Nutritional status and quality of life of patients with advanced gastroenteropancreatic neuroendocrine neoplasms in Spain: the NUTRIGETNE (GETNE-S2109) study
Authors: del Olmo-García Maribel , Hernandez-Rienda Lorena , Garcia-Carbonero Rocio , Hernando Jorge , Custodio Ana , Anton-Pascual Beatriz , Gomez Marta , Palma Milla Samara , Suarez Lorena , Bellver Marta , Alonso Vicente , Serrano Raquel , Valdés Nuria , Melian Marcos , Febrero Beatriz , Sampedro-Nuñez Miguel Antonio , Biarnes Josefina , Díaz-Pérez José Ángel , Molina-Cerrillo Javier , Lopez Carlos , Martínez Olmos Miguel Ángel , Merino-Torres Juan Francisco , Capdevila Jaume , Argente Pla María ,   NUTRIGETNE Group, Jiménez-Fonseca Paula , Alonso-Gordoa Teresa , Ruiz Grandos Alvaro , Brox Noemi , Isabel Castro Pais Ana , Duyos Mato Navia , Cabezas Agrícola José Manuel , Diéguez Marta , Díaz Lucía , Monge Pilar , Gándara Carmen , Casteras Anna , García-Álvarez Alejandro , Micó Garcia Andrea 
Published: February 2025

Abstract
Patients with advanced gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) have impaired nutritional and physical performance due to the cancer pathophysiology and its treatment. The NUTRIGETNE study sought to characterize the nutritional status of patients with advanced GEP-NENs in Spain. This is a cross-sectional study that included patients with advanced GEP-NENs receiving active oncological treatment. Patients had a complete physical examination, anthropometry, bioelectrical impedance, dynamometry, laboratory analysis, and a comprehensive nutritional risk assessment. Malnutrition was defined according to Global Leadership Initiative on Malnutrition (GLIM) criteria. The study included 399 patients out of the 400 planned (Pearson’s χ2; α 0.05). Median age was 62 years (22-83). Tumors most commonly originated in the small intestine (43.9%) and the pancreas (41.6%), 94.7% were metastatic, and 36.7%, 49.4%, and 12.5% were G1, G2, and G3, respectively. Malnutrition prevalence was 61.9% (25.8% moderate; 36.1% severe), mainly due to low muscle mass (50.9%), which was the most prevalent GLIM phenotypic criteria. Moreover, malnutrition showed a correlation with decreased hand grip strength (mean 23 vs 31.9 kg; P &lt;.001) and phase angle (median 5o vs 5.6o; P &lt;.001). The prevalence of sarcopenia was 15%. Malnutrition was more frequent in patients with diabetes (74.4% vs 56.7%; P &lt;.001), NECs (82.1% vs 60.3%; P =.062), and in those treated with chemotherapy (71.2% vs 59.7%; P =.058), whereas it did not correlate with tumor origin (P =.507), histological grade (P =.781), or functionality (P =.465). Malnutrition was correlated to body mass index (BMI) (P =.015), although it was also diagnosed in a high proportion of patients with no weight loss (63%, 54.1%, and 65.1% of patients with normal BMI, overweight, and obesity, respectively). Cachexia was present in 109 (27.3%) patients. Malnutrition is very prevalent and commonly underdiagnosed in patients with GEP-NENs. It is associated with sarcopenia and a worse QoL, requiring a multifactorial nutritional assessment. Certain factors such as the presence of diabetes may require closer monitoring due to a higher risk of malnutrition.