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

Abstract

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/m(2) (range, 15.6 to 39.6 kg/m(2)). 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 PGSGA (r=-0.530, p ˂ 0.001). A significant weight loss of ˃ 5% of the original body weight within 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.