Muscle matters: Prognostic implications of malnutrition and muscle health parameters in patients with cancer. A secondary analysis of a randomised trial - Olpe, T.; Wunderle, C.; Bargetzi, L.; Tribolet, P.; Laviano, A.; Stanga, Z.; Prado, C. M.; Mueller, B.; Schuetz, P. (Clin Nutr, 2024)
BACKGROUND: Low muscle mass and malnutrition are independently associated with an increased risk of adverse outcomes in patients with cancer. However, it is not yet clear which parameter is most indicative of these risks. This study investigates the prognostic significance of different parameters reflecting malnutrition and muscle health in a well-characterised oncology population at nutritional risk. METHODS: This preplanned secondary analysis included patients with cancer from a Swiss-wide, randomised-controlled nutritional trial. We investigated associations among malnutrition markers (i.e., malnutrition diagnosis based on modified Global Leadership Initiative on Malnutrition (GLIM) criteria, albumin concentration) and muscle health markers (i.e., hand grip strength, computed tomography (CT)-based muscle mass and radiodensity) with 180-day all-cause mortality (primary outcome). RESULTS: We included 269 patients with a main admission diagnosis of cancer and available CT scans. In a mutually adjusted model, four parameters contributed to risk assessment including modified malnutrition diagnosis (GLIM) (HR 1.78 (95%CI 1.17 to 2.69), p = 0.007, AUC 0.58), low albumin concentration (HR 1.58 (95%CI 1.08 to 2.31), p = 0.019, AUC 0.62), low handgrip strength (HR 2.05 (95%CI 1.43 to 2.93), p = 0.001, AUC 0.62) and low muscle radiodensity (HR 1.39 (95%CI 0.90 to 2.16), p = 0.139, AUC 0.63). Combining these parameters resulted in a model with high prognostic power regarding 180-day mortality (overall AUC 0.71). CONCLUSIONS: In this study of inpatients with cancer at nutritional risk, several malnutrition and muscle health parameters emerged as independent prognostic indicators for mortality. The use of these parameters may improve risk stratification and guide nutritional interventions in this vulnerable population. TRIAL REGISTRATION: ClinicalTrials.gov, number NCT02517476.
Keywords: journalArticle; *Hand Strength; *Malnutrition/diagnosis/mortality; *Muscle, Skeletal/physiopathology/diagnostic imaging; *Neoplasms/mortality/complications; Abbott Nutrition. The institution of Z.Stanga received speaking honoraria and; Aged; CMP has received honoraria and/or paid consultancy from Abbott Nutrition,; Cancer; Ct; Female; Glim; Humans; Male; Malnutrition; Middle Aged; Muscle; Nutricia, Nestle Health Science, Pfizer, and AMRA Medical. CMP has a conflict of; Nutrition Assessment; Nutritional Status; Prognosis; Risk Assessment; Sarcopenia; Serum Albumin/analysis/metabolism; Switzerland/epidemiology; Tomography, X-Ray Computed; except in abstract form; institution. All other authors report no conflicts of interest. The results; interest with Dr. Vickie Baracos and Dr. Lisa Martin, who are both from the same; presented in this paper have not been published previously in whole or part,; research support from Nestle Health Science, Abbott Nutrition and Fresenius Kabi; unrestricted grant money unrelated to this project from Nestle Health Science and