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  1. Ng, Wai Han, Norshariza Jamhuri, Zuwariah Abdul Rahman, Betti Sharina, Mohd Haniff Lai, Siti Nuraini Mohd Samwil
    Malays J Nutr, 2018;24(4):627-635.
    MyJurnal
    Introduction: Malnutrition is a frequent complication in cancer patients and can
    negatively affect treatment outcome. Preliminary audit conducted at the Oncology
    Clinic, National Cancer Institute (NCI), found that only 5.8% of outpatients underwent
    nutrition screening using the Malnutrition Screening Tool (MST), and only 2.6% of
    dietitian referrals were recorded. This audit aims to determine the rate of adherence
    to nutritional screening, and to implement remedial measures for improved patient
    care. Methods: This was a cross-sectional audit comprising three phases, namely
    initial audit, remedial measures and re-audit. Criteria audited include screening
    rate using MST and dietitian referral based on MST scores. Standards were set at
    100% for both criteria. Data collected for initial audit were patients’ MST scores
    records and total dietitian referral forms retrieved from Electronic Medical Records.
    After initial audit, self-administered questionnaires for nurses and physicians were
    developed to identify barriers. Measures implemented for change included patientadministered MST to shorten screening time, and procedure flowchart to facilitate
    referral. After 6 months, a re-audit was conducted. Results: Total subjects for
    initial audit and re-audit were 349 and 390, respectively. Initial audit and re-audit
    showed screening rate using MST increased significantly from 6.3% to 79.5%, but
    there was no significant change for the dietitian referral rate. Conclusion: This
    clinical audit has led to a change in the policy in NCI outpatient clinics whereby
    nurses directly schedule dietitian referrals without going through physicians for
    patients with MST scores ≥2. Continuous audit and monitoring are necessary to
    facilitate improvement in MST implementation for better outpatient care.
  2. Ng WH, Zaid ZA, Yusof BNM, Nordin SA, Lim PY
    Cancer Treat Res Commun, 2024;39:100813.
    PMID: 38582031 DOI: 10.1016/j.ctarc.2024.100813
    BACKGROUND & AIMS: Accumulating evidence showed that inflammation contributes markedly to cancer progression, with C-reactive protein (CRP) being one of the lengthily studied inflammation marker. For breast cancer (BCa), pre-treatment elevated CRP upon diagnosis was linked with increased mortality. This study aimed to identify factors predictive of elevated CRP in pre-treatment BCa population that can serve as potential therapeutic targets to reduce inflammation.

    METHODS: This is a cross-sectional study using multiple logistic regression to identify predictors of elevated CRP among pre-treatment, newly diagnosed BCa patients. Studied variables were socio-demographic and medical characteristics, anthropometric measurements [body weight, Body Mass Index, body fat percentage, fat mass/fat free mass ratio, muscle mass, visceral fat], biochemical parameters [albumin, hemoglobin, white blood cell (WBC), neutrophil, lymphocyte], energy-adjusted Dietary Inflammatory Index, handgrip strength (HGS), scored Patient Generated-Subjective Global Assessment, physical activity level and perceived stress scale (PSS).

    RESULTS: A total of 105 participants took part in this study. Significant predictors of elevated CRP were body fat percentage (OR 1.222; 95 % CI 1.099-1.358; p < 0.001), PSS (OR 1.120; 95 % CI 1.026-1.223; p = 0.011), low vs normal HGS (OR 41.928; 95 % CI 2.155-815.728; p = 0.014), albumin (OR 0.779; 95 % CI 0.632-0.960; p = 0.019), and WBC (OR 1.418; 95% CI 1.024-1.963; p = 0.036).

    CONCLUSION: Overall, predictors of elevated CRP in pre-treatment, newly diagnosed BCa population were body fat percentage, PSS, HGS category, albumin and WBC.

  3. Ng WH, Abu Zaid Z, Mohd Yusof BN, Amin Nordin S, Lim PY
    Ann Med, 2023;55(2):2303399.
    PMID: 38242100 DOI: 10.1080/07853890.2024.2303399
    BACKGROUND: Obesity, particularly excessive body fat, is an established risk factor and substantial prognostic determinant in breast cancer. Recent studies suggested that diet-related inflammation plays a key role in obesity. This study aimed to determine the association between energy-adjusted dietary inflammatory index (E-DII) and body composition, particularly body fat percentage, among patients with newly diagnosed breast cancer.

    MATERIALS AND METHODS: This cross-sectional study was conducted on 124 breast cancer outpatients within the first year of diagnosis and yet to commence oncological treatment. Body composition parameters [body weight, body mass index (BMI), body fat percentage, fat mass over fat-free mass ratio (FM/FFM), muscle mass, and visceral fat] were obtained using a bioelectrical impedance analyzer. Body fat percentage was categorized into two groups which were normal (<35%) and high (≥35%). The E-DII was calculated from the validated 165-items Food Frequency Questionnaire (FFQ) and categorized into three groups or tertiles. Multiple logistic regression analysis was used to determine the association between the E-DII and body fat percentage.

    RESULTS: Mean body weight, body fat percentage, FM/FFM, and visceral fat increased as E-DII increased from the lowest tertile (T1) to the most pro-inflammatory tertile (T3) (p for trend <0.05). E-DII was positively associated with body fat percentage (OR 2.952; 95% CI 1.154-7.556; p = 0.024) and remained significant after adjustment for cancer stage, age, physical activity, ethnicity, smoking history, and presence of comorbidities. Compared to T1, participants in T3 had a significantly lower consumption of fiber, vitamin A, beta-carotene, vitamin C, iron, thiamine, riboflavin, niacin, vitamin B6, folic acid, zinc, magnesium, and selenium, but a higher intake of total fat, saturated fat, and monounsaturated fatty acids.

    CONCLUSIONS: A higher E-DII was associated with increased body fat percentage, suggesting the potential of advocating anti-inflammatory diet to combat obesity among newly diagnosed breast cancer patients.

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