Ishida Yuria, Maeda Keisuke, Murotani Kenta, Shimizu Akio, Ueshima Junko, Nagano Ayano, Sonoi Norihiro, Inoue Tatsuro, Mori Naoharu
Department of Nutrition, Aichi Medical University Hospital, Aichi, Japan; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Aichi, Japan.
Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Aichi, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu Aichi, Japan; Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu Aichi, Japan.
Nutrition. 2023 Nov;115:112152. doi: 10.1016/j.nut.2023.112152. Epub 2023 Jul 3.
Conventional diagnostic criteria for cachexia are based on Western studies. The aim of this study was to investigate trends in body mass index (BMI) and the rate of weight change associated with adverse outcomes in Asian patients with advanced cancer.
This retrospective cohort study was conducted using the administrative claims database compiled by the Japan Medical Data Center Inc. The study was conducted between April 2014 and September 2022 on patients with advanced cancer. A Cox regression model was used to perform a restricted cubic spline analysis with four knots for BMI and weight change. Additionally, thin-plate smoothed splines were used to generate contour plots of the odds ratios of BMI and weight change for mortality.
The study analyzed 48 600 patients. The mean age was 71.9 ± 10 y. There were 33 051 men (68%) and 17 853 deaths (37%). The smoothed splines for BMI showed that low BMI was associated with high hazard ratio (HR, [95% confidence interval]; BMI = 18.5 kg/m, HR, 1.2; [1.1-1.2]; BMI = 25 kg/m, HR, 0.9; [0.9-0.9]). The smoothed spline of weight change showed a higher HR with an increasing rate of weight change (weight change rate -10%, HR, 1.1; [1.1-1.2]; weight change rate +10%, HR, 1; [1-1]). In the thin-plate smoothed spline analysis, patients with BMI <17 to 18.5 kg/m were at a higher risk for death regardless of weight change.
Low BMI, a large degree of weight change, or a combination of both, predicted death in Asian patients with advanced cancer.
恶病质的传统诊断标准基于西方研究。本研究旨在调查亚洲晚期癌症患者的体重指数（BMI）趋势以及与不良结局相关的体重变化率。
本回顾性队列研究使用了日本医疗数据中心公司汇编的行政索赔数据库。该研究于2014年4月至2022年9月对晚期癌症患者进行。采用Cox回归模型对BMI和体重变化进行四分位限制立方样条分析。此外，使用薄板样条生成BMI和体重变化与死亡率比值比的等高线图。
该研究分析了48600例患者。平均年龄为71.9±10岁。有33051名男性（68%），17853例死亡（37%）。BMI的样条显示，低BMI与高风险比（HR，[95%置信区间]）相关；BMI = 18.5 kg/m²，HR，1.2；[1.1 - 1.2]；BMI = 25 kg/m²，HR，0.9；[0.9 - 0.9]）。体重变化的样条显示，随着体重变化率增加HR更高（体重变化率-10%，HR，1.1；[1.1 - 1.2]；体重变化率+10%，HR，1；[1 - 1]）。在薄板样条分析中，无论体重变化如何，BMI<17至18.5 kg/m²的患者死亡风险更高。
低BMI、大幅度体重变化或两者结合可预测亚洲晚期癌症患者的死亡。
