Journal of Cachexia, Sarcopenia and Muscle最新文献_第9页

Comment on: ‘Triceps skinfold-albumin index significantly predicts the prognosis of cancer cachexia: A multicentre cohort study’ by Yin et al. 评论：Yin等人的“三角肌皮褶白蛋白指数显著预测癌症恶病质的预后：一项多中心队列研究”。

IF 8.9 1区医学

Journal of Cachexia, Sarcopenia and Muscle

Pub Date : 2023-08-07 DOI: 10.1002/jcsm.13304

Ping'an Ding, Haotian Wu, Jiaxiang Wu, Chenyu Sun, Muzi Meng, Peigang Yang, Yang Liu, Lingjiao Meng, Qun Zhao

The study by Yin et al.¹ is greatly appreciated for their contributions to research, particularly in developing the triceps skinfold-albumin index (TA). This new comprehensive index combines fat mass and nutritional status to evaluate malnutrition and has been identified as independently associated with the prognosis of patients with cancer cachexia. Yin et al.¹ successfully identified different cut-off values of TA for each gender, which divided patients into normal and low groups. The different groups showed significant differences in prognostic effects, with normal TA patients being significantly associated with lower mortality and the opposite association found for lower TA patients. Additionally, TA demonstrated a wide discrimination performance for the prognosis of patients of all ages. This study is particularly meaningful for two main reasons. Firstly, despite being calculated by only two sample parameters, TA's accuracy for predicting the prognosis of patients with cancer cachexia is higher than that of previous predictive indices, such as NRI, PNI, and SII. Furthermore, TA is cost-effective and easy to use. Secondly, the gender-specific cut-off values of TA are consistent with the differences in nutrition between men and women. Moreover, this prospective, large sample, and geographically multi-centre cohort study ensures reliable confirmation of the results. Therefore, based on these aspects, TA may be considered a clinically meaningful and promising indicator for predicting the prognosis of patients with cancer cachexia.

Nonetheless, the generalizability of the previous findings of TA was not confirmed in patients with diverse cancer types or undergoing various treatments. To address this gap, we investigated the clinical applicability of TA as a predictive tool for cancer cachexia in patients with locally advanced gastric cancer (LAGC) across multiple prospective cohorts (NCT01516944, NCT02555358, NCT03349866, and NCT01962246) registered in our institution. The study included 1266 LAGC patients, of which 898 (70.93%) had complete serum albumin values and detailed triceps skinfold thickness (mm) data. Of these patients, 188 (20.94%) were diagnosed with cancer cachexia based on the 2011 International Consensus on Cancer Cachexia criteria outlined by Fearon et al.² The median age of the patients diagnosed with cancerous cachexia was 60 years (interquartile range [IQR], 35–77), with 125 (66.49%) males and 63 (33.51%) females. Our analysis revealed that mean TA was lower in males than in females in the cohort (51.8 vs. 56.3). We stratified the patients into high and low TA groups based on the optimal cut-off values (male: TA < 45.6, female: TA < 49.9) established in the previous study by Yin et al.¹ Out of 188 patients, 57 (30.32%) were classified in the low TA group. During a median follow-up of 65.8 months (12.9–109.7 months), 2

