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Zhang X, Li JH, Zhang Q, Li QQ, Zhang KP, Tang M, Ge YZ, Li W, Xu HX, Guo ZQ, Shi HP. Relationship Between Prognostic Nutritional Index and Mortality in Overweight or Obese Patients with Cancer: A Multicenter Observational Study. J Inflamm Res 2021; 14:3921-3932. [PMID: 34421305 PMCID: PMC8373303 DOI: 10.2147/jir.s321724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/28/2021] [Indexed: 12/16/2022] Open
Abstract
Background Overweight and obese patients with cancer present with chronic inflammation, dysfunctional antitumor immunity and malnutrition risk. Prognostic nutritional index (PNI) is a promising indicator for predicting inflammatory, immunological and nutritional states; however, its prognostic value in overweight and obese patients with cancer has not been explored. Therefore, the aim of the current study was to explore the prognostic value of PNI levels in overweight and obese patients with cancer. Methods The current large-scale retrospective cohort multicenter study included 3532 patients. Time-dependent receiver operating characteristic (ROC) curve analysis was used to determine the prediction accuracy of PNI levels for mortality of overweight and obese patients with cancer. Restricted cubic splines were used to model the association between PNI levels and mortality. Association between low PNI and overall survival rate was analyzed using the Kaplan–Meier method and Cox regression model. Results Area under the curve (AUC) of the PNI for all-cause mortality was higher compared with that of the neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in overweight and obese patients with cancer. There was a significant inverse relationship between PNI levels and all-cause mortality (per SD increment-HR: 0.79; 95% CI: 0.74, 0.85; P<0.001). Subgroup analysis showed that the risk for mortality significantly decreased with increase in PNI levels in patients at risk of malnutrition (per SD increment-HR: 0.67; 95% CI: 0.57, 0.78; P<0.001) and elderly patients (per SD increment-HR: 0.74; 95% CI: 0.64, 0.84; P<0.001). In addition, PNI levels showed an inverse association with mortality in patients without malnutrition risk (per SD increment-HR: 0.81; 95% CI: 0.75, 0.88; P<0.001). Subgroup analysis based on tumor type showed that low PNI was an independent predictor of poor prognosis for patients with lung cancer, gastric cancer and hepatobiliary and pancreatic cancer. Conclusion Low PNI levels are associated with an increased risk for all-cause mortality. PNI level is a potential effective inflammation-based prognostic tool for overweight and obese patients with cancer.
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Affiliation(s)
- Xi Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China.,Department of Radiotherapy, Affiliated Hospital of Hebei University, Baoding, 071000, People's Republic of China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People's Republic of China
| | - Jing-Hua Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of Hebei University, Baoding, 071000, People's Republic of China
| | - Qi Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People's Republic of China
| | - Qin-Qin Li
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People's Republic of China
| | - Kang-Ping Zhang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People's Republic of China
| | - Meng Tang
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People's Republic of China
| | - Yi-Zhong Ge
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People's Republic of China
| | - Wei Li
- Cancer Center of the First Hospital of Jilin University, Changchun, 130021, People's Republic of China
| | - Hong-Xia Xu
- Department of Clinical Nutrition, Daping Hospital, Third Military Medical University (Army Medical University), Chongqing, 400042, People's Republic of China
| | - Zeng-Qing Guo
- Department of Medical Oncology, Fujian Cancer Hospital, Fujian Medical University, Fujian, 350014, People's Republic of China
| | - Han-Ping Shi
- Department of Gastrointestinal Surgery/Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, People's Republic of China.,Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition, Beijing, 100038, People's Republic of China
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2
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Hughes TM, Shah K, Noria S, Pawlik T. Is BMI associated with post-operative complication risk among patients undergoing major abdominal surgery for cancer? A systematic review. J Surg Oncol 2018; 117:1009-1019. [DOI: 10.1002/jso.24999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/01/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Tasha M. Hughes
- The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Kejal Shah
- The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Sabrena Noria
- The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Timothy Pawlik
- The Ohio State University Wexner Medical Center; Columbus Ohio
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3
