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

body mass index cancer elderly mortality obesity paradox prognosis

Journal

The American journal of clinical nutrition
ISSN: 1938-3207
Titre abrégé: Am J Clin Nutr
Pays: United States
ID NLM: 0376027

Informations de publication

Date de publication:
05 Sep 2020
Historique:
received: 14 01 2020
accepted: 27 07 2020
entrez: 5 9 2020
pubmed: 6 9 2020
medline: 6 9 2020
Statut: aheadofprint

Résumé

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. We studied whether a high BMI was associated with better survival, and whether the association differed by sex, in older patients with cancer. 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. 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. 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.

Sections du résumé

BACKGROUND 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 OBJECTIVE
We studied whether a high BMI was associated with better survival, and whether the association differed by sex, in older patients with cancer.
METHODS 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 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 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.

Identifiants

DOI: 10.1093/ajcn/nqaa238 PMID: 32889525
pubmed: 32889525
pii: S0002-9165(22)00566-4
doi: 10.1093/ajcn/nqaa238
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT02884375']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.

Auteurs

Claudia Martinez-Tapia (C)

IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est Créteil University (UPEC), Créteil, France.

Thomas Diot (T)

IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est Créteil University (UPEC), Créteil, France.

Nadia Oubaya (N)

IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est Créteil University (UPEC), Créteil, France.
Public Health Department, Public Assistance-Paris Hospitals (AP-HP), Henri-Mondor Hospital, Créteil, France.

Elena Paillaud (E)

IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est Créteil University (UPEC), Créteil, France.
Geriatric Department, Public Assistance-Paris Hospitals (AP-HP), Georges-Pompidou European Hospital (HEGP), Paris, France.

Johanne Poisson (J)

Geriatric Department, Public Assistance-Paris Hospitals (AP-HP), Georges-Pompidou European Hospital (HEGP), Paris, France.

Mathilde Gisselbrecht (M)

Onco-Geriatric Department, Public Assistance-Paris Hospitals (AP-HP), Georges-Pompidou European Hospital (HEGP), Paris, France.

Laure Morisset (L)

Oncogeriatrics Coordination Unit, Curie Institute, Paris, France.

Philippe Caillet (P)

IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est Créteil University (UPEC), Créteil, France.
Geriatric Department, Public Assistance-Paris Hospitals (AP-HP), Georges-Pompidou European Hospital (HEGP), Paris, France.

Aurélie Baudin (A)

Clinical Research Unit (URC Mondor), Public Assistance-Paris Hospitals (AP-HP), Henri-Mondor Hospital, Créteil, France.

Fréderic Pamoukdjian (F)

IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est Créteil University (UPEC), Créteil, France.
Coordination Unit in Geriatric Oncology, Geriatric Department, Public Assistance-Paris Hospitals (AP-HP), Avicenne Hospital, Bobigny, France.

Amaury Broussier (A)

IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est Créteil University (UPEC), Créteil, France.
Department of Geriatrics, Public Assistance-Paris Hospitals (AP-HP), Henri-Mondor Hospital/Emile Roux Hospital, Créteil, France.

Sylvie Bastuji-Garin (S)

IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est Créteil University (UPEC), Créteil, France.
Public Health Department, Public Assistance-Paris Hospitals (AP-HP), Henri-Mondor Hospital, Créteil, France.
Clinical Research Unit (URC Mondor), Public Assistance-Paris Hospitals (AP-HP), Henri-Mondor Hospital, Créteil, France.

Marie Laurent (M)

IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est Créteil University (UPEC), Créteil, France.
Internal Medicine and Geriatric Department, Public Assistance-Paris Hospitals (AP-HP), Henri-Mondor Hospital, Créteil, France.

Florence Canouï-Poitrine (F)

IMRB-EA 7376 CEpiA (Clinical Epidemiology and Ageing Unit), Paris-Est Créteil University (UPEC), Créteil, France.
Public Health Department, Public Assistance-Paris Hospitals (AP-HP), Henri-Mondor Hospital, Créteil, France.

Classifications MeSH