Yin等人的研究1因其对研究的贡献而受到高度赞赏，特别是在开发肱三头肌皮褶-白蛋白指数(TA)方面。这个新的综合指数结合了脂肪量和营养状况来评估营养不良，并已被确定为与癌症恶病质患者的预后独立相关。Yin等人1成功地识别出不同性别TA的临界值，将患者分为正常组和低组。不同组在预后效果上表现出显著差异，正常TA患者与较低的死亡率显著相关，而较低TA患者的死亡率则相反。此外，TA对所有年龄段患者的预后表现出广泛的判别性能。这项研究之所以特别有意义，主要有两个原因。首先，尽管TA仅由两个样本参数计算，但其预测癌症恶病质患者预后的准确性高于以往的预测指标，如NRI、PNI、SII。此外，TA具有成本效益和易于使用的特点。其次，TA的性别分界值与男女营养差异是一致的。此外，这项前瞻性、大样本、地理上多中心的队列研究确保了结果的可靠确认。因此，基于这些方面，TA可能被认为是预测癌症恶病质患者预后的一项具有临床意义和前景的指标。然而，在不同癌症类型或接受不同治疗的患者中，先前TA发现的普遍性尚未得到证实。为了解决这一差距，我们通过在我院注册的多个前瞻性队列(NCT01516944、NCT02555358、NCT03349866和NCT01962246)研究了TA作为局部晚期胃癌(LAGC)患者癌症恶病质预测工具的临床适用性。本研究纳入1266例LAGC患者，其中898例(70.93%)具有完整的血清白蛋白值和详细的三头肌皮褶厚度(mm)数据。根据Fearon等人提出的2011年国际癌症恶病质共识标准，其中188例(20.94%)被诊断为癌性恶病质。2诊断为癌性恶病质的患者中位年龄为60岁(四分位间距[IQR]， 35-77)，其中男性125例(66.49%)，女性63例(33.51%)。我们的分析显示，该队列中男性的平均TA低于女性(51.8比56.3)。我们根据最佳临界值将患者分为高、低TA组(男性:TA <45.6，女:TA <49.9)， Yin等人在之前的研究中建立1 188例患者中，57例(30.32%)被划分为低TA组。中位随访65.8个月(12.9 ~ 109.7个月)，术后病理II期患者死亡20例(36.36%)，III期患者死亡64例(48.12%)。结果显示，高TA组患者的总生存率(OS)明显高于低TA组(61.83% vs. 40.35%， P = 0.004)(图1A)。此外，高TA组患者的无病生存率(DFS)高于低TA组(56.49% vs 28.07%， P <0.001)(图1D)。基于肿瘤pTNM分期的亚组分析也显示，与低TA组相比，II期和III期患者的高TA与延长的OS和DFS相关[(II期:OS: 70.59% vs. 52.38%， P = 0.044;DFS: 64.71% vs. 47.62%， P = 0.027);(III期:OS: 58.76% vs. 33.33%， P = 0.002;DFS: 53.61%对16.67%，P <0.001)](图1B,C,E,F)。我们的研究结果表明，TA可以作为预测LAGC伴癌恶病质患者预后和复发情况的有用工具，这与Yin等人最初的研究结果相似。1癌症患者常并发癌恶病质，对其预后和生存时间有负面影响。3,4因此，为癌症恶病质患者确定可靠且具有成本效益的预后标志物至关重要。虽然已经研究了蛋白质和炎症生物标志物来预测LAGC恶病质患者的预后5,6，但其成本高和影响单一的方面限制了其临床应用。TA作为一种综合了脂肪量和营养状况的癌症恶病质的综合预后预测指标，提供了有意义的预后分层，已被证明对不同肿瘤病理或不同临床治疗的恶病质LAGC患者具有临床意义。我们要感谢尹良玉等人在改善癌症恶病质预后和提供临床可靠的生物标志物方面做出的宝贵贡献。

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引用次数: 1

Weight-adjusted waist as an integrated index for fat, muscle and bone health in adults 体重调整后的腰围是成年人脂肪、肌肉和骨骼健康的综合指标。

IF 8.9 1区医学

Journal of Cachexia, Sarcopenia and Muscle

Pub Date : 2023-08-07 DOI: 10.1002/jcsm.13302

Kyoung Jin Kim, Serhim Son, Kyeong Jin Kim, Sin Gon Kim, Nam Hoon Kim

Background

Unhealthy body composition, including high fat mass, low muscle mass and low bone mass, is a critical health issue in adults. The weight-adjusted waist index (WWI) estimates fat and muscle mass and may have implications for bone health. We examined its association with body composition outcomes in a large Korean adult cohort.

Methods

This study used data from the Korean National Health and Nutrition Examination Survey (2008–2011). WWI was calculated as waist circumference (cm) divided by the square root of body weight (kg). Dual-energy X-ray absorptiometry was used to measure bone mineral density (BMD), appendicular lean mass (ALM) and total body fat percentage. Unhealthy body composition was defined as combined presence of high fat mass, low bone mass and low muscle mass.

