The relationship between systemic inflammation, body composition and clinical outcomes in patients with operable colorectal cancer at low and medium to high nutritional risk

Abstract

BackgroundIn accordance with European Society of Parenteral and Enteral Nutrition guidelines, the combination of malnutrition universal screening tool (MUST), systemic inflammation [modified Glasgow prognostic score (mGPS)] and body composition [skeletal muscle index (SMI) and skeletal muscle density (SMD)] were examined in relation to clinical outcomes in patients undergoing surgery for colorectal cancer (CRC).MethodsData were collected for stages I–III CRC patients from prospectively maintained data base at the academic department of surgery, Glasgow Royal Infirmary. From the initial sample of 1046, pre‐admission MUST score was available in 984 patients. The classification into low malnutrition risk (MUST = 0, n = 810) and moderate to high malnutrition risk (MUST 1 to ≥2, n = 174) groups and their relationship to systemic inflammatory response and body composition (SMI and SMD) with clinical outcomes were examined using univariate and multivariate analyses.ResultsCompared with those patients at low nutrition risk (MUST = 0), patients at moderate to high malnutrition risk (MUST 1 to ≥2) had an elevated mGPS (P < 0.001), neutrophil lymphocyte ratio (NLR) (P < 0.001), low SMI (P ≤ 0.001) and low SMD (P = 0.015). MUST was an important prognostic factor for length of hospital stay (P < 0.001) and 3 years overall survival (P < 0.001).In low malnutrition risk patients (MUST = 0), those who were systemically inflammed (mGPS 1/2, n = 187), had an elevated NLR (P < 0.001), low SMI (P < 0.001), low SMD (P < 0.01), increased post‐operative complications (P < 0.05), longer hospital stay >7 days (P < 0.001), and poorer 3 years survival (P < 0.05) compared with those who were not systemically inflamed. On multivariate analysis, American Society of Anaesthesiologist (ASA) score (P < 0.05) and mGPS (P < 0.05) were independently associated with increased risk of clinical complications. ASA, mGPS, and NLR were independently associated with prolonged hospital stay (P < 0.05, P < 0.05, and P < 0.001, respectively). ASA, tumour, node, metastasis stage, and mGPS were independently associated with overall survival (P < 0.01, P < 0.001, and P < 0.05, respectively).In medium‐risk to high‐risk patients (MUST = 1/2), those who were systemically inflamed (mGPS 1/2, n = 75) had higher ASA (P < 0.05), elevated NLR (P < 0.01), low SMI (P = 0.05) and low SMD (P < 0.05), increased length of hospital stay (P < 0.05), and poorer 3 years survival (P < 0.01), compared with those who were not systemically inflamed.ConlusionsA small proportion of patients with primary operable CRC was at nutrition risk as defined by MUST alone in both low risk nutrition patients and medium/high risk nutrition patients. The systemic inflammatory response was associated with lower SMI, lower SMD, and poor clinical outcomes. The systemic inflammatory response is an important measure in the nutritional assessment of patients undergoing surgery for CRC.

Citri Reticulatae Pericarpium extract and flavonoids reduce inflammation in RAW 264.7 macrophages by inactivation of MAPK and NF‐κB pathways

“…Inflammation, an evolutionarily conserved mechanism, stimulates the immune system to eliminate pathogens and promote tissue repair and recovery in order to combat infections and tissue damage (Furman et al., 2019). However, a prolonged or excessive inflammatory response is recognized to be associated with various diseases, including different cancers (Abbass et al., 2020; Alvarez‐Diaz et al., 2020), diabetes (Perry et al., 2015; Yuan et al., 2019), and cardiovascular diseases (Ferreira et al., 2018; Jaiswal & Libby, 2020). Extensive studies support the important regulatory roles of inducible nitric oxide (NO) synthase (iNOS) and cyclooxygenase‐2 (COX‐2) in inflammatory responses with activation of nuclear factor kappa‐light chain‐enhancer of activated B cells (NF‐κB) and/or mitogen‐activated protein kinases (MAPK) signaling pathways (W. S. Choi et al., 2014; Zhou et al., 2021).…”