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Fujiwara Y, Fukuda S, Tsujie M, Kitani K, Inoue K, Hayashi T, Ishikawa H, Yukawa M, Inoue M. Outcome predictors for patients with stage II/III gastric cancer who undergo gastrectomy and S-1 adjuvant chemotherapy. Oncol Lett 2017; 14:1621-1627. [PMID: 28789388 PMCID: PMC5529945 DOI: 10.3892/ol.2017.6286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 02/13/2017] [Indexed: 01/20/2023] Open
Abstract
Predictors of survival in patients with stage II/III gastric cancer (GC) who received tegafur/gimeracil/oteracil (S-1) adjuvant chemotherapy (ACT) subsequent to gastrectomy were examined. Additionally, the association between dose intensity of S-1 and survival rate was investigated. A total of 62 patients with stage II/III gastric cancer were retrospectively evaluated, each of whom had received a curative D2 gastrectomy and S-1 ACT. The relative performance (RP; administered/planned S-1 doses ×100%), body mass index (BMI), prognostic nutritional index (PNI) and body weight (BW) were calculated, and the association of survival with these factors and other clinicopathological parameters was examined. The 1-year treatment continuation rate for S-1 was 94.2%, excluding patients who experienced cancer recurrences during their ACT year. The initial S-1 reduction rate was 38.7%. Patients with stage II/IIIA disease exhibited significantly improved 5-year overall survival rates compared with patients with stage IIIB GC, 81.6/73.7 vs. 33.8% (P<0.01). No association between RP and survival was observed. BMI, BW and PNI were significantly decreased following surgery compared with preoperative states. In the univariate analysis, postoperative BW loss (BMI loss), pathological stage and >7 lymph node metastases were significantly associated with outcome (P<0.05); in the multivariate analysis, postoperative BW loss >10.6% and pathological stages were independent prognostic factors for survival. Continuing S-1 ACT for the full year exhibited a greater effect on survival compared with dosage. Early postoperative nutritional deterioration may decrease the survival rates in these patients.
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Affiliation(s)
- Yoshinori Fujiwara
- Department of Digestive Surgery, Nara Hospital, Kindai University School of Medicine, Ikoma, Nara 630-0293, Japan
- Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Okayama 701-0192, Japan
| | - Shuichi Fukuda
- Department of Digestive Surgery, Nara Hospital, Kindai University School of Medicine, Ikoma, Nara 630-0293, Japan
| | - Masanori Tsujie
- Department of Digestive Surgery, Nara Hospital, Kindai University School of Medicine, Ikoma, Nara 630-0293, Japan
| | - Kotaro Kitani
- Department of Digestive Surgery, Nara Hospital, Kindai University School of Medicine, Ikoma, Nara 630-0293, Japan
| | - Keisuke Inoue
- Department of Digestive Surgery, Nara Hospital, Kindai University School of Medicine, Ikoma, Nara 630-0293, Japan
| | - Tomonori Hayashi
- Department of Pharmacy, Nara Hospital, Kindai University School of Medicine, Ikoma, Nara 630-0293, Japan
| | - Hajime Ishikawa
- Department of Digestive Surgery, Nara Hospital, Kindai University School of Medicine, Ikoma, Nara 630-0293, Japan
| | - Masao Yukawa
- Department of Digestive Surgery, Nara Hospital, Kindai University School of Medicine, Ikoma, Nara 630-0293, Japan
| | - Masatoshi Inoue
- Department of Digestive Surgery, Nara Hospital, Kindai University School of Medicine, Ikoma, Nara 630-0293, Japan
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4
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Huang L, Wei ZJ, Li TJ, Jiang YM, Xu AM. A prospective appraisal of preoperative body mass index in D2-resected patients with non-metastatic gastric carcinoma and Siewert type II/III adenocarcinoma of esophagogastric junction: results from a large-scale cohort. Oncotarget 2017; 8:68165-68179. [PMID: 28978106 PMCID: PMC5620246 DOI: 10.18632/oncotarget.19251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/16/2017] [Indexed: 02/06/2023] Open
Abstract
Objective To prospectively investigate associations of presurgical body mass index (BMI) with clinicopathological factors and its prognostic significance in radically D2-resected patients with non-metastasized gastric cancer (GC) and Siewert type II/III adenocarcinoma of esophagogastric junction (AEG). Methods A large prospective cohort consisting of radically-resected GC and AEG patients was analyzed. Follow-up was successful in 671 out of 700 patients, who were categorized into underweight (BMI<18.5), normal-weight (BMI=18.5-22.9), overweight (BMI=23-24.9), and obese (BMI≥25) groups according to Asian standards. BMI-associated factors were explored using multivariable logistic regression with adjustment. Cancer-specific survival analyses were conducted applying both univariable and multivariable Cox regression methods. Results Pre-operation, higher hemoglobin levels and smaller anemia proportions were observed in larger BMI groups. Higher BMI tended to be associated with higher neutrophil-lymphocyte ratios (NLRs). Patients with higher BMI had smaller tumors and more often stage I tumors, but longer surgical time and