Results

A total of 5983 individuals (3034 men [50.7%] and 2949 women [49.3%]; mean age: 63.5 ± 8.7 years) were included. WWI was positively correlated with total body fat percentage (r = 0.478, P < 0.001) and inversely with ALM/weight (r = −0.485, P < 0.001) and BMD at the lumbar spine (r = −0.187, P < 0.001), femoral neck (r = −0.269, P < 0.001) and total hip (r = −0.255, P < 0.001). Higher WWI quartiles correlated with lower BMD, T-scores and ALM/weight, along with increased total body fat, evident in both genders and more pronounced in women, even after adjusting for confounders. This trend remained statistically significant across WWI quartiles for all analyses (P < 0.001). Higher WWI quartiles were also significantly associated with higher odds of unhealthy body composition, with adjusted odds ratio in the highest WWI group of 18.08 (95% CI, 4.32–75.61) in men and 6.36 (95% CI, 3.65–11.07) in women. The optimal cutoff values of WWI for unhealthy body composition were 10.4 cm/√kg in men and 10.5 cm/√kg in women.

Conclusions

In community-dwelling adults, high WWI values are associated with unfavourable body composition outcomes, indicating high fat mass, low muscle mass and low bone mass. WWI can potentially serve as an integrated index of body composition, underscoring the need for further research to validate its use in clinical settings.

背景：不健康的身体组成，包括高脂肪、低肌肉和低骨量，是成年人的一个关键健康问题。体重调整后的腰围指数（WWI）估计脂肪和肌肉质量，可能对骨骼健康有影响。我们在一个大型韩国成年队列中研究了它与身体成分结果的关系。方法：本研究使用了韩国国民健康和营养检查调查（2008-2011年）的数据。WWI计算为腰围（cm）除以体重（kg）的平方根。采用双能X线骨密度仪测量骨密度（BMD）、阑尾瘦块（ALM）和全身脂肪百分比。不健康的身体组成被定义为高脂肪、低骨量和低肌肉的综合存在。结果：共有5983人（3034名男性[507%]和2949名女性[49.3%]；平均年龄：63.5±8.7岁）被纳入。WWI与全身脂肪百分比呈正相关（r=0.478，P结论：在社区居住的成年人中，高WWI值与不利的身体成分结果有关，表明高脂肪量、低肌肉量和低骨量。WWI可以作为身体成分的综合指标，强调需要进一步研究来验证其在临床环境中的应用。

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引用次数: 0

Association of malignant ascites with systemic inflammation and muscle loss after treatment in advanced-stage ovarian cancer 晚期癌症治疗后恶性腹水与全身炎症和肌肉损失的相关性。

IF 8.9 1区医学

Journal of Cachexia, Sarcopenia and Muscle

Pub Date : 2023-07-28 DOI: 10.1002/jcsm.13289

Chia-Sui Weng, Wan-Chun Huang, Chih-Long Chang, Ya-Ting Jan, Tze-Chien Chen, Jie Lee

Background

Malignant ascites is prevalent in advanced-stage ovarian cancer and may facilitate identification of the drivers of muscle loss. This study aimed to evaluate the association of ascites with changes in systemic inflammation and muscle after treatment of advanced-stage ovarian cancer.

Methods

We evaluated 307 patients with advanced-stage (III/IVA) ovarian cancer who underwent primary debulking surgery and adjuvant platinum-based chemotherapy between 2010 and 2019. The changes in skeletal muscle index (SMI) and radiodensity (SMD) were measured using pre-surgery and post-chemotherapy portal-venous phase contrast-enhanced computed tomography scans at L3. Systemic inflammation was measured using albumin levels, prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR). Primary endpoint was the changes in SMI and SMD after treatment. Linear regression analysis was used to test associations between muscle change and other covariates. Mediation analysis was used to determine the mediator.

