营养与炎症状态及抑郁症状对美国癌症幸存者死亡率的综合影响：来自美国国家健康与营养检查调查（NHANES）的结果

Combined influence of nutritional and inflammatory status and depressive symptoms on mortality among US cancer survivors: Findings from the NHANES.

作者信息

Yao Jiazhen, Chen Xiaohong, Meng Fang, Cao Hanzhong, Shu Xiaochen

机构信息

Department of Epidemiology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou 215123, China.

Department of Anesthesiology, Tumor Hospital Affiliated to Nantong University, Nantong 226361, China; Department of Anesthesiology, Nantong Tumor Hospital, Nantong 226361, China.

出版信息

Brain Behav Immun. 2024 Jan;115:109-117. doi: 10.1016/j.bbi.2023.10.002. Epub 2023 Oct 11.

DOI:10.1016/j.bbi.2023.10.002

PMID:37820973

Abstract

BACKGROUND

Inflammation and nutrition and depression are interrelated, and both are related to changes in mortality rates. We investigated the association of nutritional and inflammation index or depressive symptoms with the risk of all-cause mortality or cause-specific mortality among cancer survivors.

METHODS

A prospective cohort of a nationally representative sample of cancer survivors, aged 40 years or older (n = 2331; weighted population, 15 248 255; 67.6 ± 11.0 years; 50.6 % males), were recruited from the US National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. Advanced lung cancer inflammation index (ALI) reflected inflammation and nutritional status and Patient Health Questionnaire 9 (PHQ-9) demonstrated depressive symptoms. The independent and joint associations of ALI and PHQ-9 score with mortality outcomes were examined among cancer survivors and Cox regression analysis based on weights was used to calculate the relative risk.

RESULTS

We identified 605 all-cause deaths (cancer, 204; non-cancer, 401) over a median of 6.2 years of follow-up (15,385 person-years; interquartile range, 3.3-9.8 years). High ALI was observed to be consistently associated with lower risks of all-cause (hazard ratio [HR], 0.516; 95 % CI, 0.400-0.667) and non-cancer (HR, 0.414; 95 % CI, 0.291-0.588) mortality compared with low ALI in a series of adjusted models. Meanwhile, lower PHQ-9 score (0-4) was associated with lower risks of all-cause (HR, 0.686; 95 % CI, 0.521-0.903) and non-cancer (HR, 0.686; 95 % CI, 0.474-0.992) mortality compared with higher PHQ-9 score (≥10). Furthermore, joint analyses showed that high ALI was associated with a decreased risk of death among cancer survivors who were not depressive. Specifically, survivors with high ALI but not depressive symptoms had the lowest overall (HR, 0.404; 95 % CI, 0.228-0.715) risks.

CONCLUSION

In this cohort study, we observed impact of nutritional and inflammatory status and depressive symptoms on mortality among cancer survivors, with the lowest risks of death from both all causes and non-cancer being noted among the combination of high level ALI with no depression.

摘要

背景

炎症、营养与抑郁相互关联，且二者均与死亡率变化有关。我们调查了营养和炎症指标或抑郁症状与癌症幸存者全因死亡率或特定病因死亡率风险之间的关联。

方法

从2005年至2018年的美国国家健康和营养检查调查（NHANES）中招募了一个具有全国代表性的40岁及以上癌症幸存者前瞻性队列（n = 2331；加权人口为15248255；年龄67.6±11.0岁；男性占50.6%）。晚期肺癌炎症指数（ALI）反映炎症和营养状况，患者健康问卷9（PHQ - 9）显示抑郁症状。在癌症幸存者中检查了ALI和PHQ - 9评分与死亡率结果的独立和联合关联，并使用基于权重的Cox回归分析来计算相对风险。

结果

在中位6.2年的随访期（15385人年；四分位间距为3.3 - 9.8年）内，我们确定了605例全因死亡（癌症死亡204例；非癌症死亡401例）。在一系列调整模型中，与低ALI相比，高ALI始终与较低的全因死亡率（风险比[HR]，0.516；95%置信区间[CI]，0.400 - 0.667）和非癌症死亡率（HR，0.414；95% CI，0.291 - 0.588）相关。同时，与较高的PHQ - 9评分（≥10）相比，较低的PHQ - 9评分（0 - 4）与较低的全因死亡率（HR，0.686；95% CI，0.521 - 0.903）和非癌症死亡率（HR，0.686；95% CI，0.474 - 0.992）相关。此外，联合分析表明，高ALI与非抑郁癌症幸存者的死亡风险降低有关。具体而言，具有高ALI但无抑郁症状的幸存者总体风险最低（HR，0.404；95% CI，0.228 - 0.715）。