Jingtao Jiang, Qin Shi, Qing Xu, Ruizhen Wu, Jianhong Ma
Malnutrition in head and neck cancer surgical patients is influenced by both clinical and treatment-related factors, as well as cognitive-behavioral pathways. Higher nutritional knowledge and practice scores were independently associated with lower odds of malnutrition, supporting the need for risk-stratified nutritional management. High-risk patients, particularly those with significant treatment burden or comorbidities, require intensive nutritional support and symptom management, while patients at medium or low risk may benefit more from educational and behavioral interventions aimed at closing the knowledge-practice gap. Given the cross-sectional design, these findings should be interpreted as associations rather than causal relationships.
OBJECTIVE: To assess the nutritional knowledge, attitudes, and practices (KAP) among inpatients undergoing head and neck cancer surgery and evaluate its association with GLIM-defined malnutrition, providing evidence for targeted nutritional interventions.
METHODS: In this single-center cross-sectional study (April 2023-January 2025), consecutive sampling was used to enroll patients. All participants received routine nutritional risk screening using the Nutritional Risk Screening 2002 (NRS-2002). Those with NRS-2002 scores ≥ 3 underwent detailed nutritional assessment using the Global Leadership Initiative on Malnutrition (GLIM) criteria. A structured KAP questionnaire was administered to all participants.
RESULTS: A total of 626 patients were enrolled. The prevalence of GLIM-defined malnutrition was 14.9% (93/626). Weak to moderate correlations were observed among knowledge, attitude, and practice scores (r = 0.229-0.326, p < 0.001). Malnourished patients had significantly lower KAP scores than well-nourished patients (p < 0.05). Multivariable regression analysis showed that cumulative treatment burden was the factor most strongly associated with malnutrition (p < 0.001), with patients undergoing reoperation for recurrent nasopharyngeal carcinoma after prior radiotherapy and surgery having the highest odds (OR = 5.45, 95% CI: 2.25-13.16, p < 0.001). After adjustment for treatment burden and clinical confounders, higher knowledge (OR = 0.90 per 5-point increment, 95% CI: 0.82-0.98, p = 0.016) and practice scores (OR = 0.86 per 5-point increment, 95% CI: 0.74-0.98, p = 0.029) remained significantly associated with lower odds of malnutrition. Comorbidities were also associated with higher odds of malnutrition in a dose-dependent manner (OR = 3.60 for ≥ 2 comorbidities, 95% CI: 1.72-7.53, p = 0.001).
CONCLUSION: Malnutrition in head and neck cancer surgical patients is influenced by both clinical and treatment-related factors, as well as cognitive-behavioral pathways. Higher nutritional knowledge and practice scores were independently associated with lower odds of malnutrition, supporting the need for risk-stratified nutritional management. High-risk patients, particularly those with significant treatment burden or comorbidities, require intensive nutritional support and symptom management, while patients at medium or low risk may benefit more from educational and behavioral interventions aimed at closing the knowledge-practice gap. Given the cross-sectional design, these findings should be interpreted as associations rather than causal relationships.