Results

The median (range) age was 53 (23–83) years. The median duration (range) of follow-up was 5.2 (1.1–11.3) years. Overall, 187 (60.9%) patients had ascites. The changes in muscle and systemic inflammatory markers after treatment were significantly different between patients with and without ascites (SMI: −3.9% vs. 2.2%, P < 0.001; SMD: −4.0% vs. −0.4%, P < 0.001; albumin: −4.4% vs. 2.1%, P < 0.001; PNI: −8.4% vs. −0.1%, P < 0.001; NLR: 20.6% vs. −29.4%, P < 0.001; and PLR: 1.7% vs. −19.4%, P < 0.001). The changes in SMI and SMD were correlated with the changes in albumin, PNI, NLR, and PLR (all P < 0.001). In multiple linear regression, ascites and NLR changes were negatively while albumin change was positively correlated with SMI change (ascites: β = −3.19, P < 0.001; NLR change: β = −0.02, P = 0.003; albumin change: β = 0.37, P < 0.001). Ascites and NLR changes were negatively while PNI change was positively correlated with SMD change (ascites: β = −1.28, P = 0.02; NLR change: β = −0.02, P < 0.001; PNI change: β = 0.11, P = 0.04). In mediation analysis, ascites had a direct effect on SMI change (P < 0.001) and an indirect effect mediated by NLR change (indirect effects = −1.61, 95% confidence interval [CI]: −2.22 to −1.08) and albumin change (indirect effects = −2.92, 95% CI: −4.01 to −1.94). Ascites had a direct effect on SMD change (P < 0.001) and an indirect eff

背景：恶性腹水在晚期癌症中普遍存在，可能有助于识别肌肉损失的驱动因素。本研究旨在评估晚期癌症治疗后腹水与全身炎症和肌肉变化的关系。方法：我们评估了307例癌症晚期（III/IVA）患者，他们在2010年至2019年间接受了初级减瘤手术和辅助铂基化疗。使用术前和化疗后L3的门静脉期对比增强计算机断层扫描测量骨骼肌指数（SMI）和放射密度（SMD）的变化。使用白蛋白水平、预后营养指数（PNI）、中性粒细胞淋巴细胞比率（NLR）和血小板淋巴细胞比率（PLR）测量全身炎症。主要终点是治疗后SMI和SMD的变化。线性回归分析用于检验肌肉变化和其他协变量之间的相关性。使用中介分析来确定调解员。结果：中位（范围）年龄为53岁（23-83岁）。随访的中位持续时间（范围）为5.2年（1.1-11.3）。总的来说，187名（60.9%）患者有腹水。有腹水和无腹水患者治疗后肌肉和全身炎症标志物的变化有显著差异（SMI:3.9%vs.2.2%，P结论：晚期卵巢癌症在初次减瘤手术和辅助化疗后，恶性腹水与全身炎症增强和肌肉损失有关。腹水与肌肉损失之间的联系可能是由全身炎症介导的。

