The obesity paradox for mid- and long-term mortality in older cancer patients: a prospective multicenter cohort study

Abstract

Background Overweight and obesity are associated with adverse health outcomes. However, substantial literature suggests that they are associated with longer survival among older people. This “obesity paradox” remains controversial. In the context of cancer, the association between overweight/obesity and mortality is complicated by concomitant weight loss (WL). Sex differences in the relation between BMI (in kg/m2) and survival have also been observed. Objectives We studied whether a high BMI was associated with better survival, and whether the association differed by sex, in older patients with cancer. Methods We studied patients aged ≥70 y from the ELCAPA (Elderly Cancer Patients) prospective open cohort (2007–2016; 10 geriatric oncology clinics, Greater Paris urban area). The endpoints were 12- and 60-mo mortality. We created a variable combining BMI at cancer diagnosis and WL in the previous 6 mo, and considered 4 BMI categories—underweight (BMI < 22.5), normal weight (BMI = 22.5–24.9), overweight (BMI = 25–29.9), and obesity (BMI ≥ 30)—and 3 WL categories—<5% (minimal), 5% to <10% (moderate), and ≥10% (severe). Univariate and multivariate Cox proportional hazards analyses were conducted in men and women. Results A total of 2071 patients were included (mean age: 81 y; women: 48%; underweight: 30%; normal weight: 23%; overweight: 33%; obesity: 14%; predominant cancer sites: colorectal (18%) and breast (16%); patients with metastases: 49%). By multivariate analysis, obese women with WL < 5% had a lower 60-mo mortality risk than normal-weight women with WL < 5% (adjusted HR: 0.56; 95% CI: 0.37, 0.86; P = 0.012). Overweight/obese women with WL ≥ 5% did not have a lower mortality risk than normal-weight women with WL < 5%. Overweight and obese men did not have a lower mortality risk, irrespective of WL. Conclusions By taking account of prediagnosis WL, only older obese women with cancer with minimal WL had a lower mortality risk than their counterparts with normal weight. This trial was registered at clinicaltrials.gov as NCT02884375.

Fat mass assessment using the triceps skinfold thickness enhances the prognostic value of the Global Leadership Initiative on Malnutrition criteria in patients with lung cancer

“…However, since the prognostic value of obesity or overweight (as defined by the BMI) in other cancers is controversial (42) , it's unclear whether these findings are generalizable to other cancer populations. Interestingly, during the interaction analysis, patients in the malnourished + normal TSF group had different modifications associated with the CC, depending on the stratification method used (optimal stratification or AWGS 2019 standards, Table 4).…”

“…The impact of body size on patient outcomes has recently been garnering great clinical interest (28,42,43) . The BMI is the best known index among the various parameters developed to assess body size.…”

“…Therefore, these findings might support including a fat mass assessment as a component in the GLIM criteria, at least for LC patients. However, since the prognostic value of obesity or overweight (as defined by the BMI) in other cancers is controversial (42) , it is unclear whether these findings are generalisable to other cancer populations.…”

Clinical Characteristics, Care Trajectories and Mortality Rate of SARS-CoV-2 Infected Cancer Patients: A Multicenter Cohort Study

“…Nevertheless, in the French CORONADO trial [ 18 ] evaluating the risk of mechanical ventilation or death by day 7 of hospital admission, no relationship between obesity and mortality was observed in patients >75-years-old. The existence of an obesity paradox phenomenon might be explored in older patients with COVID-19 [ 19 ]. Primary data support a greater risk of more severe COVID-19 outcomes in patients with type 2 diabetes [ 20 ].…”

Impact on the Nutritional Status and Inflammation of Patients with Cancer Hospitalized after the SARS-CoV-2 Lockdown

“…The International Agency for Research on Cancer (IARC) established that overweight and obesity are associated with increased cancer incidence for more than 10 types of cancer [35,36]. However, published studies paradoxically observed the greater survival of oncological patients in association with overweight and obesity [37][38][39][40]. The analysis of body composition, the measurement of weight loss, and development of cancer cachexia may explain this "obesity paradox" [41].…”