The Diversity of Nutritional Status in Cancer: New Insights

Learning Objectives After completing this course, the reader will be able to: Explain how malnutrition (deficit or excess) is used as a decisive factor in treatment of cancer patients. Describe the interactions and influences of overweight/obesity on tumor metabolism and of individualized tumor metabolism on tumor burden and undernutrition. Use the association of sarcopenic obesity to predict and manage poorer performance status and decreased survival in cancer patients. This article is available for continuing medical education credit at CME.TheOncologist.com Objective. Nutritional status in cancer has been mostly biased toward undernutrition, an issue now in dispute. We aimed to characterize nutrition status, to analyze associations between nutritional and clinical/cancer‐related variables, and to quantify the relative weights of nutritional and cancer‐related features. Methods. The cross‐sectional study included 450 nonselected cancer patients (ages 18–95 years) at referral for radiotherapy. Nutritional status assessment included recent weight changes, body mass index (BMI) categorized by World Health Organization's age/sex criteria, and Patient‐Generated Subjective Global Assessment (PG‐SGA; validated/specific for oncology). Results. BMI identified 63% as ≥25 kg/m2 (43% overweight, 20% obese) and 4% as undernourished. PG‐SGA identified 29% as undernourished and 71% as well nourished. Crossing both methods, among the 319 (71%) well‐nourished patients according to PG‐SGA, 75% were overweight/obese and only 25% were well nourished according to BMI. Concordance between BMI and PG‐SGA was evaluated and consistency was confirmed. More aggressive/advanced stage cancers were more prevalent in deficient and excessive nutritional status: in 83% (n = 235/282) of overweight/obese patients by BMI and in 85% (n = 111/131) of undernourished patients by PG‐SGA. Results required adjustment for diagnoses: greater histological aggressiveness was found in overweight/obese prostate and breast cancer; undernutrition was associated with aggressive lung, colorectal, head‐neck, stomach, and esophageal cancers (p < .005). Estimates of effect size revealed that overweight/obesity was associated with advanced stage (24%), aggressive breast (10%), and prostate (9%) cancers, whereas undernutrition was associated with more aggressive lung (6%), colorectal (6%), and head‐neck (6%) cancers; in both instances, age and longer disease duration were of significance. Conclusion. Undernutri