition is crucial for improving recovery and prognosis (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe PG-SGA tool is a modified subjective global assessment (SGA) developed specifically for nutritional screening in cancer patients. Malnutrition incidence varies among different malignancies, in patients with head and neck cancer or digestive tract tumors at higher risk for malnutrition than those with other types of tumors (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA cross-sectional study in China, found that 35.3% of patients had moderate malnutrition, and 45.1% had severe malnutrition based on the PG-SGA tool (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA prospective study in Iran, found that the average of PG-SGA at the end of the treatment of gastrointestinal patients was 9.68, and mean BMI at the beginning of the treatment for female and male patients was 24.44\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 and 22.55\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9 kg/m2. There was a significant relationship between duration of treatment and BMI (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn the present study, the average BMI was 23.03\u0026thinsp;\u0026plusmn;\u0026thinsp;4.46 kg/m2, which could be attributed to the long period between the onset of clinical manifestations of malignancy, especially dysphagia, and anorexia, and lack of food intake until the patients\u0026rsquo; visit to the medical team, as well as inadequate nutritional advice.\u003c/p\u003e\u003cp\u003eBased on the Karnofsky physical performance status, about 37.1% of the patients were unable to perform their daily activities and about 37.9% and 83.6% of the patients had decreased muscle mass and hand strength, respectively. Patients with lower physical function may require assistance with food preparation and consumption and their prognosis may be worse.\u003c/p\u003e\u003cp\u003eIn the study by Lewandowska et al., 28% of the patients were classified as normal according to the Karnofsky index, while 45% required assistance from others, 49% needed periodic care in health centers, and 13% needed constant care in health centers (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn our study, based on the sarcopenia index, 14.7% of patients were in the pre-sarcopenia stage, 43.1% had sarcopenia, and and16.4% had severe sarcopenia. Also, statistical analysis revealed a significant relationship between\u003c/p\u003e\u003cp\u003eThe study by Chia et al., which investigated 20,416 patients with various cancers, found that mortality was significantly higher in patients with sarcopenia than those without sarcopenia with a ratio of 1.42 (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur study, highlights the inappropriate nutritional status of patients with gastric cancer, and the need for the early nutritional intervention and clinical symptom management. In our population, only seven patients were referred for nutrition counseling in our study, indicating the need for improved access to nutritional support for these patients..\u003c/p\u003e\u003cp\u003eIn the present study, patients with gastric malignancy were old (60.77\u0026thinsp;\u0026plusmn;\u0026thinsp;11.95 years), 35.3% (41 people) were illiterate and only 6.9% (8 people) had supplementary insurance. our study found that many patients with gastric cancer have a low socio-economic status, which may affect their access to proper nutrition and healthcare (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). These patients may benefit from counseling, social support, and continuous care to maintain proper nutritional status. It is urgent to revise, standardize, and popularize practical and feasible guidelines for nutritional support in the whole country.\u003c/p\u003e\u003cp\u003eThe strengths of our study include sampling by a trained individual and participation of patients from all over Iran through large referral hospitals.\u003c/p\u003e\u003cp\u003eIn conclusion, malnutrition is common in patients with gastric cancer and has a significant impact on sarcopenia. Early identification and timely nutritional intervention are crucial for improving recovery and prognosis in these patients. Improved access to nutritional support and healthcare may also benefit patients with low socioeconomic status.\u003c/p\u003e\u003cp\u003eThis article is extracted from the master's thesis (no. 4001661)\u003c/p\u003e\u003cp\u003eSource of funding Mashhad University of Medical Science\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eCompliance with ethical standards\u003c/h2\u003e\u003cp\u003e This study was approved by the Ethics Committee of each participating hospital.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eEthics Declarations:\u003c/h2\u003e\u003cp\u003e This study was conducted in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its subsequent amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding Statement:\u003c/h2\u003e\u003cp\u003eThe authors did not receive support from any organization for the submitted work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eSM, ME, MMN, AN, HR contributed to designing the studyHRAN, GMF,ZKH contributed to provided the dataset used for analysis.FAS contributed to writing the manuscript.SM, ME, FAS contributed to designing the study and analyzing the data.FAS, HR, ME, MMN, HRAN, GMF, ZKH, AN AND SM contributed to revised the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFerlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. 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Br J Nutr. 2013;109(5):894\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Footnotes","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Skeletal Muscle Index (SMI ) reduced for man less than 7 kg/m2 and for women less than 5.5 kg/m2.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Gastric cancer. Patient-generated subjective global assessment (PG-SGA). Malnutrition. Sarcopenia","lastPublishedDoi":"10.21203/rs.3.rs-8026504/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8026504/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eobjectives\u003c/h2\u003e\u003cp\u003eThe nutritional problems and low quality of life in patients with gastric cancer have become important goals of current cancer treatment. The purpose of this study was to assess the nutritional status of outpatient gastric cancer patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe recruited outpatient gastric cancer patients referred for chemotherapy to a tertiary hospital in Tehran and Mashhad, Iran between February and July 2023. Demographic information, malignancy and treatments characteristics were collected. We used the Patient-generated Subjective Global Assessment (PG-SGA), anthropometric parameters, clinical symptoms, hand-grip strength (HGS), and dietary intakes. For sarcopenia, we used The Sarcopenia: revised European consensus on definition and diagnosis (EWGSOP2).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOne hundred and sixteen patients were assessed. The mean age was 60.77\u0026thinsp;\u0026plusmn;\u0026thinsp;11.95, and 70% were male. The mean PG-SGA was 14.98\u0026thinsp;\u0026plusmn;\u0026thinsp;7.78. We found that 94% of the patients were malnourished (PG-SGA score\u0026thinsp;\u0026ge;\u0026thinsp;4), and 72.4% of the patients required urgent nutritional support (PG-SGA score\u0026thinsp;\u0026ge;\u0026thinsp;9). 73.2% were underweight. Significant weight loss was seen in 73.2%. Also, 85.3% of the patients had sarcopenia, with 16.4% having severe sarcopenia. Older age (\u0026gt;\u0026thinsp;65 years, p\u0026thinsp;=\u0026thinsp;0.006), tumor site (p\u0026thinsp;=\u0026thinsp;0.02), cancer duration (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), weight loss in the last one month (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and 6 months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), walking velocity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and sarcopenia (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were associated with PG-SGA score. There was a negative correlation between PG-SGA score and global quality of life (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no correlation between previous surgery and PG-SGA score (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eMalnutrition and sarcopenia are prevalent in patients with gastric cancer during chemotherapy. Therefore, nutritional assessment and interventions should be promptly evaluated and provided as soon as possible to improve the nutritional status of outpatients with gastric cancer in Iran.\u003c/p\u003e","manuscriptTitle":"The Nutritional Assessment of Gastric Cancer Outpatients and its Relation with Sarcopenia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-26 12:41:24","doi":"10.21203/rs.3.rs-8026504/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4e909a4c-c4c1-49a3-94db-4fac79d1f700","owner":[],"postedDate":"November 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-11T19:08:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-26 12:41:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8026504","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8026504","identity":"rs-8026504","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}