The Body Mass Index Paradox in Head and Neck Cancer: A Systematic Review and Meta-Analysis

Hobday, Sara; Armache, Maria; Paquin, Rebecca; Nurimba, Margaret; Baddour, Khalil; Linder, Daniel F.; Kouame, Gail; Tharrington, Shafer; Albergotti, William Greer; Mady, Leila J.

doi:10.1080/01635581.2022.2102659

Cited by 10 publications

(4 citation statements)

References 73 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Individual nutritional indicators (BMI, HGS, and CC) can complement nutritional assessment and have been associated with negative outcomes in patients with cancer [25,41]. In our study, low BMI according to the WHO criteria [23] was identi ed in 13.5% of patients, and this group had longer LOS than patients with normal BMI.…”

Section: Prevalence Of Nutritional Risk Malnutrition and Nutritional ...mentioning

confidence: 68%

“…Nutritional indicators have been used as a complement to nutritional assessment in patients with cancer because of their relationship to malnutrition, including body mass index (BMI), calf circumference (CC), and handgrip strength (HGS) [18][19][20][21][22]. BMI most commonly categorizes patients into underweight, normal weight, overweight, and obesity [23], where very low BMI (< 18 kg/m 2 ) has been associated with poor clinical outcomes, including an increased risk of death [24,25]. CC measurement is strongly associated with skeletal muscle mass, serving as a useful predictor of hospital readmission and mortality in patients with cancer [20,21,26].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Low BMI Demonstrates Satisfactory Specificity for Diagnosing Malnutrition and is Associated with Longer Hospitalization in Patients with Gastrointestinal or Head and Neck Cancer: A Prospective Cohort Study

Soares,

Stefani,

Scott

et al. 2024

Preprint

View full text Add to dashboard Cite

Purpose Few studies have evaluated the individual performance of the nutritional indicators body mass index (BMI), calf circumference (CC), and handgrip strength (HGS) for the diagnosis of malnutrition in the cancer setting. We aimed to evaluate the ability of these nutritional indicators to accurately diagnose malnutrition and their association with hospital length of stay (LOS) in patients with cancer. Methods This cohort study prospectively evaluated 171 patients with gastrointestinal or head and neck cancer. Nutritional status was assessed within 48 hours of hospital admission using BMI, CC, and HGS as well as 2 reference standards: Subjective Global Assessment (SGA) and Patient-Generated SGA (PG-SGA). The accuracy of each nutritional indicator was measured by the area under the receiver operating characteristic curve (AUC), compared with the reference standards. Multiple logistic regression analysis, adjusted for confounders, was used to determine whether malnutrition was associated with LOS. Results Of 171 patients, 59.1% had low CC, 46.2% had low HGS, and 13.5% had low BMI. The SGA and PG-SGA scores indicated malnutrition in 57.3% and 87.1% of patients, respectively. All nutritional indicators had poor accuracy in diagnosing malnutrition (AUC < 0.70). However, compared with SGA and PG-SGA, low BMI had satisfactory specificity (> 80%) and was associated with 1.79 times higher odds of LOS ≥ 6 days. Malnutrition diagnosed by SGA and PG-SGA increased the odds of LOS ≥ 6 days by 3.60-fold and 2.78-fold, respectively. Conclusion Low BMI showed adequate specificity for diagnosing malnutrition and was associated with longer LOS in patients with gastrointestinal or head and neck cancer.

show abstract

Section: Prevalence Of Nutritional Risk Malnutrition and Nutritional ...mentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Low BMI Demonstrates Satisfactory Specificity for Diagnosing Malnutrition and is Associated with Longer Hospitalization in Patients with Gastrointestinal or Head and Neck Cancer: A Prospective Cohort Study

Soares,

Stefani,

Scott

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…45 In a meta-analysis investigating the association of BMI with OS in patients with HNC, the mortality risk was higher in patients with overweight (BMI: 25-30 kg/m 2 ) and lower in patients with underweight (BMI: <18.5 kg/m 2 ) relative to that for patients with normal weight (BMI: 18.5-25 kg/m 2 ). 46 However, studies suggested that employing BMI may not be the most suitable approach to define malnutrition in individuals with cancer due to its inability to consider changes in body composition and nutritional status at the serum level. 47,48 Shih et al demonstrated that the area under the curve for GNRI exceeded those for serum albumin and BMI, providing evidence to support that the prognostic efficacy of GNRI outperformed that of serum albumin and BMI in their study setting.…”