{"title":"Association of malignant ascites with systemic inflammation and muscle loss after treatment in advanced-stage ovarian cancer","authors":"Chia-Sui Weng, Wan-Chun Huang, Chih-Long Chang, Ya-Ting Jan, Tze-Chien Chen, Jie Lee","doi":"10.1002/jcsm.13289","DOIUrl":"10.1002/jcsm.13289","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Malignant ascites is prevalent in advanced-stage ovarian cancer and may facilitate identification of the drivers of muscle loss. This study aimed to evaluate the association of ascites with changes in systemic inflammation and muscle after treatment of advanced-stage ovarian cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated 307 patients with advanced-stage (III/IVA) ovarian cancer who underwent primary debulking surgery and adjuvant platinum-based chemotherapy between 2010 and 2019. The changes in skeletal muscle index (SMI) and radiodensity (SMD) were measured using pre-surgery and post-chemotherapy portal-venous phase contrast-enhanced computed tomography scans at L3. Systemic inflammation was measured using albumin levels, prognostic nutritional index (PNI), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR). Primary endpoint was the changes in SMI and SMD after treatment. Linear regression analysis was used to test associations between muscle change and other covariates. Mediation analysis was used to determine the mediator.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median (range) age was 53 (23–83) years. The median duration (range) of follow-up was 5.2 (1.1–11.3) years. Overall, 187 (60.9%) patients had ascites. The changes in muscle and systemic inflammatory markers after treatment were significantly different between patients with and without ascites (SMI: −3.9% vs. 2.2%, <i>P</i> < 0.001; SMD: −4.0% vs. −0.4%, <i>P</i> < 0.001; albumin: −4.4% vs. 2.1%, <i>P</i> < 0.001; PNI: −8.4% vs. −0.1%, <i>P</i> < 0.001; NLR: 20.6% vs. −29.4%, <i>P</i> < 0.001; and PLR: 1.7% vs. −19.4%, <i>P</i> < 0.001). The changes in SMI and SMD were correlated with the changes in albumin, PNI, NLR, and PLR (all <i>P</i> < 0.001). In multiple linear regression, ascites and NLR changes were negatively while albumin change was positively correlated with SMI change (ascites: β = −3.19, <i>P</i> < 0.001; NLR change: β = −0.02, <i>P</i> = 0.003; albumin change: β = 0.37, <i>P</i> < 0.001). Ascites and NLR changes were negatively while PNI change was positively correlated with SMD change (ascites: β = −1.28, <i>P</i> = 0.02; NLR change: β = −0.02, <i>P</i> < 0.001; PNI change: β = 0.11, <i>P</i> = 0.04). In mediation analysis, ascites had a direct effect on SMI change (<i>P</i> < 0.001) and an indirect effect mediated by NLR change (indirect effects = −1.61, 95% confidence interval [CI]: −2.22 to −1.08) and albumin change (indirect effects = −2.92, 95% CI: −4.01 to −1.94). Ascites had a direct effect on SMD change (<i>P</i> < 0.001) and an indirect eff","PeriodicalId":186,"journal":{"name":"Journal of Cachexia, Sarcopenia and Muscle","volume":null,"pages":null},"PeriodicalIF":8.9,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jcsm.13289","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9881316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comment on 'Hand grip strength-based cachexia index as a predictor of cancer cachexia and prognosis in patients with cancer' by Xie et al. Xie等人对“基于握力的恶病质指数作为癌症患者癌症恶病质和预后的预测指标”的评论。

IF 8.9 1区医学

Journal of Cachexia, Sarcopenia and Muscle

Pub Date : 2023-07-28 DOI: 10.1002/jcsm.13298

Ping'an Ding, Jiaxiang Wu, Haotian Wu, Chenyu Sun, Muzi Meng, Scott Lowe, Yuan Tian, Honghai Guo, Lingjiao Meng, Qun Zhao

The study conducted by Xie et al.¹ caught our attention, and we extend our gratitude for their valuable contribution. Measuring skeletal muscle index can be costly and tedious. Xie et al. proposed an alternative by using hand grip strength (HGS) to establish a new composite index, HGS-based cachexia index (CXI) (H-CXI), which is calculated as [HGS (kg)/height (m)2 × serum albumin (g/L)]/neutrophil-to-lymphocyte ratio. The H-CXI proved to be a rapid and accurate assessment tool, which can effectively evaluate the risk of cachexia and clinical outcome in cancer patients. The study revealed that H-CXI is independently associated with patient prognosis and is linked to age, pathological stage, systemic inflammation, and nutritional status. Low H-CXI was found to be an independent predictor of cachexia and prognosis in cancer patients. Moreover, H-CXI has shown to be a better prognosis evaluation tool for patients with the same pathological stage. In light of these findings, H-CXI is an economic and procedural advantage over the original CXI, is a comprehensive indicator, and is a multi-centre, prospective, large-sample study that provides reliable results. H-CXI has a reliable clinical effect and a broad clinical prospect in predicting prognosis and cancer cachexia.

