Obesity paradox in cancer: new insights provided by body composition

Gonzalez, Maria Cristina; Pastore, Carla Alberici; Orlandi, Silvana Paiva; Heymsfield, Steven B.

doi:10.3945/ajcn.113.071399

Cited by 257 publications

(203 citation statements)

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“…It is known that paradoxical obesity represents a good prognostic factor in the evolution of certain entities, such as in acute coronary syndromes, chronic heart failure, chronic renal disease and pneumonia (36)(37)(38)(39). Gruber et al described the concept of paradoxical obesity in 2002 by suggesting obesity as a good prognostic factor in patients undergoing percutaneous transluminal coronary angioplasty in short and long term (36).…”

Section: Discussionmentioning

confidence: 99%

“…Gruber et al described the concept of paradoxical obesity in 2002 by suggesting obesity as a good prognostic factor in patients undergoing percutaneous transluminal coronary angioplasty in short and long term (36). Recently, González et al (37) reported that ambulatory patients with cancer and sarcopenia (low rate of fat-free mass) have a higher risk of death. The few reports that include oncologic patients suggest that obesity is a factor to consider in the response to oncologic treatment, and in the progression and resolution of oncologic disease over the medium or long term (40)(41)(42).…”

Section: Discussionmentioning

confidence: 99%

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Incidence of high body mass index in critically ill cancer patients

Ñamendys‐Silva

Guevara-García²,

Arredondo-Armenta³

et al. 2017

Nutr Hosp

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence of high body mass index in critically ill cancer patients

Ñamendys‐Silva

Guevara-García²,

Arredondo-Armenta³

et al. 2017

Nutr Hosp

View full text Add to dashboard Cite

“…However, it has also been proposed that the obesity paradox may not be a true phenomenon, since large adipose tissue is frequently associated with large muscularity, which may be the real reason for the better outcome. To address this uncertainty, Gonzalez et al analysed the survival of cancer patients (22) . When stratified according to BMI, the longest survival was observed for those cancer patients with BMI > 25.…”

Section: Obesity Paradox In Cachexiamentioning

confidence: 99%

Cachexia: clinical features when inflammation drives malnutrition

2015

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“…A low FFM has been linked to mortality in older and obese patients [19,20]. Thus, it would seem logical to consider that FFM at diagnosis may predict survival.…”

Section: Body Weight Versus Body Compositionmentioning

confidence: 99%

Should patients with ALS gain weight during their follow-up?

et al. 2015

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a b s t r a c tIt was recently postulated that a nutritional intervention aiming at achieving weight gain might increase survival in ALS patients. This article discusses the effect of nutritional status and weight gain on survival, respiratory status and physical function. Based on the available literature, it remains unknown whether weight gain during the progression of the disease improves survival whatever the baseline body weight is. A high body mass index may impair respiratory muscle function and passive mobilization of paretic patients. Future research should evaluate the effect of changes in weight and body composition on clinical outcome while taking into account respiratory muscle strength and physical function.Ó 2015 Elsevier Inc. All rights reserved.Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with a life expectancy of 2 to 5 y. Effective treatment for ALS is lacking. A multidisciplinary approach [1], non-invasive ventilation [2], riluzole, and enteral nutrition via percutaneous endoscopic gastrostomy have been shown to improve survival and quality of life to some extent [1]. In a recently published article, it was postulated that a nutritional intervention, aiming at achieving weight gain, might be a therapeutic option for patients with ALS [3]. These assumptions relied on the increased survival with a high-calorie diet in an ALS mouse model [4] and on the lower risk for ALS in overweight or obese individuals [5].Here we summarize the effect of initial nutritional status and weight gain during follow-up on survival and respiratory and physical function to explore whether weight gain is beneficial for patients with ALS.Weight and body mass index at diagnosis and survival A study of 92 patients with ALS demonstrated that a history of weight loss at diagnosis was significantly associated with survival [7]. After adjustment for age, sex, bulbar versus non-bulbar onset, ALS functional rating scale (ALSFRS), manual muscular testing, forced vital capacity, and diagnostic delay, the study found a 30% increase in risk for death for each 5% weight loss and a 20% increase in risk for death for each BMI unit loss.In the same study population, undernutrition at diagnosis, defined as a BMI <18.5 kg/m 2 if <70 y or <21 kg/m 2 if 70 y (n ¼ 8), was not associated with survival, after the aforementioned adjustments [7]. Effect of obesity was not assessed. A larger study stratified 285 patients with ALS according to BMI categories at baseline [8]. BMI categories were not predictive of survival or rate of progression. However, only 3 patients were undernourished and 65 were obese. A shorter survival in patients with ALS and a baseline BMI <18.5 kg/m 2 (n ¼ 9) than in those with a higher BMI was reported in univariate Cox regressions [9]. One group of researchers studied 427 patients with ALS [10]. A decreased survival was seen in patients with a BMI >35 or <18.5 kg/m 2 at diagnosis; thus a U-shaped relationship between BMI and survival was established. This finding was confirmed in the PRO-ACT (Po...

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Obesity paradox in cancer: new insights provided by body composition

Abstract: The obesity paradox is present in cancer patients only when obesity is defined by BMI. Patients with sarcopenic obesity had the poorest prognosis. Cancer patients with high mortality risk can be identified by a body-composition assessment.

Cited by 257 publications

References 35 publications

Incidence of high body mass index in critically ill cancer patients

Incidence of high body mass index in critically ill cancer patients

Cachexia: clinical features when inflammation drives malnutrition

Should patients with ALS gain weight during their follow-up?

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