Association Between Poor Health-Related Quality of Life and Malnutrition Using a “Gold Standard” Nutritional Assessment and Four Screening Tests Before Surgery

Objectives: To compare the health-related quality of life (HRQoL) profiles of surgical patients who were assessed with a "gold-standard" nutritional assessment and 4 preoperative nutritional screening tools. Methods: This single-centre, cross-sectional study involved patients undergoing major elective cardiothoracic or general surgery. After written informed consent, the patient's nutritional status was assessed by a blinded registered dietitian using the SGA (gold standard). Another co-investigator assessed the patient's nutritional status using the Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), short-form Mini Nutritional Assessment (MNA-SF), and Preoperative Nutrition Screening (PONS). All assessments were performed one day before surgery. We simultaneously measured the HRQoL index by the Chinese (Hong Kong) version of the EuroQoL EQ-5D. The HRQoL profile has 5 domains: mobility, self-care, usual activities, pain, and anxiety. Multivariate analysis of variance (MANOVA) was used to assess the association of preoperative malnutrition on the composite 5 domains in EQ-5D after adjusting for type of surgery, age, frailty, comorbidity and social support. Results: Of the 512 patients (median [IQR] age 65 [59-71] years old; 332 men [65%]), 164 (32%) were moderately or severely malnourished. After adjustment, the mean preoperative EQ-5D index was lower in malnourished patients than in well-nourished patients (0.82 vs 0.91, mean difference [MD] 0.09, 95%CI 0.06-0.13). Preoperative malnutrition (by SGA) was strongly associated with poorer mobility, less usual activities, more pain, higher anxiety and was moderately associated with self-care ability (P=0.048). All 4 screening tests detected differences in the mean preoperative EQ-5D index between nutritional status groups. Compared to SGA, all 4 screening tests showed similar strong associations with usual activity, pain and anxiety domains, but not with the self-care domain. Conclusions: After adjustment for type of surgery, age, frailty, comorbidity and social support, malnutrition remained associated with poorer HRQoL before surgery. However, preoperative nutritional screening tests did not show the association across all individual domains of HRQoL. Funding Sources: General Research Fund (GRF#14104222).