It was found that the study analysed tumours of varying types with different pathological factors, potentially impacting the outcome. Additionally, the study lacked a prospective approach with rigorous inclusion criteria to evaluate the clinical applicability of H-CXI. Thus, a cohort study with registration number NCT01516944 was conducted to explore the clinical applicability of H-CIX as a predictor of cancer cachexia and prognosis among patients with locally advanced gastric cancer (LAGC). The study prospectively enrolled 290 LAGC patients who underwent direct radical surgical resection, of whom 111 (38.28%) had complete serologic and anthropometric data. The cohort primarily composed of males (62.16%) with a mean age of 58 years. Based on the optimal cut-off value for H-CXI from a previous study, 61 (54.95%) patients were categorized into the high H-CXI group and the remaining 50 (45.05%) into the low H-CXI group. During the follow-up period with a median duration of 64.9 months, 21 (18.92%) patients developed cancer cachexia, and patients in the high H-CXI group had a significantly lower risk of developing cancer cachexia than those in the low H-CXI group (11.48% vs. 28.00%, P = 0.027). Furthermore, patients in the high H-CXI group showed significantly better overall survival (OS) and disease-free survival (DFS) rates than those in the low H-CXI group (OS: 59.02% vs. 36.00%, P = 0.0043; DFS: 54.10% vs. 26.00%, P = 0.0024). Moreover, subgroup analysis revealed better 5-year OS and DFS rates for patients with high H-CXI at all pathological stages. Thus, the study found that H-CXI effectively predicted the prognosis and the risk of de

Xie et al.1的研究引起了我们的注意，我们对他们的宝贵贡献表示感谢。测量骨骼肌指数既昂贵又乏味。Xie等人提出了一种替代方法，利用手握力(HGS)建立新的复合指数——基于HGS的恶病质指数(CXI) (H-CXI)，计算方法为[HGS (kg)/身高(m)2 ×血清白蛋白(g/L)]/中性粒细胞与淋巴细胞比值。事实证明，H-CXI是一种快速准确的评估工具，可以有效地评估癌症患者恶病质的风险和临床结局。研究显示，H-CXI与患者预后独立相关，与年龄、病理分期、全身性炎症和营养状况有关。低H-CXI被发现是癌症患者恶病质和预后的独立预测因子。此外，H-CXI已被证明是同一病理分期患者更好的预后评估工具。根据这些发现，H-CXI在经济和程序上优于原始的CXI，是一个全面的指标，是一个多中心、前瞻性、大样本的研究，提供了可靠的结果。H-CXI在预测预后和肿瘤恶病质方面具有可靠的临床效果和广阔的临床前景。研究发现，该研究分析了具有不同病理因素的不同类型的肿瘤，这些因素可能会影响结果。此外，该研究缺乏前瞻性方法和严格的纳入标准来评估H-CXI的临床适用性。因此，我们开展了一项注册号为NCT01516944的队列研究，探讨H-CIX作为局部晚期胃癌(LAGC)患者癌症恶病质和预后预测因子的临床适用性。该研究前瞻性地招募了290例接受直接根治性手术切除的LAGC患者，其中111例(38.28%)具有完整的血清学和人体测量数据。该队列主要由男性(62.16%)组成，平均年龄58岁。根据既往研究中H-CXI的最佳临界值，61例(54.95%)患者被划分为高H-CXI组，其余50例(45.05%)患者被划分为低H-CXI组。在中位随访时间为64.9个月期间，21例(18.92%)患者发生癌症恶病质，高H-CXI组患者发生癌症恶病质的风险显著低于低H-CXI组(11.48% vs. 28.00%， P = 0.027)。此外，高H-CXI组患者的总生存率(OS)和无病生存率(DFS)明显优于低H-CXI组(OS: 59.02% vs. 36.00%， P = 0.0043;DFS: 54.10% vs. 26.00%， P = 0.0024)。此外，亚组分析显示，在所有病理阶段，高H-CXI患者的5年OS和DFS率都更高。因此，本研究发现H-CXI可有效预测LAGC患者的预后及发生恶性恶病质的风险，与前人研究结果一致。恶病质在癌症患者中普遍存在，并对其生活质量和治疗结果产生负面影响。2,3因此，鉴别生物标志物对于及时发现和评估发生恶病质的高危患者至关重要。一些研究已经证明CXI作为预测癌症患者预后的生物标志物的潜在功效。然而，CXI的实际应用受到相关成本和骨骼肌指数测试程序复杂性的限制。遗憾的是，最近开发CXI的研究一直处于停滞状态。幸运的是，H-CXI是一种有效预测癌症恶病质和预后的有用指标。除方便快捷外，还为TNM分期预后分层提供了有效补充。我们对谢等人的宝贵贡献表示感谢，并认识到他们的发现对相关领域的重要意义。H-CXI方法可以对患有恶病质的LAGC患者的肌肉、营养和炎症状况进行全面评估。该方法对患者的预后评估和个体化治疗具有重要的参考意义。我们对LAGC患者的队列研究表明，H-CXI在预测和评估LAGC患者恶病质和预后方面具有较高的准确性。H-CXI具有提高LAGC患者临床评价和治疗策略的潜力，最终有利于患者的生存(图1)。本研究得到河北省政府基金培养杰出人才项目(No. 2019012)的支持;河北省公共卫生委员会县级公立医院适宜卫生技术推广与储存项目(2019024);河北大学科技攻关计划项目(项目编号:8111111);ZD2019139)。

