Supplementary Material for: Prevalence of Undernutrition and Its Contributing Factors Among Cancer Patients in Africa – A Systematic Review and Meta-Analysis of Observational Studies

Introduction: Cancer poses a significant burden in Africa, where limited resources and infrastructure compound the challenges of managing the disease. Undernutrition, a critical concern among cancer patients, can profoundly affect treatment outcomes and overall prognosis. Despite its importance, the prevalence of undernutrition among African cancer patients remains poorly understood. Methods: Five major databases were searched for observational studies that reported the prevalence of undernutrition, from inception till February 2024. Study selection, data extraction, and quality assessment were conducted by at least two independent reviewers. The NIH criteria for observational studies were used for quality assessment. A random-effects meta-analysis model was used to estimate the overall undernutrition prevalence, with subgroup analyses conducted based on country and population characteristics. Results: Twenty-four studies involving 4,283 participants met the inclusion criteria, most studies included children (41%), followed by adults (37%), and women (19%). The overall undernutrition prevalence among African cancer patients was estimated at 32.8% (95% CI, 25.1%, 41.67%) with substantial heterogeneity observed (I² = 95.4%, P < 0.0001). Subgroup analyses revealed significant variations in prevalence across countries and population groups. Conclusion: Undernutrition is a serious issue among African cancer patients and requires an urgent response with targeted interventions. Tailored nutritional support strategies, considering demographic and regional contexts, are essential for improving patient outcomes.

引言：癌症在非洲造成沉重疾病负担，当地资源与基础设施匮乏进一步加剧了疾病管理的挑战。营养不良（undernutrition）是癌症患者面临的关键健康问题，可对治疗结局与整体预后产生显著影响。尽管营养不良的重要性不言而喻，但目前学界对非洲癌症患者的营养不良患病率仍缺乏充分认知。
方法：本研究检索了5个主流数据库自建库至2024年2月收录的、报告了营养不良患病率的观察性研究。文献筛选、数据提取与质量评价均由至少2名独立评价者独立完成，质量评价采用美国国立卫生研究院（NIH）观察性研究质量评价标准。本研究采用随机效应荟萃分析（meta-analysis）模型估算整体营养不良患病率，并依据国家与人群特征开展亚组分析。
结果：共有24项符合纳入标准的观察性研究被纳入分析，共涉及4283名受试者；其中多数研究以儿童为研究对象（占比41%），其次为成人（37%），女性相关研究占比19%。非洲癌症患者的整体营养不良患病率估计为32.8%（95%置信区间（confidence interval, CI）：25.1%~41.67%），研究间存在显著异质性（I²=95.4%，P<0.0001）。亚组分析结果显示，不同国家与人群组的营养不良患病率存在显著差异。
结论：营养不良是非洲癌症患者面临的严峻公共卫生问题，亟需开展针对性干预措施予以应对。结合人口统计学与地域特征制定个性化营养支持策略，对改善患者治疗结局至关重要。