Cereda Emanuele, Caraccia Marilisa, Klersy Catherine, Cappello Silvia, Turri Annalisa, Borioli Valeria, Stobäus Nicole, Giannoni Antonello, Arcaini Luca, Benazzo Marco, Palladini Giovanni, Pedrazzoli Paolo, Norman Kristina, Caccialanza Riccardo
Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Clin Nutr. 2021 Feb;40(2):615-623. doi: 10.1016/j.clnu.2020.06.011. Epub 2020 Jun 23.
BACKGROUND & AIMS: Estimation errors associated with bioelectric impedance evaluation may affect the accuracy of body composition and its prognostic value. We evaluated the prognostic value of a new body composition parameter (Nutrigram®) obtained from bioimpedance vectorial analysis-derived body cell mass and its association with nutritional and functional status.
Data of Italian and German cancer patients observed prospectively until death were used. Multivariable models (adjusted for age, gender, hydration status, performance status, and disease's stage) were built in both cohorts to assess the association between body composition outcome parameters (low fat-free mass [FFM], <15 [females] and <17 [males] kg/m; low standardized phase angle [SPA], <-1.65; low Nutrigram®, <510 [females] and <660 [males] mg/24 h/m) and 1-year all-cause mortality, low body mass index (BMI; <20 [<70 years] and <22 [≥70 years] kg/m), clinically significant weight loss (WL; ≥10% in 6 months) and low handgrip strength (HG; <20 [females] and <30 [males] kg).
Low Nutrigram® was independently associated with mortality in both Italian (HR = 1.84 [95%CI, 1.18-2.86]; P = 0.007) and German cohorts (HR = 1.52 [95%CI, 1.17-2.07]; P = 0.008). Low FFMI and low SPA did not predict survival in the German cohort. In patients with low Nutrigram®, worse nutritional and functional status were observed in both study populations. Performance of models addressing the study endpoints showed substantial consistency with both cohorts, particularly of those including low Nutrigram®.
We validated a new prognostic body composition parameter, which is easier to interpret than standard nutritional parameters and may be useful for identifying cancer patients at nutritional risk, requiring early nutritional support.
生物电阻抗评估相关的估计误差可能会影响身体成分的准确性及其预后价值。我们评估了一种从生物电阻抗矢量分析得出的身体细胞质量获得的新身体成分参数（Nutrigram®）的预后价值，及其与营养和功能状态的关联。
使用了对意大利和德国癌症患者进行前瞻性观察直至死亡的数据。在两个队列中建立多变量模型（根据年龄、性别、水合状态、体能状态和疾病分期进行调整），以评估身体成分结果参数（低去脂体重[FFM]，女性<15kg/m，男性<17kg/m；低标准化相位角[SPA]，<-1.65；低Nutrigram®，女性<510mg/24h/m，男性<660mg/24h/m）与1年全因死亡率、低体重指数（BMI；<70岁者<20kg/m，≥70岁者<22kg/m）、具有临床意义的体重减轻（WL；6个月内≥10%）和低握力（HG；女性<20kg，男性<30kg）之间的关联。
低Nutrigram®在意大利队列（HR = 1.84[95%CI，1.18 - 2.86]；P = 0.007）和德国队列（HR = 1.52[95%CI，1.17 - 2.07]；P = 0.008）中均与死亡率独立相关。低FFMI和低SPA在德国队列中不能预测生存情况。在低Nutrigram®的患者中，两个研究人群的营养和功能状态均较差。针对研究终点的模型表现显示两个队列具有高度一致性，尤其是那些包含低Nutrigram®的模型。
我们验证了一个新的预后身体成分参数，它比标准营养参数更易于解释，可能有助于识别有营养风险的癌症患者，这些患者需要早期营养支持。
