Department of Clinical Nutrition, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, 400042, China; Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China.
Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China.
Clin Nutr. 2022 Jan;41(1):153-164. doi: 10.1016/j.clnu.2021.11.026. Epub 2021 Nov 24.
BACKGROUND & AIMS: The optimal thresholds to define a survival-related low fat mass index (FMI) in Asian oncology populations remains largely unknown. This study sought to derive the sex-specific FMI cutoffs and analyze the independent and joint associations of a low FMI, handgrip weakness, and the Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition with cancer survival.
We performed a multicenter cohort study including 2376 patients with cancer. The FMI was measured by bioelectrical impedance analysis and the best thresholds were determined using an optimal stratification (OS) method. Low handgrip strength (HGS) and malnutrition were defined based on the Asian Working Group for Sarcopenia 2019 framework and the GLIM, respectively. The associations of a low FMI, handgrip weakness and malnutrition with survival were estimated independently and jointly by calculating multivariable-adjusted hazard ratios (HRs).
The study enrolled 1303 women and 1073 men with a mean age of 57.7 years and a median follow-up of 1267 days. The OS-defined FMI cutoffs were <5 kg/m in women and <7.7 kg/m in men. A low FMI, low HGS and malnutrition were identified in 1188 (50%), 1106 (46.5%) and 910 (38.3%) patients, respectively. A low FMI was adversely associated with the nutritional status, physical performance, quality of life and hospitalization costs. A low FMI (HR = 1.50, 95%CI = 1.16 to 1.92) and malnutrition (HR = 1.31, 95%CI = 1.08 to 1.59) were independently associated with mortality. Overall, the FMI plus GLIM-defined malnutrition showed the maximal joint prognostic impact, and patients with a combined low FMI and malnutrition had the worst survival (HR = 1.93, 95%CI = 1.48 to 2.52).
Low FMI-indicated fat depletion outperforms and strengthens the prognostic value of handgrip weakness and GLIM-defined malnutrition for cancer survival. These findings indicate the importance of including fat mass assessment during routine cancer care to help guide strategies to optimize survival outcomes.
在亚洲肿瘤人群中，定义与生存相关的低脂肪量指数（FMI）的最佳阈值仍知之甚少。本研究旨在确定性别特异性 FMI 截断值，并分析低 FMI、握力弱和全球营养不良倡议（GLIM）定义的营养不良与癌症生存的独立和联合关联。
我们进行了一项多中心队列研究，纳入了 2376 名癌症患者。FMI 通过生物电阻抗分析测量，最佳截断值使用最优分层（OS）方法确定。低握力（HGS）和营养不良分别根据亚洲肌肉减少症工作组 2019 框架和 GLIM 定义。通过计算多变量调整后的风险比（HR），分别独立和联合评估低 FMI、握力弱和营养不良与生存的关联。
研究纳入了 1303 名女性和 1073 名男性患者，平均年龄为 57.7 岁，中位随访时间为 1267 天。OS 定义的 FMI 截断值为女性<5 kg/m，男性<7.7 kg/m。1188 例（50%）、1106 例（46.5%）和 910 例（38.3%）患者分别存在低 FMI、低 HGS 和营养不良。低 FMI 与营养状况、身体机能、生活质量和住院费用呈负相关。低 FMI（HR=1.50，95%CI=1.16 至 1.92）和营养不良（HR=1.31，95%CI=1.08 至 1.59）与死亡率独立相关。总体而言，FMI 加 GLIM 定义的营养不良显示出最大的联合预后影响，同时存在低 FMI 和营养不良的患者生存最差（HR=1.93，95%CI=1.48 至 2.52）。
低 FMI 提示脂肪消耗优于并增强握力弱和 GLIM 定义的营养不良对癌症生存的预后价值。这些发现表明，在常规癌症护理中纳入脂肪量评估的重要性，以帮助指导优化生存结果的策略。