postsurgical stay. In multivariable analyses, higher hemoglobin levels, upper tumor location, poorer differentiation, and higher NLR were significantly associated with higher BMI. Overall, survival analyses revealed no significant role of BMI. However, in further stratifications after adjustment, compared to patients with normal BMI, obese patients had better survival in women, but worse in those with AEG; underweight was associated with reduced mortality risk in tumors differentiated well to moderately; overweight patients had increased death hazard when having thrombocytopenia. Conclusion Overall, preoperative BMI had limited prognostic significance in operated GC patients. However, under specific conditions (e.g., female, AEG, good differentiation, and thrombocytopenia), BMI might indicate postoperative survival.
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Affiliation(s)
- Lei Huang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhi-Jian Wei
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tuan-Jie Li
- Department of General Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - Yu-Ming Jiang
- Department of General Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, China
| | - A-Man Xu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Department of General Surgery, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
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5
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Laffitte AM, Polakowski CB, Kato M. Early oral re-feeding on oncology patients submitted to gastrectomy for gastric cancer. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28:200-3. [PMID: 26537147 PMCID: PMC4737363 DOI: 10.1590/s0102-67202015000300014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/25/2015] [Indexed: 12/23/2022]
Abstract
Background: There is no advantage in maintaining patients on oral fasting after
gastrointestinal elective resection. The early feeding up to 48 h can be
beneficial, because it reduces infectious complications and hospital stay. Aim: Evaluate the evolution and tolerance of early oral diet in postoperative period
after gastrectomy for gastric cancer. Methods: Anthropometric assessment was performed on the day of surgery, weight, height,
body mass index and weight loss were measured. Acceptance of diet was evaluated as
food intake (amount accepted) and gastrointestinal symptoms such as nausea,
vomiting, constipation, diarrhea, abdominal distension, postoperative
complications and hospital stay. Results: The sample consisted of 23 patients, 17 with partial gastrectomy and six with
total gastrectomy. In the assessment of nutritional status 9% were malnourished,
54.5% normal weight, 9% overweight and 27.2% obese, but 54% had weight loss. There
was good acceptance of the diet in 96,9% of the sample. Nausea and abdominal
distension were present in 4,3% and 65.2% constipation. Surgical complications
according to the Clavien scalle, 13% had grade V, 4.3% grade IIIA, 8.7% grade I
and 73% did not have complications. The length of hospital stay was 5±2.2 days.
Conclusion: Early postoperative re-feeding in total and partial gastrectomy was well tolerated
by patients.
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6
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Liu Y, Dong Y, Wu X, Chen H, Wang S. Influence of high body mass index on mortality and infectious outcomes in patients who underwent open gastrointestinal surgery: A meta-analysis. Am J Infect Control 2016; 44:572-8. [PMID: 26831275 DOI: 10.1016/j.ajic.2015.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 11/29/2015] [Accepted: 12/01/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND The influence of high body mass index (BMI) on mortality and infectious outcomes of patients following open gastrointestinal surgery was unclear. This meta-analysis aimed to resolve this controversy. METHODS PubMed and EMBASE were searched by 2 researchers. High and normal BMIs were defined as ≥25 and 18.5-24.99, respectively. Odds ratios (ORs) were calculated to compare the pooled effect sizes. The primary outcome was mortality. The secondary outcome was infectious outcomes, including surgical site, pulmonary infections, and urinary tract infections. RESULTS Eleven eligible articles with 51,307 patients total were included. Compared with normal BMIs, high BMIs did not increase the risk of mortality (OR, 0.78; 95% confidence interval [CI], 0.58-1.06; P = .12). The secondary outcome indicated a significantly higher risk of infectious outcomes in high-BMI patients (OR, 1.34; 95% CI; 1.13-1.58; P = .0007). Among high-BMI patients, the risks of surgical site infections (OR, 1.75; 95% CI, 1.33-2.3; P < .0001) and pulmonary infections (OR, 1.2; 95% CI, 1.02-1.40; P = .03) increased significantly; urinary tract infections (OR, 1.10; 95% CI, 0.92-1.31; P = .30) did not show statistical difference. CONCLUSIONS High BMI was associated with higher risks of infectious outcomes, including surgical site infections and pulmonary infections after open gastrointestinal surgery, but no association was observed between high BMI and urinary tract infections.
