接受手术治疗的住院头颈癌患者的营养知识、态度和实践（KAP）与GLIM定义营养不良：中国一项横断面研究

文献信息

中文摘要

目的： 评估接受头颈癌手术的住院患者的营养知识、态度和实践（KAP），并评价其与GLIM定义营养不良的关联，为针对性营养干预提供依据。
方法： 在这项单中心横断面研究（2023年4月至2025年1月）中，采用连续抽样纳入患者。所有参与者均接受营养风险筛查2002（NRS-2002）进行常规营养风险筛查。NRS-2002评分≥3者接受全球营养不良领导倡议（GLIM）标准的详细营养评估。对所有参与者实施结构化KAP问卷。
结果： 共纳入626例患者。GLIM定义营养不良的患病率为14.9%（93/626）。知识、态度和实践评分之间观察到弱至中度相关性（r=0.229-0.326，p<0.001）。营养不良患者的KAP评分显著低于营养良好患者（p<0.05）。多变量回归分析显示，累积治疗负担是与营养不良关联最强的因素（p<0.001），其中既往接受放疗和手术后因复发性鼻咽癌再次手术的患者比值比最高（OR=5.45，95% CI：2.25-13.16，p<0.001）。在调整治疗负担和临床混杂因素后，较高的知识评分（每增加5分，OR=0.90，95% CI：0.82-0.98，p=0.016）和实践评分（每增加5分，OR=0.86，95% CI：0.74-0.98，p=0.029）仍与较低的营养不良比值比显著相关。合并症也与营养不良的较高比值比呈剂量依赖性相关（≥2种合并症OR=3.60，95% CI：1.72-7.53，p=0.001）。
结论： 头颈癌手术患者的营养不良受临床和治疗相关因素以及认知行为路径的影响。较高的营养知识和实践评分与较低的营养不良比值比独立相关，支持需要风险分层营养管理。高风险患者，特别是具有显著治疗负担或合并症者，需要强化营养支持和症状管理，而中低风险患者可能更多受益于旨在弥合知识-实践差距的教育和行为干预。鉴于横断面设计，这些发现应解释为关联而非因果关系。

英文摘要

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.