Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis

Abstract

Malnutrition predicts poorer clinical outcomes for people with cancer. Older adults with cancer are a complex, growing population at high risk of weight-losing conditions. A number of malnutrition screening tools exist, however the best screening tool for this group is unknown. The aim was to systematically review the published evidence regarding markers and measures of nutritional status in older adults with cancer (age ≥ 70). A systematic search was performed in Ovid Medline, EMBASE, Web of Science, CINAHL, British Nursing Database and Cochrane CENTRAL; search terms related to malnutrition, cancer, older adults. Titles, abstracts and papers were screened and quality-appraised. Data evaluating ability of markers of nutritional status to predict patient outcomes were subjected to meta-analysis or narrative synthesis. Forty-two studies, describing 15 markers were included. Meta-analysis found decreased food intake was associated with mortality (OR 2.15 [2.03–4.20] p = < 0.00001) in univariate analysis. Prognostic Nutritional Index (PNI) was associated with overall survival (HR 1.89 [1.03–3.48] p = 0.04). PNI markers (albumin, total lymphocyte count) could be seen as markers of inflammation rather than nutrition. There a suggested relationship between very low body mass index (BMI) (<18 kg/m2) and clinical outcomes. No tool was identified as appropriate to screen for malnutrition, as distinct from inflammatory causes of weight-loss. Risk of cancer-cachexia and sarcopenia in older adults with cancer limits the tools analysed. Measures of food intake predicted mortality and should be included in clinical enquiry. A screening tool that distinguishes between malnutrition, cachexia and sarcopenia in older adults with cancer is needed.

Baseline prognostic nutritional index and changes in pretreatment body mass index associate with immunotherapy response in patients with advanced cancer

“…The predictive value of nutritional status for ICI efficacy is not well-established, which is in contrast with the plethora of data supporting the association between malnutrition and overall survival. [21][22][23] Only one recent study reported that patients with non-small cell lung cancer (NSCLC) with a PNI ≤45.5 had significantly worse ORR, DCR and PFS as compared with patients with PNI >45.5. 24 Yet, there are several reasons that poor nutritional status could impair ICI effectiveness.…”

Diagnosing undernutrition children and adults: new French criteria. Why, for what and for whom? A joint statement of the French National Authority for Health and French Federation of Nutrition

“…In adults, the dominant cause of decreased body weight is a decrease in food consumption, caused either by the unavailability of sufficient food to meet energy requirements or by anorexia or any other cause limiting the patient's ability to eat (Tables 2 and 6). For example, in elderly patients with cancer, a recent meta-analysis found that decreased food consumption was associated with mortality (OR 2•1; P < 0•00001) (67) . Assessment of dietary intake is therefore of major importance in the evaluation of nutritional status.…”

Role of Inflammatory and Immune-Nutritional Prognostic Markers in Patients Undergoing Surgical Resection for Biliary Tract Cancers

“…Great emphasis has recently been attributed to the role of nutritional and inflammatory status in growth, biological aggressiveness and spread of different types of cancers [ 10 , 11 , 12 ]. Previous studies investigated and often validated the prognostic role of several preoperative inflammatory and immune-nutritional markers in different malignancies [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”