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Validity and Reliability of Korean Version of Simplified Nutritional Appetite Questionnaire in Patients with Advanced Cancer: A Multicenter, Longitudinal Study

Cancer Research and Treatment 2019년 51권 4호 p.1612 ~ 1619
 ( Oh So-Yeon ) - Pusan National University Yangsan Hospital Department of Internal Medicine

고수진 ( Koh Su-Jin ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Internal Medicine
 ( Baek Ji-Yeon ) - National Cancer Center Center for Colorectal Cancer
 ( Kwon Kyung-A ) - Dongnam Institute of Radiological and Medical Sciences Department of Internal Medicine Division of Hematology-Oncology
 ( Jeung Hei-Cheul ) - Yonsei University College of Medicine Gangnam Severance Hospital Department of Internal Medicine
 ( Lee Kyung-Hee ) - Yeungnam University College of Medicine Department of Internal Medicine
 ( Won Young-Woong ) - Hanyang University Guri Hospital Department of Internal Medicine
 ( Lee Hyun-Jung ) - Dongguk University Ilsan Hospital Department of Internal Medicine


Purpose: Malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. Nutrition risk screening aims to increase awareness and allow early recognition and treatment of cancer cachexia. Therefore, screenings should be brief, inexpensive, highly sensitive, and have good specificity. Simplified Nutritional Appetite Questionnaire (SNAQ) is a simple screening tool including four questions, and validated to predict weight loss within 6 months in community-dwelling adults and nursing home residents. Our study aimed to translate the SNAQ into Korean, and to assess the validity and reliability of the translated screening tool in advanced cancer patients.

Materials and Methods: The SNAQ was translated into Korean according to linguistic validation. The internal consistency of the SNAQ was evaluated by Cronbach’s alpha coefficient. Test-retest reliability was evaluated using the intraclass correlation coefficient. Concurrent validity was evaluated by measuring the Pearson’s correlation coefficient between the SNAQ and Mini-Nutritional Assessment (MNA) and Patient-Generated Subjective Global Assessment (PG-SGA).

Results: In the 194 patients included in full analysis set, cancer stage was predominantly metastatic (98.5%), the mean age was 60 years (range, 23 to 81 years), and the mean body mass index was 24 kg/m2 (range, 15.6 to 39.6 kg/m2). According to MNA score ≤ 11, 57 patients (29.4%) were malnourished. The mean score (±standard deviation) of the Korean version of the SNAQ was 13.8±2.5 with a range of 6-19. Cronbach’s alpha coefficient was 0.737, and intraclass correlation coefficient was 0.869. The SNAQ was moderately correlated with MNA (r=0.404, p < 0.001) and PG-SGA (r=?0.530, p < 0.001). A significant weight loss of > 5% of the original bodyweightwithin 6 months occurred in 46 of the 186 patients (24.7%). SNAQ score ≤ 14 predicted > 5% weight loss with a sensitivity of 56.5% and a specificity of 44.3%.

Conclusion: The Korean version of the SNAQ had high validity and reliability. SNAQ is useful for the screening tool for advanced cancer patients. The SNAQ had a limitation to predict impending weight loss in advanced cancer patients.


Nutritional assessment; Simplified Nutritional Appetite Questionnaire; Neoplasms; Weight loss
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