Martinez-Tapia Claudia, Diot Thomas, Oubaya Nadia, Paillaud Elena, Poisson Johanne, Gisselbrecht Mathilde, Morisset Laure, Caillet Philippe, Baudin Aurélie, Pamoukdjian Fréderic, Broussier Amaury, Bastuji-Garin Sylvie, Laurent Marie, Canouï-Poitrine Florence
IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est Créteil University (UPEC), Créteil, France.
Public Health Department, Public Assistance-Paris Hospitals (AP-HP), Henri-Mondor Hospital, Créteil, France.
Am J Clin Nutr. 2021 Jan;113(1):129-141. doi: 10.1093/ajcn/nqaa238. Epub 2020 Sep 5.
Overweight and obesity are associated with adverse health outcomes. However, substantial literature suggests that they are associated with longer survival among older people. This "obesity paradox" remains controversial. In the context of cancer, the association between overweight/obesity and mortality is complicated by concomitant weight loss (WL). Sex differences in the relation between BMI (in kg/m2) and survival have also been observed.
We studied whether a high BMI was associated with better survival, and whether the association differed by sex, in older patients with cancer.
We studied patients aged ≥70 y from the ELCAPA (Elderly Cancer Patients) prospective open cohort (2007-2016; 10 geriatric oncology clinics, Greater Paris urban area). The endpoints were 12- and 60-mo mortality. We created a variable combining BMI at cancer diagnosis and WL in the previous 6 mo, and considered 4 BMI categories-underweight (BMI < 22.5), normal weight (BMI = 22.5-24.9), overweight (BMI = 25-29.9), and obesity (BMI ≥ 30)-and 3 WL categories-<5% (minimal), 5% to <10% (moderate), and ≥10% (severe). Univariate and multivariate Cox proportional hazards analyses were conducted in men and women.
A total of 2071 patients were included (mean age: 81 y; women: 48%; underweight: 30%; normal weight: 23%; overweight: 33%; obesity: 14%; predominant cancer sites: colorectal (18%) and breast (16%); patients with metastases: 49%). By multivariate analysis, obese women with WL < 5% had a lower 60-mo mortality risk than normal-weight women with WL < 5% (adjusted HR: 0.56; 95% CI: 0.37, 0.86; P = 0.012). Overweight/obese women with WL ≥ 5% did not have a lower mortality risk than normal-weight women with WL < 5%. Overweight and obese men did not have a lower mortality risk, irrespective of WL.
By taking account of prediagnosis WL, only older obese women with cancer with minimal WL had a lower mortality risk than their counterparts with normal weight.This trial was registered at clinicaltrials.gov as NCT02884375.
超重和肥胖与不良健康结局相关。然而，大量文献表明，它们与老年人更长的生存期相关。这种“肥胖悖论”仍存在争议。在癌症背景下，超重/肥胖与死亡率之间的关联因伴随的体重减轻（WL）而变得复杂。还观察到体重指数（BMI，单位：kg/m²）与生存之间关系的性别差异。
我们研究了高BMI是否与老年癌症患者更好的生存相关，以及这种关联是否因性别而异。
我们研究了来自ELCAPA（老年癌症患者）前瞻性开放队列（2007 - 2016年；大巴黎市区的10家老年肿瘤诊所）中年龄≥70岁的患者。终点为12个月和60个月死亡率。我们创建了一个变量，将癌症诊断时的BMI与前6个月的WL相结合，并考虑4个BMI类别——体重过轻（BMI < 22.5）、正常体重（BMI = 22.5 - 24.9）、超重（BMI = 25 - 29.9）和肥胖（BMI≥30）——以及3个WL类别——<5%（轻微）、5%至<10%（中度）和≥10%（重度）。对男性和女性进行单变量和多变量Cox比例风险分析。
共纳入2071例患者（平均年龄：81岁；女性：48%；体重过轻：30%；正常体重：23%；超重：33%；肥胖：14%；主要癌症部位：结直肠癌（18%）和乳腺癌（16%）；有转移的患者：49%）。通过多变量分析，WL < 5%的肥胖女性60个月死亡风险低于WL < 5%的正常体重女性（调整后HR：0.56；95%CI：0.37，0.86；P = 0.012）。WL≥5%的超重/肥胖女性死亡风险并不低于WL < 5%的正常体重女性。超重和肥胖男性无论WL情况如何，死亡风险均未降低。
考虑到诊断前的WL情况，只有癌症诊断时体重减轻轻微的老年肥胖女性死亡风险低于体重正常的女性。本试验已在clinicaltrials.gov注册，注册号为NCT02884375。