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Affiliation(s)
- Yunhong Liu
- Department of Infection Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Nursing School of Shandong University, Jinan, Shandong Province, China
| | - Yanyan Dong
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Xiaohui Wu
- Department of Infection Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; Nursing School of Shandong University, Jinan, Shandong Province, China
| | - Hongbo Chen
- Nursing School of Shandong University, Jinan, Shandong Province, China
| | - Shuhui Wang
- Department of Infection Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
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7
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Clinical and Oncological Value of Preoperative BMI in Gastric Cancer Patients: A Single Center Experience. Gastroenterol Res Pract 2015; 2015:810134. [PMID: 25759721 PMCID: PMC4338394 DOI: 10.1155/2015/810134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/20/2015] [Accepted: 01/20/2015] [Indexed: 12/12/2022] Open
Abstract
Introduction. The impact of preoperative BMI on surgical outcomes and long-term survival of gastric cancer patients was investigated in various reports with contrasting results. Materials & Methods. A total of 378 patients who underwent a surgical resection for primary gastric cancer between 1994 and 2011 were retrospectively studied. Patients were stratified according to BMI into a normal group (<25, group A), an overweight group (25-30, group B), and an obesity group (≥30, group C). These 3 groups were compared according to clinical-pathological characteristics, surgical treatment, and long-term survival. Results. No significant correlations between BMI and TNM (2010), UICC stage (2010), Lauren's histological type, surgical results, lymph node dissection, and postoperative morbidity and mortality were observed. Factors related to higher BMI were male gender (P < 0.05), diabetes (P < 0.001), and serum blood proteins (P < 0.01). A trend to fewer lymph nodes retrieved during gastrectomy with lymphadenectomy in overweight patients (B and C groups) was observed, although not statistically significant. There was no difference in overall survival or disease-specific survival between the three groups. Conclusion. According to our data, BMI should not be considered a significant predictor of postoperative complications or long-term result in gastric cancer patients.
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8
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Minami Y, Kawai M, Fujiya T, Suzuki M, Noguchi T, Yamanami H, Kakugawa Y, Nishino Y. Family history, body mass index and survival in Japanese patients with stomach cancer: a prospective study. Int J Cancer 2014; 136:411-24. [PMID: 24890283 DOI: 10.1002/ijc.29001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/12/2014] [Accepted: 05/15/2014] [Indexed: 12/29/2022]
Abstract
Family history and nutritional status may affect the long-term prognosis of stomach cancer, but evidence is insufficient and inconsistent. To clarify the prognostic factors of stomach cancer, we conducted a prospective study of 1,033 Japanese patients with histologically confirmed stomach cancer who were admitted to a single hospital between 1997 and 2005. Family history of stomach cancer and pretreatment body mass index (BMI) were assessed using a self-administered questionnaire. Clinical data were retrieved from a hospital-based cancer registry. All patients were completely followed up until December, 2008. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated according to family history in parents and siblings and BMI category. During a median follow-up of 5.3 years, 403 all-cause and 279 stomach cancer deaths were documented. Although no association with family history was observed in the patients overall, analysis according to age group found an increased risk of all-cause death associated with a history in first degree relatives (HR = 1.61, 95% CI: 0.93-2.78, p = 0.09) and with a parental history (HR = 1.86, 95% CI: 1.06-3.26) among patients aged under 60 years at diagnosis. BMI was related to all-cause and stomach cancer death among patients aged 60 and over, showing a J-shaped pattern (HR of all-cause death = 2.28 for BMI < 18.5; HR = 1.61 for 25 ≤ vs. ≥ 23.0 to < 25.0 kg/m(2)). A family history of stomach cancer, especially parental history, may affect mortality among younger stomach cancer patients, whereas nutritional status may be a prognostic factor in older patients.