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引用次数: 1

Underweight status and development of end-stage kidney disease: A nationwide population-based study 终末期肾病的超重状况和发展：一项全国性的基于人群的研究。

IF 8.9 1区医学

Journal of Cachexia, Sarcopenia and Muscle

Pub Date : 2023-07-28 DOI: 10.1002/jcsm.13297

Chang Seong Kim, Tae Ryom Oh, Sang Heon Suh, Hong Sang Choi, Eun Hui Bae, Seong Kwon Ma, Bongseong Kim, Kyung-Do Han, Soo Wan Kim

Background

Underweight status increases the risk of cardiovascular disease and mortality in the general population. However, whether underweight status is associated with an increased risk of developing end-stage kidney disease is unknown.

Methods

A total of 9 845 420 participants aged ≥20 years who underwent health checkups were identified from the Korean National Health Insurance Service database and analysed. Individuals with underweight (body mass index [BMI] < 18.5 kg/m²) and obesity (BMI ≥ 25 kg/m²) were categorized according to the World Health Organization recommendations for Asian populations.

Results

During a mean follow-up period of 9.2 ± 1.1 years, 26 406 participants were diagnosed with end-stage kidney disease. After fully adjusting for other potential predictors, the moderate to severe underweight group (<17 kg/m²) had a significantly higher risk of end-stage kidney disease than that of the reference (normal) weight group (adjusted hazard ratio, 1.563; 95% confidence interval, 1.337–1.828), and competing risk analysis to address the competing risk of death also showed the similar results (adjusted hazard ratio, 1.228; 95% confidence interval, 1.042–1.448). Compared with that of the reference BMI group (24–25 kg/m²), the adjusted hazard ratios for end-stage kidney disease increased as the BMI decreased by 1 kg/m². In the sensitivity analysis, sustained underweight status or progression to underweight status over two repeated health checkups, when compared with normal weight status, had a higher hazard ratio for end-stage kidney disease.

Conclusions

Underweight status is associated with an increased risk of end-stage kidney disease, and this association gradually strengthens as BMI decreases.

背景：在普通人群中，体重不足会增加患心血管疾病和死亡的风险。然而，体重不足是否与发展为终末期肾病的风险增加有关尚不清楚。方法：从韩国国家健康保险服务数据库中确定并分析了9 845 420名年龄≥20岁接受健康检查的参与者。根据世界卫生组织针对亚洲人群的建议，对体重不足（体重指数[BMI]2）和肥胖（BMI≥25 kg/m2）的个体进行分类。结果：在9.2±1.1年的平均随访期内，26406名参与者被诊断为终末期肾病。在对其他潜在预测因素进行充分调整后，中度至重度体重不足组（2）患终末期肾病的风险显著高于参考（正常）体重组（调整后的危险比为1.563；95%置信区间为1.337-1.828），针对死亡竞争风险的竞争风险分析也显示出类似的结果（调整后的危险比为1.228；95%置信区间为1.042-1.448）。与参考BMI组（24-25 kg/m2）相比，终末期肾病的调整后危险比随着BMI降低1 kg/m2而增加。在敏感性分析中，与正常体重状态相比，持续的体重不足状态或在两次重复健康检查后发展为体重不足状态，对终末期肾病的风险比更高。结论：体重不足与终末期肾病的风险增加有关，并且这种联系随着BMI的降低而逐渐加强。

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引用次数: 0