Nutritional vulnerability, food insecurity, and unmet supportive care needs in multiple myeloma: a cross-sectional study from China

Background Multiple myeloma patients experience nutritional vulnerability through disease-related factors, treatment toxicity, and systemic inflammation, yet comprehensive assessment integrating validated nutrition screening with health equity dimensions remains limited. This study characterized nutritional vulnerability prevalence, determinants, and supportive-care access barriers among Chinese multiple myeloma patients. Methods This single-center, cross-sectional observational study conducted at Shanxi Provincial Key Laboratory, Taiyuan, China (January 2020–December 2024) employed comprehensive assessment including Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF), Edmonton Symptom Assessment System (ESAS), EORTC QLQ-C30/MY20 quality of life questionnaires, anthropometry, handgrip strength, biochemical markers, food insecurity screening and systematic barriers evaluation. Multivariable logistic regression identified independent predictors of composite nutritional vulnerability; principal component analysis explored multidimensional phenotype structure. Results Among 286 patients completing assessment (mean age 59.8 ± 13.0 years; 52.4% male; 49.3% relapsed/refractory), 57.3% (95% CI: 51.6–62.9) had moderate-to-high nutritional risk, including 7.0% with critical vulnerability. Risk increased across treatment phases (50.7% newly diagnosed, 44.7% remission, 63.7% relapsed, 74.0% refractory; p-trend = 0.002), and composite nutritional vulnerability affected 61.2%. High symptom burden (ESAS ≥40) was dominant independent correlate (adjusted OR = 5.03, 95% CI: 3.08–10.05; p < 0.001), whereas disease stage and treatment intensity were not independently associated. Despite risk, 61.6% of affected patients had unmet nutritional support needs. Oral nutritional supplement use occurred in 45.1% overall, with only modest variation by risk status (42.6–50.0%; p = 0.035). Food insecurity affected 48.3% of patients, demonstrated a strong income gradient ( p < 0.001), and remained independently associated with vulnerability (adjusted OR = 2.12, 95% CI: 1.39–3.24). Nutritional vulnerability was associated with large quality-of-life deficits in global health, physical, and role functioning (adjusted mean differences 35.9–40.5 points; all p < 0.001). Conclusion Nutritional vulnerability in multiple myeloma is highly prevalent, symptom-driven, and inadequately addressed despite devastating quality of life impact, with food insecurity and systemic access barriers compounding clinical risk among socioeconomically vulnerable populations.