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Affiliation(s)
- Yuko Minami
- Division of Community Health, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan; Division of Cancer Epidemiology and Prevention, Miyagi Cancer Center Research Institute, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi, Japan
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9
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Han SY, Kim CS. Does denture-wearing status in edentulous South Korean elderly persons affect their nutritional intakes? Gerodontology 2014; 33:169-76. [DOI: 10.1111/ger.12125] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Sun Young Han
- Research Institute for Dental Care Policy; Korean Dental Association; Seoul Korea
| | - Cheoul Sin Kim
- Research Institute for Dental Care Policy; Korean Dental Association; Seoul Korea
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10
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Silva PS, Sperandio da Silva GM, de Souza AP, Cardoso CSA, Fonseca CA, Brito PD, Saraiva RM, Brasil PEA, Pinheiro RO, Hasslocher-Moreno AM, Xavier SS, Sousa AS. Effects of omega-3 polyunsaturated fatty acid supplementation in patients with chronic chagasic cardiomyopathy: study protocol for a randomized controlled trial. Trials 2013; 14:379. [PMID: 24216069 PMCID: PMC4225749 DOI: 10.1186/1745-6215-14-379] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 10/28/2013] [Indexed: 01/06/2023] Open
Abstract
Background Chronic chagasic cardiomyopathy is an inflammatory disease that occurs in approximately 30% of patients infected by the protozoan Trypanosoma cruzi, and it has a profile of high morbidity and mortality. The worst prognosis and the progression of this cardiomyopathy are associated with an exacerbated immune response and the production of proinflammatory cytokines, which also occur in other cardiomyopathies. Some nutrients, including omega-3 polyunsaturated fatty acids (PUFAs), promote the inhibition and/or stimulation of cytokine production. The objective of this trial is to study the effects of omega-3 PUFA supplementation on the inflammatory response and lipid profile in patients with chronic chagasic cardiomyopathy. Methods/Design This is a parallel, randomized, placebo-controlled, double-blind clinical trial with 40 patients that will be conducted at a reference unit for Chagas disease patients, where the patients will be selected. The study will include patients with chronic chagasic cardiomyopathy who are 18 years of age or older. The exclusion criteria are (a) ongoing diarrheal disease, (b) inflammatory bowel disease, (c) diabetes or other endocrine disease, (d) use of fibrates, niacin, or statins, (e) use of anti-inflammatory drugs, (f) pregnant and lactating women, (g) use of vitamin, mineral, or omega-3 supplementation during the previous 30 days, (h) hospital admission during the study, and (i) other associated cardiomyopathies. The intervention will be treatment with omega-3 PUFAs at a dose of 3 g/day for 8 weeks, compared to placebo (corn oil). The primary endpoints will be the concentrations of inflammatory markers (interleukin (IL)-1, IL-2, IL-4, IL-6, IL-10, tumor necrosis factor (TNF)α, interferon (IFN)γ, and transforming growth factor (TGF)β). Secondary endpoints will be the fasting glucose, lipid, and anthropometric profiles. For statistical analysis, we plan to run either a t test or Wilcoxon test (numerical variables) and Pearson’s χ2 or Fisher’s exact test (categorical data), as appropriate. Discussion Evidence suggests that the anti-inflammatory action of omega-3 PUFAs may have beneficial effects on chronic chagasic cardiomyopathy, as shown for other cardiomyopathies, due to improved control of the inflammatory response. At the end of the study, we predict that patients will have lower inflammatory markers and an improved metabolic and anthropometric profile. Trial registration Current Controlled Trials NCT01863576
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Affiliation(s)
- Paula S Silva
- Serviço de Nutrição, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Av, Brasil 4365, Manguinhos, Rio de Janeiro, Brasil.
