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Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis

Bullock, Alex F.; Greenley, Sarah L.; McKenzie, Gordon A.G.; Paton, Lewis W.; Johnson, Miriam J.


Alex F. Bullock

Gordon A.G. McKenzie

Lewis W. Paton


© 2020, The Author(s). Malnutrition predicts poorer clinical outcomes for people with cancer. Older adults with cancer are a complex, growing population at high risk of weight-losing conditions. A number of malnutrition screening tools exist, however the best screening tool for this group is unknown. The aim was to systematically review the published evidence regarding markers and measures of nutritional status in older adults with cancer (age ≥ 70). A systematic search was performed in Ovid Medline, EMBASE, Web of Science, CINAHL, British Nursing Database and Cochrane CENTRAL; search terms related to malnutrition, cancer, older adults. Titles, abstracts and papers were screened and quality-appraised. Data evaluating ability of markers of nutritional status to predict patient outcomes were subjected to meta-analysis or narrative synthesis. Forty-two studies, describing 15 markers were included. Meta-analysis found decreased food intake was associated with mortality (OR 2.15 [2.03–4.20] p = < 0.00001) in univariate analysis. Prognostic Nutritional Index (PNI) was associated with overall survival (HR 1.89 [1.03–3.48] p = 0.04). PNI markers (albumin, total lymphocyte count) could be seen as markers of inflammation rather than nutrition. There a suggested relationship between very low body mass index (BMI) (


Bullock, A. F., Greenley, S. L., McKenzie, G. A., Paton, L. W., & Johnson, M. J. (2020). Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis. European journal of clinical nutrition, 74, 1519–1535.

Journal Article Type Review
Acceptance Date Mar 31, 2020
Online Publication Date May 4, 2020
Publication Date 2020-11
Deposit Date May 3, 2022
Publicly Available Date Oct 27, 2022
Journal European Journal of Clinical Nutrition
Print ISSN 0954-3007
Electronic ISSN 1476-5640
Publisher Nature Publishing Group
Peer Reviewed Peer Reviewed
Volume 74
Pages 1519–1535
Keywords Biomarkers; Cancer; Nutrition
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© The Author(s) 2020. This article is published with open access.<br /> Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit

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