Abstract
BACKGROUND: Undernutrition contributes to nearly half of global cancer-related deaths. In Ethiopia, previous studies using the Subjective Global Assessment (SGA) have reported an undernutrition prevalence of 30-60% among cancer patients. The Global Leadership Initiative on Malnutrition (GLIM) criteria offer a standardized, evidence-based approach by combining phenotypic and etiologic factors. However, their application and related evidence remain limited in Ethiopia, particularly in Bahir Dar City. OBJECTIVE: To assess the prevalence of undernutrition and its associated factors among adult cancer patients receiving follow-up care at public referral hospitals in Bahir Dar City, Northwest Ethiopia, in 2024. METHODS: An institution-based cross-sectional study was conducted among 403 cancer patients on follow-up at Felege Hiwot and Tibebe Ghion Comprehensive Specialized Hospitals from June 8 to July 8, 2024. Participants were selected using a simple random sampling technique. Data were collected via face-to-face interviews using a structured questionnaire and through chart reviews. Anthropometric measurements, dietary intake, and clinical data were used to assess undernutrition based on the GLIM criteria. Data were entered using the KoboToolbox and analyzed with SPSS version 26. Bivariable and multivariable binary logistic regression analyses were conducted to identify factors associated with undernutrition. Statistical significance was determined at a 95% confidence interval (CI) and p-value < 0.05. RESULTS: The study included 393 participants, yielding a response rate of 97.8%. The prevalence of undernutrition among adult cancer patients was 50.3% (95% CI: 44.4%-55.5%), with 31.5% classified as severely undernourished and 18.8% as moderately undernourished. Multivariable analysis identified four factors significantly associated with undernutrition: loss of appetite (AOR = 18.21, 95% CI: 10.01-33.12), presence of chronic comorbidities (AOR = 3.86, 95% CI: 1.67-8.94), female sex (AOR = 2.17, 95% CI: 1.17-4.03), and larger tumor size, with the highest risk observed in T4 tumors (AOR = 17.98, 95% CI: 6.45-29.19). CONCLUSION: Undernutrition was common among adult cancer patients in Bahir Dar City, with loss of appetite, female sex, tumor size, and comorbidities as significant predictors. Early application of the GLIM criteria, management of treatment-related symptoms, and targeted nutrition interventions for high-risk groups, particularly women, are recommended to improve patient outcomes. CLINICAL TRIAL NUMBER: Not applicable.