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11
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Kong F, Li H, Fan Y, Zhang X, Cao S, Yu J, Ren X, Hao X. Overweight patients achieve ideal body weight following curative gastrectomy resulting in better long-term prognosis. Obes Surg 2013; 23:650-6. [PMID: 23371777 DOI: 10.1007/s11695-012-0847-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The relationship between body mass index (BMI) and long-term outcome in gastric cancer patients following radical gastrectomy continues to be debated. We investigated the association between BMI, clinicopathological features, and prognosis in Chinese gastric carcinoma patients. METHODS A retrospective consecutive cohort study was performed on 1,296 patients who underwent gastrectomy with curative intent at the Tianjin Cancer Institute Hospital between 1999 and 2004. The clinicopathological characteristics, overall 5-year survival rate (OS), and preoperative and six-month postoperative BMIs of both overweight (BMI ≥ 25 kg/m(2); H-BMI; n = 364) and non-overweight (BMI <25 kg/m(2); N-BMI; n = 932) patients were compared. RESULTS Among these patients, 364 (28.1 %) were overweight. The OS was significantly higher in the H-BMI than N-BMI group (33.2 vs. 24.1 %, respectively; p < 0.001). Preoperative and six-month postoperative BMIs were 27.1 ± 2.0 and 24.8 ± 2.0 kg/m(2), respectively, in the H-BMI group (p < 0.001), whereas they were 21.7 ± 2.2 and 20.7 ± 2.2 kg/m(2), respectively, in the N-BMI group (p = 0.007). There was significantly better differentiation (p = 0.034), less distant metastases (p = 0.006), and a lower metastatic lymph node ratio (p = 0.014) observed in the H-BMI groups. Multivariate analyses indicated age, BMI, pathological tumor depth, distant metastases, metastatic lymph node ratio, and tumor size as independent prognostic factors. CONCLUSIONS Our findings suggest that overweight patients were less likely to have tumors with aggressive features and can achieve ideal body weight following curative gastrectomy, possibly resulting in better long-term prognosis.
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Affiliation(s)
- Fanming Kong
- Department of Biotherapy, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, China
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12
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Wu XS, Wu WG, Li ML, Yang JH, Ding QC, Zhang L, Mu JS, Gu J, Dong P, Lu JH, Liu YB. Impact of being overweight on the surgical outcomes of patients with gastric cancer: A meta-analysis. World J Gastroenterol 2013; 19:4596-4606. [PMID: 23901238 PMCID: PMC3725387 DOI: 10.3748/wjg.v19.i27.4596] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/31/2013] [Accepted: 06/20/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of being overweight on the surgical results of patients with gastric cancer.
METHODS: Comprehensive electronic searches of the PubMed, Web of Science, and Cochrane Library databases were conducted. Studies were identified that included patients with surgical complications from gastric cancer who were classified as normal weight [body mass index (BMI) < 25 kg/m2] or overweight (BMI ≥ 25 kg/m2). The operative time, retrieved lymph nodes, blood loss, and long-term survival were analyzed. A subgroup analysis was conducted based on whether patients received laparoscopic or open gastrectomy procedures. All statistical tests were performed using ReviewerManager 5.1.2 software.
RESULTS: This meta-analysis included 23 studies with 20678 patients (15781 with BMI < 25 kg/m2; 4897 with BMI ≥ 25 kg/m2). Overweight patients had significantly increased operation times [MD: -29.14; 95%CI: -38.14-(-20.21); P < 0.00001], blood loss [MD: -194.58; 95%CI: -314.21-(-74.95); P = 0.001], complications (RR: 0.75; 95%CI: 0.66-0.85; P < 0.00001), anastomosis leakages (RR: 0.59; 95%CI: 0.42-0.82; P = 0.002), and pancreatic fistulas (RR: 0.486; 95%CI: 0.34-0.63; P < 0.00001), whereas lymph node retrieval was decreased significantly in the overweight group (MD: 1.69; 95%CI: 0.75-2.62; P < 0.0001). In addition, overweight patients had poorer long-term survival (RR: 1.14; 95%CI: 1.07-1.20; P < 0.0001). No significant difference was detected for the mortality and length of hospital stay.
