The diversity of nutritional status in cancer: new insights

Abstract

Objective: Nutritional status in cancer has been mostly biased toward undernutrition, an issue now in dispute. We aimed to characterize nutrition status, to analyze associations between nutritional and clinical/cancer-related variables, and to quantify the relative weights of nutritional and cancer-related features.

Methods: The cross-sectional study included 450 nonselected cancer patients (ages 18-95 years) at referral for radiotherapy. Nutritional status assessment included recent weight changes, body mass index (BMI) categorized by World Health Organization's age/sex criteria, and Patient-Generated Subjective Global Assessment (PG-SGA; validated/specific for oncology).

Results: BMI identified 63% as >or=25 kg/m(2) (43% overweight, 20% obese) and 4% as undernourished. PG-SGA identified 29% as undernourished and 71% as well nourished. Crossing both methods, among the 319 (71%) well-nourished patients according to PG-SGA, 75% were overweight/obese and only 25% were well nourished according to BMI. Concordance between BMI and PG-SGA was evaluated and consistency was confirmed. More aggressive/advanced stage cancers were more prevalent in deficient and excessive nutritional status: in 83% (n = 235/282) of overweight/obese patients by BMI and in 85% (n = 111/131) of undernourished patients by PG-SGA. Results required adjustment for diagnoses: greater histological aggressiveness was found in overweight/obese prostate and breast cancer; undernutrition was associated with aggressive lung, colorectal, head-neck, stomach, and esophageal cancers (p < .005). Estimates of effect size revealed that overweight/obesity was associated with advanced stage (24%), aggressive breast (10%), and prostate (9%) cancers, whereas undernutrition was associated with more aggressive lung (6%), colorectal (6%), and head-neck (6%) cancers; in both instances, age and longer disease duration were of significance.

Conclusion: Undernutrition and overweight/obesity have distinct implications and bear a negative prognosis in cancer. This study provides novel data on the prevalence of overweight/obesity and undernutrition in cancer patients and their potential role in cancer histological behavior.

Conflict of interest statement

Disclosures

Mariana Ramos Chaves: None; Carolina Boléo-Tomé: None; Isabel Monteiro-Grillo: None; Maria Camilo: None; Paula Ravasco: None.

Section editors Eduardo Bruera and Russell Portenoy have disclosed no financial relationships relevant to the content of this article.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias.

Figures

Figure 1.

Cancer histology according to diagnoses. *Others included multiple myeloma, sarcoma, leukemia, thymoma, meningioma, plasmocytoma, melanoma, cancer of the bladder, kidney, or pancreas, or occult primary tumor metastases.

Figure 2.

BMI nutritional status by diagnoses. *Others included multiple myeloma, sarcoma, leukemia, thymoma, meningioma, plasmocytoma, melanoma, cancer of the bladder, kidney, or pancreas, or occult primary tumor metastases.

Figure 3.

PG-SGA nutritional status (A, B, or C) by diagnoses. *Others included multiple myeloma, sarcoma, leukemia, thymoma, meningioma, plasmocytoma, melanoma, cancer of the bladder, kidney, or pancreas, or occult primary tumor metastases.

Figure 4.

Patients' distribution according to BMI and cancer histological grades (1 = well differentiated; 2 = moderately differentiated; 3 = poorly differentiated); = one patient.

Figure 5.

Patient nutritional status by the PG-SGA (A, B, or C) distributed according to histological grades (1 = well differentiated; 2 = moderately differentiated; 3 = poorly differentiated).