The impact of protein-energy malnutrition on clinical outcomes in hospitalized gastric cancer patients: A population-based analysis.
Authors: Rabia Iqbal, Henry Kimball, Mrunanjali Gaddam, Supriya Peshin, Samridhi Sinha, Kalimullah Quadri
Journal: Journal of Clinical Oncology (2025)

503 Background: Protein-energy malnutrition (PEM) is considered an adverse prognostic factor in various clinical conditions. Patients with gastric cancer are at an increased risk of malnutrition because of factors such as loss of appetite due to the tumor, difficulty swallowing, malabsorption, and metabolic changes caused by the cancer. However, the implications of protein-energy malnutrition (PEM) in gastric cancer patients are not well studied. Through this study, we wanted to examine how PEM affects clinical outcomes in hospitalized patients with gastric cancer. Methods: We used the National Inpatient Sample (NIS) from 2018 to 2020 to detect patients with a primary diagnosis of gastric cancer and a secondary diagnosis of protein energy malnutrition (PEM). We used the chi-square and student T-test to analyze categorical and continuous variables. Confounders were adjusted using multivariable regression analysis, and the adjusted odds ratio (aOR) was calculated. Results: We detected a total of 1673915 patients with the primary diagnosis of gastric cancer using ICD-10 codes. Of them, 401,739 (24%) of the patients had a secondary diagnosis of PEM. The mean age of the patients was 66 years (p-value &lt;0.01). Of these, 56% of the patients were male, while the remaining 44% were female (p-value &lt;0.001). Based on race, 68% of the patients belonged to the White Race, 12% were African Americans, and 11% were Hispanics (p-value &lt;0.001). It was observed that the presence of PEM was associated with higher mortality (aOR 1.6, p-value &lt;0.001). There was also higher hospitalization cost ($109522 vs. 75725, p-value &lt;0.001) and mean length of stay (LOS) (9.1 days vs. 5.6 days, p-value &lt;0.001). PEM in gastric cancer patients was also associated with higher odds of sepsis (aOR 1.6, p-value &lt;0.001), gastritis (aOR aOR 1.2, p-value &lt;0.001), gastrointestinal (GI) bleeding (aOR 1.1, p-value &lt;0.001) and acute kidney injury (AKI) (aOR 1.7, p-value &lt;0.001). Conclusions: Our study demonstrates that protein-energy malnutrition (PEM) is associated with increased mortality, higher hospitalization costs, and longer stays in hospitalized gastric cancer patients. These findings emphasize the need for regular nutritional assessment and management to improve clinical outcomes in this population. Comparison of outcomes in hospitalized gastric cancer patients with and without protein-energy malnutrition (PEM). Hospital Outcomes Gastric Cancer Patients with PEM Gastric Cancer Patients without PEM Adjusted Odds ratio (aOR) 95% Confidence Interval P-value Mortality 9.1% (n=36999) 5.3% (n=68100) 1.6 1.5-1.7 &lt;0.001 Length of Stay 9.1 5.6 3.0 2.7-3.3 &lt;0.001 Sepsis 10% (n=41915) 6.4% (n= 82035) 1.6 1.5-1.6 &lt;0.001 Gastritis 3.9% (n=16174) 3.3% (n=41879) 1.2 1.1-1.31 &lt;0.001 GI Bleeding 7.1% (n= 28949) 6% (n= 28949) 1.1 1.0-1.2 &lt;0.001 AKI 28% (n=117439) 19% (n=1268134) 1.7 1.7-1.8 &lt;0.001