CONCLUSION: This meta-analysis demonstrates that a high BMI not only increases the surgical difficulty and complications but also impairs the long-term survival of patients with gastric cancer.
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Impact of being overweight on the surgical outcomes of patients with gastric cancer: A meta-analysis. World J Gastroenterol 2013; 19:4596-4606. [DOI: 10.3748/wjg.v19.i28.4596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
AIM: To investigate the effect of being overweight on the surgical results of patients with gastric cancer.
METHODS: Comprehensive electronic searches of the PubMed, Web of Science, and Cochrane Library databases were conducted. Studies were identified that included patients with surgical complications from gastric cancer who were classified as normal weight [body mass index (BMI) < 25 kg/m2] or overweight (BMI ≥ 25 kg/m2). The operative time, retrieved lymph nodes, blood loss, and long-term survival were analyzed. A subgroup analysis was conducted based on whether patients received laparoscopic or open gastrectomy procedures. All statistical tests were performed using ReviewerManager 5.1.2 software.
RESULTS: This meta-analysis included 23 studies with 20678 patients (15781 with BMI < 25 kg/m2; 4897 with BMI ≥ 25 kg/m2). Overweight patients had significantly increased operation times [MD: -29.14; 95%CI: -38.14-(-20.21); P < 0.00001], blood loss [MD: -194.58; 95%CI: -314.21-(-74.95); P = 0.001], complications (RR: 0.75; 95%CI: 0.66-0.85; P < 0.00001), anastomosis leakages (RR: 0.59; 95%CI: 0.42-0.82; P = 0.002), and pancreatic fistulas (RR: 0.486; 95%CI: 0.34-0.63; P < 0.00001), whereas lymph node retrieval was decreased significantly in the overweight group (MD: 1.69; 95%CI: 0.75-2.62; P < 0.0001). In addition, overweight patients had poorer long-term survival (RR: 1.14; 95%CI: 1.07-1.20; P < 0.0001). No significant difference was detected for the mortality and length of hospital stay.
CONCLUSION: This meta-analysis demonstrates that a high BMI not only increases the surgical difficulty and complications but also impairs the long-term survival of patients with gastric cancer.
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Lim H, Cho G, Kim S. Evaluation of nutrient intake and diet quality of gastric cancer patients in Korea. Nutr Res Pract 2012; 6:213-20. [PMID: 22808345 PMCID: PMC3395786 DOI: 10.4162/nrp.2012.6.3.213] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 03/05/2012] [Accepted: 03/20/2012] [Indexed: 12/29/2022] Open
Abstract
This study was conducted to identify dietary factors that may affect the occurrence of gastric cancer in Koreans. Preoperative daily nutrition intake and diet quality of patients diagnosed with gastric cancer were evaluated. Collected data were comparatively analyzed by gender. The results were then used to prepare basic materials to aid in the creation of a desirable postoperative nutrition management program. The subjects of this study were 812 patients (562 men and 250 women) who were diagnosed with gastric cancer and admitted for surgery at Soonchunhyang University Hospital between January 2003 and December 2010. Nutrition intake and diet quality were evaluated by the 24-hr recall method, the nutrient adequacy ratio, mean adequacy ratio (MAR), nutrient density (ND), index of nutritional quality (INQ), dietary variety score (DVS), and dietary diversity score (DDS). The rate of skipping meals and eating fast, alcohol consumption, and smoking were significantly higher in males than those in females. The levels of energy, protein, fat, carbohydrate, phosphorous, sodium, potassium, vitamin B1, vitamin B2, niacin, and cholesterol consumption were significantly higher in males than those in females. Intake of fiber, zinc, vitamin A, retinol, carotene, folic acid were significantly higher in females than those in males. MAR in males was significantly higher (0.83) than that in females (0.79). INQ values were higher in females for zinc, vitamin A, vitamin B2, vitamin B6, and folic acid than those in males. The average DVS was 17.63 for females and 13.19 for males. The average DDS was 3.68 and the male's average score was 3.44, whereas the female's average score was 3.92. In conclusion, males had more dietary habit problems and poor nutritional balance than those of females. Our findings suggest that proper nutritional management and adequate dietary education for the primary prevention of gastric cancer should be emphasized in men.
