Supportive Care in Cancer

, Volume 23, Issue 6, pp 1495–1502 | Cite as

NRS-2002 for pre-treatment nutritional risk screening and nutritional status assessment in head and neck cancer patients

  • Helena Orell-KotikangasEmail author
  • Pia Österlund
  • Kauko Saarilahti
  • Paula Ravasco
  • Ursula Schwab
  • Antti A. Mäkitie
Original Article



The aim of this study was to assess the value of nutritional risk screening-2002 (NRS-2002) as a nutritional risk screening and status assessment method and to compare it with nutritional status assessed by subjective and objective methods in the screening of head and neck cancer patients.


Sixty-five consecutive patients (50 male), with a median age of 61 years (range, 33–77), with head and neck squamous cell carcinoma (HNSCC) were enrolled prior to cancer therapy. Nutritional status was assessed by NRS-2002, patient-generated subjective global assessment (PG-SGA), handgrip strength (HGS) and mid-arm muscle area (MAMA).


Twenty-eight percent of patients were at nutritional risk based on NRS-2002, and 34 % were malnourished according to PG-SGA, while 43 % had low HGS. NRS-2002 cut-off score of ≥3 compared with the nutritional status according to PG-SGA showed 77 % specificity and 98 % sensitivity (K = 0.78). NRS-2002 was able to predict malnutrition (PG-SGA BC) both in men (p < 0.001) and in women (p < 0.05). NRS-2002 identified correctly patients with malnutrition with a score of ≥3 (p < 0.001) and risk patients with a score of ≥2 (p < 0.001).


These results suggest that NRS-2002 seems to be a reliable indicator of malnutrition, while NRS-2002 with the cut-off score of ≥2 seems to be more reliable for nutrition screening in head and neck cancer patients prior to oncological treatment.


Nutritional status Nutritional risk screening Patient-generated subjective global assessment 



This study was financially supported by grants from the Finnish Cultural Foundation and the Helsinki University Central Hospital Research Funds, Helsinki, Finland. The study sponsors did not have any involvement in the study design, data collection, analysis and interpretation of data, the writing of the manuscript and in the decision to submit the manuscript for publication.

Statement of authorship

HOK, AM, US and KS designed the study. HOK was the main author of the manuscript, performed all the assessments of nutritional status, and analysed and interpreted data. AM supervised the project and assisted with the statistical analysis, writing the manuscript and interpretation of the results. PÖ, PR and US assisted in the interpretation of the results and writing the manuscript.

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Helena Orell-Kotikangas
    • 1
  • Pia Österlund
    • 2
  • Kauko Saarilahti
    • 2
  • Paula Ravasco
    • 3
  • Ursula Schwab
    • 4
  • Antti A. Mäkitie
    • 5
  1. 1.Department of Clinical Nutrition Therapy, RavioliHelsinki University Central HospitalHelsinkiFinland
  2. 2.Department of OncologyHelsinki University Central Hospital and University of HelsinkiHelsinkiFinland
  3. 3.Laboratório de Nutrição e Unidade de Nutrição e Metabolismo do Instituto de Medicina Molecular da Faculdade de MedicinaUniversidade de LisboaLisbonPortugal
  4. 4.Department of Clinical NutritionUniversity of Eastern Finland and Institute of Internal Medicine, Kuopio University HospitalKuopioFinland
  5. 5.Department of Otolaryngology - Head and Neck SurgeryHelsinki University Central Hospital and University of HelsinkiHelsinkiFinland

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