The Diversity of Nutritional Status in Cancer: New Insights

被引:71
作者
Chaves, Mariana Ramos [1 ]
Boleo-Tome, Carolina [1 ]
Monteiro-Grillo, Isabel [1 ,2 ]
Camilo, Maria [1 ]
Ravasco, Paula [1 ]
机构
[1] Univ Lisbon, Inst Mol Med, Unidade Nutr & Metab, Fac Med, P-1699 Lisbon, Portugal
[2] Hosp Univ Santa Maria, Serv Radioterapia, Lisbon, Portugal
关键词
Cancer; Histological aggressiveness; Nutritional status; Body mass index; Patient-Generated Subjective Global Assessment; BODY-MASS INDEX; QUALITY-OF-LIFE; BREAST-CANCER; CONTROLLED-TRIAL; WEIGHT-LOSS; OBESITY; OUTCOMES; PROGNOSIS; CHEMOTHERAPY; INTERVENTION;
D O I
10.1634/theoncologist.2009-0283
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Objective. Nutritional status in cancer has been mostly biased toward undernutrition, an issue now in dispute. We aimed to characterize nutrition status, to analyze associations between nutritional and clinical/cancer-related variables, and to quantify the relative weights of nutritional and cancer-related features. Methods. The cross-sectional study included 450 nonselected cancer patients (ages 18-95 years) at referral for radiotherapy. Nutritional status assessment included recent weight changes, body mass index (BMI) categorized by World Health Organization's age/sex criteria, and Patient-Generated Subjective Global Assessment (PG-SGA; validated/specific for oncology). Results. BMI identified 63% as >= 25 kg/m(2) (43% overweight, 20% obese) and 4% as undernourished. PG-SGA identified 29% as undernourished and 71% as well nourished. Crossing both methods, among the 319 (71%) well-nourished patients according to PG-SGA, 75% were overweight/obese and only 25% were well nourished according to BMI. Concordance between BMI and PG-SGA was evaluated and consistency was confirmed. More aggressive/advanced stage cancers were more prevalent in deficient and excessive nutritional status: in 83% (n = 235/282) of overweight/obese patients by BMI and in 85% (n = 111/131) of undernourished patients by PG-SGA. Results required adjustment for diagnoses: greater histological aggressiveness was found in overweight/obese prostate and breast cancer; undernutrition was associated with aggressive lung, colorectal, head-neck, stomach, and esophageal cancers (p < .005). Estimates of effect size revealed that overweight/obesity was associated with advanced stage (24%), aggressive breast (10%), and prostate (9%) cancers, whereas undernutrition was associated with more aggressive lung (6%), colorectal (6%), and head-neck (6%) cancers; in both instances, age and longer disease duration were of significance. Conclusion. Undernutrition and overweight/obesity have distinct implications and bear a negative prognosis in cancer. This study provides novel data on the prevalence of overweight/obesity and undernutrition in cancer patients and their potential role in cancer histological behavior. The Oncologist 2010; 15: 523-530
引用
收藏
页码:523 / 530
页数:8
相关论文
共 53 条
[11]  
COTRAN R, 2007, ROBBINS BASIC PATHOL
[12]   PROGNOSTIC EFFECT OF WEIGHT-LOSS PRIOR TO CHEMOTHERAPY IN CANCER-PATIENTS [J].
DEWYS, WD ;
BEGG, C ;
LAVIN, PT ;
BAND, PR ;
BENNETT, JM ;
BERTINO, JR ;
COHEN, MH ;
DOUGLASS, HO ;
ENGSTROM, PF ;
EZDINLI, EZ ;
HORTON, J ;
JOHNSON, GJ ;
MOERTEL, CG ;
OKEN, MM ;
PERLIA, C ;
ROSENBAUM, C ;
SILVERSTEIN, MN ;
SKEEL, RT .
AMERICAN JOURNAL OF MEDICINE, 1980, 69 (04) :491-497
[13]  
Fauci A., 2008, Harrison's Principles of Internal Medicine
[14]   Prevalence and trends in obesity among US adults, 1999-2000 [J].
Flegal, KM ;
Carroll, MD ;
Ogden, CL ;
Johnson, CL .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2002, 288 (14) :1723-1727
[15]   Obese men have higher-grade and larger tumors: an analysis of the duke prostate center database [J].
Freedland, S. J. ;
Banez, L. L. ;
Sun, L. L. ;
Fitzsimons, N. J. ;
Moul, J. W. .
PROSTATE CANCER AND PROSTATIC DISEASES, 2009, 12 (03) :259-263
[16]   Impact of obesity on biochemical control after radical prostatectomy for clinically localized prostate cancer: A report by the shared equal access regional cancer hospital database study group [J].
Freedland, SJ ;
Aronson, WJ ;
Kane, CJ ;
Presti, JC ;
Amling, CL ;
Elashoff, D ;
Terris, MK .
JOURNAL OF CLINICAL ONCOLOGY, 2004, 22 (03) :446-453
[17]  
Green C. J., 1999, Clinical Nutrition (Edinburgh), V18, P3
[18]   A difficult clinical problem: Diagnosis, impact and clinical management of cachexia in palliative care [J].
Holmes, Susan .
INTERNATIONAL JOURNAL OF PALLIATIVE NURSING, 2009, 15 (07) :319-324
[19]  
INAGAKI J, 1974, CANCER-AM CANCER SOC, V33, P568, DOI 10.1002/1097-0142(197402)33:2<568::AID-CNCR2820330236>3.0.CO
[20]  
2-2