Vol 7, No 4 (2022)
Original article
Published online: 2022-12-14

open access

Page views 3426
Article views/downloads 282
Get Citation

Connect on Social Media

Connect on Social Media

Nutritional and functional status as indices of short- and long-term prognosis in patients undergoing surgery due to colorectal cancer

Beata Szukay1, Krzysztof Tojek2, Gabriel Kowalczyk1, Natalia Mysiak1, Jacek Budzyński1
Medical Research Journal 2022;7(4):307-313.

Abstract

Introduction: Nutritional status and body composition parameters would seem to be reasonable prognostic factors in patients with colorectal cancer (CRC). The study aimed to investigate the relationships between numerous parameters of nutritional status and prognosis in patients undergoing surgery due to CRC.

Material and methods: Clinical nutritional assessment and biochemical determinations were performed on 110 patients who underwent elective surgery due to primary CRC. Body composition was also analyzed using bioelectrical impedance (BIA) and computed tomography (CT) scans at the third lumbar (L3) vertebra using OsiriX software.

Results: Patients who failed to attend a visit 3 months after surgery (n = 15; 13.6%) were more likely to be sarcopenic, with lower baseline functional status, handgrip strength, skeletal muscle (SM) parameters in BIA and a smaller SM area in CT. Compared to those who died during, on average, 3.6 years of follow-up (n = 33; 30%), patients who survived had, at baseline, a significantly higher Mini-Nutritional Assessment (MNA) score, lower waist-to-height ratio (WHtR), and higher scores on functional status scales. In a Cox’s proportional-hazards model, in addition to an advanced WHO CRC stage, scores for MNA (HR; 95% CI: 0.85; 0.74–0.98; p = 0.021), Patient-Generated Subjective Global Assessment (PG-SGA), instrumental activities of daily living (IADL), and WHtR (3.68; 1.03–13.13; p = 0.049) were independent risk factors for death.

Conclusions: Patients’ functional status 3 months after surgery due to CRC was related to baseline SM strength, mass, and functional performance, whereas 3.5-year mortality was associated with lower MNA and IADL scores and higher WHtR and PG-SGA scores.