Section: Discussionmentioning

confidence: 99%

“…Takenaka et al demonstrated that low pretreatment BMI values are associated with poor OS in patients with HNC undergoing curative treatment 44 ; this association may be attributed to cancer‐related chronic wasting, oxidative stress, and the increased protein metabolism associated with cancer cachexia 45 . In a meta‐analysis investigating the association of BMI with OS in patients with HNC, the mortality risk was higher in patients with overweight (BMI: 25–30 kg/m 2 ) and lower in patients with underweight (BMI: <18.5 kg/m 2 ) relative to that for patients with normal weight (BMI: 18.5–25 kg/m 2 ) 46 . However, studies suggested that employing BMI may not be the most suitable approach to define malnutrition in individuals with cancer due to its inability to consider changes in body composition and nutritional status at the serum level 47,48 .…”

Section: Discussionmentioning

confidence: 99%

Prognostic utility of the geriatric nutritional risk index for head and neck cancer: Systematic review and meta‐analysis

Tsai,

Kuo,

Wang

et al. 2024

Head & Neck

View full text Add to dashboard Cite

We conducted a systematic review of the literature to assess the potential prognostic utility of geriatric nutritional risk index (GNRI) for head and neck cancer (HNC). We selected studies and extracted data after searching the Cochrane Library, EMBASE, and PubMed databases. The associations between GNRI and survival outcomes were explored by calculating hazard ratios (HRs) and 95% confidence intervals (CIs) through a random‐effects meta‐analysis. We included 11 studies that involved 2887 patients with HNC. The combined HR demonstrated significant associations of low GNRI with unfavorable progression‐free survival (HR = 1.87, 95% CI = 1.32–2.65, p < 0.001) and overall survival (HR = 3.04, 95% CI = 2.30–4.03, p < 0.001). The association between the GNRI and overall survival persisted across various subgroups. The GNRI could serve as a valuable prognostic biomarker for patients with HNC. Low GNRI scores are significantly associated with unfavorable survival outcomes.

show abstract

Prognostic nutritional index (PNI) correlates with survival in head and neck cancer patients more precisely than other nutritional markers – real world data

Uri,

Horváth,

Tamás

et al. 2024

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

Purpose The survival benefit with higher body mass index (BMI) of patients suffering from head and neck squamous cell carcinoma (HNSCC) is documented as BMI paradox. As the early re-nourishment of high-risk patients determine survival, we searched for a nutritional status marker suitable for everyday screening. Grouping patients based on the 8th Edition of TNM Classification, we investigated for the first time the candidate nutritional status markers among TNM8 subgroups, including the newly introduced p16 positive oropharyngeal squamous cell cancer (OPSCC) patients. Methods We conducted a retrospective cohort study enrolling 661 patients and collecting anthropometric indices, laboratory parameters, clinical scores, nutritional risk scores. To discover the best one for screening survival analyses and correlation tests were executed. Results By performing univariate Cox regression, we found three nutritional markers significantly correlating with overall survival (OS) and cancer specific survival (CSS): BMI at diagnosis, percent of weight loss over six months and prognostic nutritional index (PNI). The latter proved to be independent of tumor stage. p16 negative OPSCC patient’s OS and CSS did not correlate with BMI, but it did correlate with PNI and percent of weight loss. BMI was the only marker correlating with OS, only in stage 4 hypopharyngeal cancer patients. All three markers significantly correlated with survival among p16 positive oropharyngeal and glottic cancer patients. Conclusion We found BMI, percent of weight loss and PNI good candidate markers for malnutrition. PNI proved to be superior in every aspect, enabling the treating physicians to discover high-risk patients in need of aggressive re-nourishment. The survival of supraglottic laryngeal squamous cancer patients seemed to be independent of these nutritional status markers, which observation should be a subject of further investigations.

show abstract

The Body Mass Index Paradox in Head and Neck Cancer: A Systematic Review and Meta-Analysis

Cited by 10 publications

References 73 publications

Low BMI Demonstrates Satisfactory Specificity for Diagnosing Malnutrition and is Associated with Longer Hospitalization in Patients with Gastrointestinal or Head and Neck Cancer: A Prospective Cohort Study

Low BMI Demonstrates Satisfactory Specificity for Diagnosing Malnutrition and is Associated with Longer Hospitalization in Patients with Gastrointestinal or Head and Neck Cancer: A Prospective Cohort Study

Prognostic utility of the geriatric nutritional risk index for head and neck cancer: Systematic review and meta‐analysis

Prognostic nutritional index (PNI) correlates with survival in head and neck cancer patients more precisely than other nutritional markers – real world data

Contact Info

Product

Resources

About