Fat mass assessment using the triceps skinfold thickness enhances the prognostic value of the Global Leadership Initiative on Malnutrition criteria in patients with lung cancer

Abstract

The present study evaluated whether fat mass assessment using the triceps skinfold (TSF) thickness provides additional prognostic value to the GLIM framework in patients with lung cancer (LC). We performed an observational cohort study including 2672 LC patients at two institutions in China. Comprehensive demographic, disease and nutritional characteristics were collected. Malnutrition was retrospectively defined using the GLIM criteria, and optimal stratification was used to determine the best thresholds for the TSF. The associations of malnutrition and TSF categories with survival were estimated independently and jointly by calculating multivariable-adjusted hazard ratios (HRs). Malnutrition was identified in 808 (30.2%) patients, and the best TSF thresholds were 9.5 mm in men and 12 mm in women. Accordingly, 496 (18.6%) patients were identified as having a low TSF. Patients with concurrent malnutrition and a low TSF had a 54% (HR = 1.54, 95%CI = 1.25 to 1.88) greater death hazard compared with well-nourished individuals, which was also greater compared to malnourished patients with a normal TSF (HR = 1.23, 95%CI = 1.06 to 1.43) or malnourished patients without TSF assessment (HR = 1.31, 95%CI = 1.14 to 1.50). These associations were concentrated among those patients with adequate muscle mass (as indicated by the calf circumference). Additional fat mass assessment using the TSF enhances the prognostic value of the GLIM criteria. Using the population-derived thresholds for the TSF may provide significant prognostic value when used in combination with the GLIM criteria to guide strategies to optimize the long-term outcomes in patients with LC.

De novo Creation and Assessment of a Prognostic Fat-Age-Inflammation Index “FAIN” in Patients With Cancer: A Multicenter Cohort Study

“…First, Harrell's C-index was calculated to assess the prognostic impact of each baseline parameter. Then, the TSF (mm) ( 20 ), age (years), neutrophil to lymphocyte ratio (NLR, as an inflammatory marker, same unit for the neutrophils and lymphocytes, such as number/L) ( 15 ) and the serum albumin (g/L, as an inflammatory and prognostic marker) ( 41 ) were manually selected to develop the FAIN index since they showed the highest C-index within their respective categories. The prototypic definition of the FAIN was: (TSF + albumin)/(age + NLR).…”

“…Additionally, cancer-related malnutrition is often linked to other nutrition status-related conditions such as cachexia and sarcopenia ( 5 , 10 – 12 ). These conditions can independently or jointly lead to an impaired quality of life (QOL) ( 13 – 15 ), reduced treatment tolerance ( 16 ), increased postoperative complications ( 17 ), delayed rehabilitation of organ function ( 18 ) and a shortened overall survival ( 7 , 19 , 20 ). Previous studies have estimated that 10–20% of cancer deaths can be attributed to malnutrition rather than the cancer itself ( 21 , 22 ).…”

“…Of the validated approaches used to screen for the risk or assess the severity of malnutrition, the Nutritional Risk Screening 2002 (NRS2002) ( 26 ) and the Patient-Generated Subjective Global Assessment (PG-SGA) ( 27 ) are the most widely used tools in Chinese oncology patients ( 15 , 19 , 28 ). The Global Leadership Initiative on Malnutrition (GLIM) ( 11 ), a set of ESPEN-endorsed guidelines aiming to unify the diagnosis of malnutrition in patients with a wide spectrum of diseases, have also been garnering increasing interest from the nutrition society ( 7 , 8 , 14 , 15 , 17 , 19 , 20 , 28 ). In addition to these questionnaire- or expert opinion-based tools, several nutrition-related indices have also been implemented to assess the nutritional status of patients, such as the Nutritional Risk Index (NRI) ( 29 ), the Controlling Nutritional Status (CONUT) index ( 30 ) and the Prognostic Nutritional Index (PNI) ( 31 ).…”

Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating

“…Medical professionals and cancer patients alike believe toxicities are inevitable and general amelioration techniques are often overlooked. Difficulty eating and malnutrition during cancer therapy are common problems that can be assessed with many tools [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]. The challenge is to have an acceptable quality and quantity of nutrient intake with minimal toxicity without compromising effective cancer treatment.…”

“…Malnutrition in cancer patients is a common problem. There are many indices and tools to define malnutrition, cachexia, and sarcopenia [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]62,[69][70][71][72][73][74][75][76][77]. Although weight loss from the time of diagnosis is one measure, the quantity and quality of food in the diet and information from the patient generated subjective global assessment (PG-SGA) tool can provide more specific information [35,36,45,51,62,66,[69][70][71][72][73][78][79][80].…”