Article available in PDF format

View PDF Download PDF file

References

  1. Chadid S, Kreger BE, Singer MR, et al. Anthropometric measures of body fat and obesity-related cancer risk: sex-specific differences in Framingham Offspring Study adults. Int J Obes (Lond). 2020; 44(3): 601–608.
  2. Lo K, Huang YQ, Shen G, et al. Effects of waist to height ratio, waist circumference, body mass index on the risk of chronic diseases, all-cause, cardiovascular and cancer mortality. Postgrad Med J. 2021; 97(1147): 306–311.
  3. Kobiela J, Wieszczy P, Reguła J, et al. Association of obesity with colonic findings in screening colonoscopy in a large population-based study. United European Gastroenterol J. 2018; 6(10): 1538–1546.
  4. Gribovskaja-Rupp I, Kosinski L, Ludwig KA. Obesity and colorectal cancer. Clin Colon Rectal Surg. 2011; 24(4): 229–243.
  5. Jung InS, Shin CM, Park SJ, et al. Association of visceral adiposity and insulin resistance with colorectal adenoma and colorectal cancer. Intest Res. 2019; 17(3): 404–412.
  6. Tojek K, Wustrau B, Czerniak B, et al. Body mass index as a biomarker for the evaluation of the "Obesity Paradox" among inpatients. Clin Nutr. 2019; 38(1): 412–421.
  7. Tojek K, Banaszkiewicz Z, Budzyński J. Body composition among patients undergoing surgery for colorectal cancer. Gastroenterology Review. 2021; 16(1): 47–55.
  8. Tojek K, Anaszewicz M, Szukay B, et al. Circulating leptin, adiponectin, and tumor necrosis factor-alpha in patients undergoing surgery due to colorectal cancer. Digestion. 2021; 102(2): 246–255.
  9. Kasi PM, Zafar SY, Grothey A. Is obesity an advantage in patients with colorectal cancer? Expert Rev Gastroenterol Hepatol. 2015; 9(11): 1339–1342.
  10. Lee DU, Fan GH, Hastie DJ, et al. The clinical impact of malnutrition on the postoperative outcomes of patients undergoing gastrectomy for gastric cancer: Propensity score matched analysis of 2011-2017 hospital database. Clin Nutr ESPEN. 2021; 46: 484–490.
  11. Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017; 36(1): 11–48.
  12. Arends J, Baracos V, Bertz H, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr. 2017; 36(5): 1187–1196.
  13. da Cunha LP, Silveira MN, Mendes MC, et al. Sarcopenia as an independent prognostic factor in patients with metastatic colorectal cancer: A retrospective evaluation. Clin Nutr ESPEN. 2019; 32: 107–112.
  14. Muscaritoli M, Arends J, Bachmann P, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017; 36(1): 11–48.
  15. Reisinger KW, van Vugt JLA, Tegels JJW, et al. Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery. Ann Surg. 2015; 261(2): 345–352.
  16. Lobo DN, Gianotti L, Adiamah A, et al. Perioperative nutrition: Recommendations from the ESPEN expert group. Clin Nutr. 2020; 39(11): 3211–3227.
  17. Ochs-Balcom HM, Cannioto R, Nie J, et al. Adipokines do not mediate the association of obesity and colorectal adenoma. J Cancer Epidemiol. 2014; 2014: 371254.
  18. Ashktorab H, Soleimani A, Nichols A, et al. Adiponectin, leptin, IGF-1, and tumor necrosis factor alpha as potential serum biomarkers for non-invasive diagnosis of colorectal adenoma in African Americans. Front Endocrinol (Lausanne). 2018; 9: 77.
  19. Li S, Pinard M, Wang Y, et al. Crosstalk between the TNF and IGF pathways enhances NF-κB activation and signaling in cancer cells. Growth Horm IGF Res. 2015; 25(5): 253–261.
  20. Gao Y, Katki H, Graubard B, et al. Serum IGF1, IGF2 and IGFBP3 and risk of advanced colorectal adenoma. Int J Cancer. 2012; 131(2): E105–E113.
  21. Lu Bo, Qian JM, Li JN. The metabolic syndrome and its components as prognostic factors in colorectal cancer: A meta-analysis and systematic review. J Gastroenterol Hepatol. 2022 [Epub ahead of print].
  22. Gholami M, Zoughi M, Larijani B, et al. The role of inflammatory miRNA-mRNA interactions in PBMCs of colorectal cancer and obesity patients. Immun Inflamm Dis. 2022; 10(11): e702.
  23. Słomian G, Świętochowska E, Nowak G, et al. Association between chemotherapy and plasma adipokines in patients with colorectal cancer. Pharmacol Rep. 2014; 66(5): 902–907.
  24. Han J, Meng Q, Shen L, et al. Interleukin-6 induces fat loss in cancer cachexia by promoting white adipose tissue lipolysis and browning. Lipids Health Dis. 2018; 17(1): 14.
