Low fat mass index outperforms handgrip weakness and GLIM-defined malnutrition in predicting cancer survival: Derivation of cutoff values and joint analysis in an observational cohort,Clinical Nutrition

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Low fat mass index outperforms handgrip weakness and GLIM-defined malnutrition in predicting cancer survival: Derivation of cutoff values and joint analysis in an observational cohort
Clinical Nutrition ( IF 6.6 ) Pub Date : 2021-11-24 , DOI: 10.1016/j.clnu.2021.11.026
Liangyu Yin ₁ , Chunhua Song ₂ , Jiuwei Cui ₃ , Nanya Wang ₃ , Yang Fan ₄ , Xin Lin ₄ , Ling Zhang ₄ , Mengyuan Zhang ₄ , Chang Wang ₃ , Tingting Liang ₃ , Wei Ji ₃ , Xiangliang Liu ₃ , Wei Li ₃ , Hanping Shi ₅ , Hongxia Xu ₄ ,

Affiliation

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.

Methods

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).

Results

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/m² in women and <7.7 kg/m² 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).

Conclusions

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.

中文翻译：

低脂肪质量指数在预测癌症存活率方面优于握力无力和 GLIM 定义的营养不良：在观察队列中推导截止值和联合分析

背景与目标

在亚洲肿瘤学人群中定义与生存相关的低脂肪质量指数 (FMI) 的最佳阈值仍然很大程度上未知。本研究旨在推导特定性别的 FMI 截止值，并分析低 FMI、握力无力和全球营养不良领导倡议 (GLIM) 定义的营养不良与癌症存活之间的独立和联合关联。

方法

我们进行了一项多中心队列研究，包括 2376 名癌症患者。通过生物电阻抗分析测量 FMI，并使用最佳分层 (OS) 方法确定最佳阈值。低握力 (HGS) 和营养不良的定义分别基于亚洲肌肉减少症工作组 2019 框架和 GLIM。通过计算多变量调整后的风险比 (HR)，独立和联合估计了低 FMI、握力无力和营养不良与生存的关联。

结果

该研究招募了 1303 名女性和 1073 名男性，平均年龄为 57.7 岁，中位随访时间为 1267 天。OS 定义的 FMI 截止值是女性 <5 kg/m ²和男性 <7.7 kg/m ²。分别在 1188 (50%)、1106 (46.5%) 和 910 (38.3%) 名患者中发现低 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关节预后影响，同时低 FMI 和营养不良的患者生存率最差（HR = 1.93, 95%CI = 1.48 至 2.52）。