The use of serum transferrin in the evaluation of protein-calorie malnutrition in cancer patients.

Forty-five patients with various malignancies of the gastrointestinal tract had their nutritional status assessed pre-operatively to determine the prevalence of malnutrition and to establish the correlation of malnutrition with post-operative outcome. Ten nutritional parameters were assessed. Based on these markers, we found a significant degree of malnutrition. Half of the study population developed some form of post-operative complication and nearly one quarter died. Of the ten nutritional markers studied, only serum transferrin had predictive value in determining post-operative outcome. The mean level of serum transferrin for patients with major complications was 162.0 mg/dl as compared with 221.2 mg/dl for those with none or minor complications. Patients with a serum transferrin level below the reference range of 200 mg/dl had most of the major life threatening complications and deaths. The other nutritional markers studied did not correlate well with post-operative outcome. We feel that serum transferrin is a useful nutritional marker to predict post-operative outcome and also to monitor the effect of nutritional support. However, based on a preliminary study, nutritional support may be required for periods longer than two weeks to show significant improvement in protein-calorie malnutrition. We will consider giving adequate support for a longer period on a further study using serum transferrin as a marker to determine its value in monitoring any reversal of malnutrition.