  25. Nattenmueller J, Hoegenauer H, Boehm J, et al. CT-based compartmental quantification of adipose tissue versus body metrics in colorectal cancer patients. Eur Radiol. 2016; 26(11): 4131–4140.
  26. Lieffers JR, Bathe OF, Fassbender K, et al. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer. 2012; 107(6): 931–936.
  27. Peng PD, van Vledder MG, Tsai S, et al. Sarcopenia negatively impacts short-term outcomes in patients undergoing hepatic resection for colorectal liver metastasis. HPB (Oxford). 2011; 13(7): 439–446.
  28. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019; 48(4): 601.
  29. Spexoto MC, Ramírez PC, de Oliveira Máximo R, et al. European Working Group on Sarcopenia in Older People 2010 (EWGSOP1) and 2019 (EWGSOP2) criteria or slowness: which is the best predictor of mortality risk in older adults? Age Ageing. 2022; 51(7).
  30. Sayer AA, Cruz-Jentoft A. Sarcopenia definition, diagnosis and treatment: consensus is growing. Age Ageing. 2022; 51(10).
  31. Jang Y, Kim T, Kim BHS, et al. Association between obesity indexes and thyroid cancer risk in Korean women: nested case-control study. Cancers (Basel). 2022; 14(19).
  32. Li ZY, Tan YT, Wang J, et al. Dose-response relationship between fat distribution and liver cancer incidence: A prospective cohort study in Chinese men. Cancer Epidemiol. 2022; 76: 102091.
  33. Schlesinger S, Aleksandrova K, Pischon T, et al. Abdominal obesity, weight gain during adulthood and risk of liver and biliary tract cancer in a European cohort. Int J Cancer. 2013; 132(3): 645–657.
  34. Agalliu I, Lin WKJ, Zhang JS, et al. Overall and central obesity and prostate cancer risk in African men. Cancer Causes Control. 2022; 33(2): 223–239.
  35. Campbell PT, Newton CC, Kitahara CM, et al. Body size indicators and risk of gallbladder cancer: pooled analysis of individual-level data from 19 prospective cohort studies. Cancer Epidemiol Biomarkers Prev. 2017; 26(4): 597–606.
  36. Kour A, Sharma S, Sambyal V, et al. Risk factor analysis for breast cancer in premenopausal and postmenopausal women of Punjab, India. Asian Pac J Cancer Prev. 2019; 20(11): 3299–3304.
  37. Kabat GC, Xue X, Kamensky V, et al. Risk of breast, endometrial, colorectal, and renal cancers in postmenopausal women in association with a body shape index and other anthropometric measures. Cancer Causes Control. 2015; 26(2): 219–229.
  38. Moore LL, Chadid S, Singer MR, et al. Metabolic health reduces risk of obesity-related cancer in framingham study adults. Cancer Epidemiol Biomarkers Prev. 2014; 23(10): 2057–2065.
  39. Wei LP, Li N, Wang G, et al. Anthropometry and the risk of colorectal cancer in males: A prospective cohort study. Zhonghua Yu Fang Yi Xue Za Zhi. 2018; 52: 685–690.
  40. Kwon JH, Ko HJ, Youn CH, et al. Obesity markers as predictors for colorectal neoplasia. J Obes Metab Syndr. 2017; 26(1): 28–35.
  41. Bachmann R, Leonard D, Nachit M, et al. Comparison between abdominal fat measured by CT and anthropometric indices as prediction factors for mortality and morbidity after colorectal surgery. Acta Gastroenterol Belg. 2018; 81(4): 477–483.
  42. Dong J, Ni YQ, Chu X, et al. Association between the abdominal obesity anthropometric indicators and metabolic disorders in a Chinese population. Public Health. 2016; 131: 3–10.
  43. Parente EB, Harjutsalo V, Forsblom C, et al. FinnDiane Study Group. The impact of central obesity on the risk of hospitalization or death due to heart failure in type 1 diabetes: a 16-year cohort study. Cardiovasc Diabetol. 2021; 20(1): 153.
  44. Wawrzeńczyk A, Kowalczyk G, Szukay B, et al. Nutritional status and body composition of patients hospitalized for exacerbated heart failure. Pol Arch Intern Med. 2021; 131(12).
  45. Hukportie DN, Li FR, Zhou R, et al. Anthropometric measures and incident diabetic nephropathy in participants with type 2 diabetes mellitus. Front Endocrinol (Lausanne). 2021; 12: 706845.
  46. Dhana K, Kavousi M, Ikram MA, et al. Body shape index in comparison with other anthropometric measures in prediction of total and cause-specific mortality. J Epidemiol Community Health. 2016; 70(1): 90–96.