| Objective: To explore the heterogeneous trajectories of nutritional status and influencing factors in patients with gastrointestinal cancer under digital health management. Methods: Patients with gastrointestinal cancer who underwent chemotherapy and received digital health-based nutritional management at Cancer Hospital, Chinese Academy of Medical Sciences and First Hospital of Shanxi Medical University from May 2021 to May 2023 were enrolled. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA). The group-based trajectory model (GBTM) was applied to identify the trajectory classes of PG-SGA scores over a 6-month follow-up period. Chi-square tests, analysis of variance (ANOVA) and logistic regression analysis were performed to find the influencing factors of different trajectories. Results: A total of 138 patients were included in the analysis. Three distinct PG-SGA trajectories were identified: "Persistent low malnutrition risk group" (18.8%), "Moderate malnutrition improvement group" (42.0%) and "Severe malnutrition improvement group" (39.1%). The three trajectory categories differed significantly in age (P=0.002), tumor type (P=0.003), baseline albumin (P=0.003) and overall adherence to the digital health management (P=0.009). Furthermore, multivariable analysis indicated that the proportions of elderly patients and patients with upper gastrointestinal cancer, as well as adherence to the digital health tool, in the "Moderate malnutrition improvement group" and "Severe malnutrition improvement group" were significantly higher than that in the "Persistent low malnutrition risk group" (P<0.05). The baseline albumin level in the "Severe malnutrition improvement group" was significantly lower than that in the "Moderate malnutrition improvement group" (P=0.003). Conclusion: The nutritional status trajectories during chemotherapy exhibited a degree of heterogeneity in patients with gastrointestinal cancer receiving digital health management. These findings emphasize the need for risk-stratified nutritional management, as well as long-term surveillance and intensified nutritional support for severely malnourished patients, with the potential to optimize clinical outcomes. |