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Affiliation(s)
- Heesook Lim
- Department of Nutrition, Soonchunhyang University Bucheon Hospital, Gyeonggi 420-767, Korea
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Chaufour-André C, Bajard A, Fingal C, Roux P, Fiorletta I, Gertych W, Rivoire M, Bonnefoy M, Bachmann P. Conséquences nutritionnelles de la chirurgie en oncogériatrie. Étude descriptive et prospective. NUTR CLIN METAB 2011. [DOI: 10.1016/j.nupar.2010.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Tokunaga M, Hiki N, Fukunaga T, Ohyama S, Yamaguchi T, Nakajima T. Better 5-year survival rate following curative gastrectomy in overweight patients. Ann Surg Oncol 2010; 16:3245-51. [PMID: 19636624 DOI: 10.1245/s10434-009-0645-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Indexed: 12/16/2022]
Abstract
BACKGROUND Westernization of lifestyle and diet has resulted in an increase in overweight patients in Japan. Although the adverse effects of higher body mass index (BMI) on early surgical outcomes are known, the relationship between BMI and long-term outcome is unclear. MATERIALS AND METHODS Clinicopathological characteristics and 5-year survival rate of overweight (BMI >or= 25 kg/m2; H-BMI; n = 1126) and nonoverweight (BMI < 25 kg/m2; N-BMI; n = 6799) patients who underwent gastrectomy with curative intent at the Cancer Institute Hospital between 1970 and 2004 were compared. RESULTS Patients in the H-BMI group tended to have earlier-stage disease. The 5-year survival rate was significantly better in the H-BMI than N-BMI group (81.5% vs 74.1%, respectively; P < .001). Postoperative mortality was 1% in both groups (P = .482), whereas postoperative morbidity was 22% and 19% in the H-BMI and N-BMI groups, respectively (P = .007). Multivariate analysis indicated overweight, age, gender, surgical procedure, histology, operation year, pT, and pN as independent prognostic factors. Subset analyses of pT and pN stages revealed overweight as an independent prognostic factor in patients with pT1 and pN0. CONCLUSION The 5-year survival rate following curative gastrectomy is better in overweight than nonoverweight Japanese patients, especially for early-stage gastric cancer. Further studies are needed to determine whether these results apply to other countries where morbidity and mortality for gastric cancer are higher than in Asian countries.
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Affiliation(s)
- Masanori Tokunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Skipworth J, Foster J, Raptis D, Hughes F. The effect of preoperative weight loss and body mass index on postoperative outcome in patients with esophagogastric carcinoma. Dis Esophagus 2009; 22:559-63. [PMID: 19222536 DOI: 10.1111/j.1442-2050.2009.00939.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Studies have shown that weight loss is associated with adverse outcomes in all treatment modalities for esophagogastric carcinoma. Because of the increased prevalence of obesity and the effectiveness of perioperative nutrition, a number of patients are now obese or have normal body mass index (BMI) at the time of treatment. We investigated the relationship between weight loss, BMI, and outcome of surgery for patients with esophagogastric carcinoma. Data were collected over a 38-month period for all patients diagnosed with operable esophagogastric cancer at two UK centers. All patients underwent resection by a single Consultant Upper Gastrointestinal Surgeon and the use of perioperative jejunal feeding was universal. Ninety-three patients (57 male) underwent esophagogastric resection; 48 had no preoperative weight loss (34 with a BMI > 25 and 14 with a BMI < 25). Forty-five patients had preoperative weight loss (20 with BMI > 25 and 25 with BMI < 25). There was no significant difference in complication rates, median hospital stay, or mortality between the four groups. A significantly higher number of patients displaying preoperative weight loss were found to have stage III disease, but difference in survival of up to 3 years did not reach statistical significance on multivariate analysis. Preoperative weight loss and low BMI did not significantly influence the complication rate, perioperative mortality rate, length of hospital stay, or short-term prognosis. We conclude that preoperative weight loss can not be reliably used as an independent predictor of poor outcome in patients undergoing surgery for esophagogastric carcinoma. However, patients with preoperative weight loss and low BMI are more likely to have advanced disease.
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Affiliation(s)
- J Skipworth
- Department of Upper GI Surgery, Royal London Hospital, Whitechapel, London, UK.
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