Association Between Fat Mass to Lean Body Mass Ratio and All-Cause Mortality Among Middle-Aged and Elderly Cancer Patients Without Obesity: A Multi-Center Observational Study in China

Hongmei Xue; Hongzhen Du; Ying Xie; Yijing Zhai; Shiming Song; Bin Luo; Hong Qiu; Kunhua Wang; Jiuwei Cui; Chunhua Song; Hongxia Xu; Wei Li; Hanping Shi; Zengning Li; Investigation on Nutrition Status and Its Clinical Outcome of Common Cancers (INSCOC) Group

doi:10.3389/fnut.2022.914020

Association Between Fat Mass to Lean Body Mass Ratio and All-Cause Mortality Among Middle-Aged and Elderly Cancer Patients Without Obesity: A Multi-Center Observational Study in China

Front Nutr. 2022 Jun 16:9:914020. doi: 10.3389/fnut.2022.914020. eCollection 2022.

Authors

Hongmei Xue^{1

2}, Hongzhen Du^{1

2}, Ying Xie^{1

2}, Yijing Zhai^{1

2}, Shiming Song^{1

2}, Bin Luo^{1

2}, Hong Qiu³, Kunhua Wang⁴, Jiuwei Cui⁵, Chunhua Song⁶, Hongxia Xu⁷, Wei Li⁵, Hanping Shi^{8

9}, Zengning Li^{1

2}; Investigation on Nutrition Status and Its Clinical Outcome of Common Cancers (INSCOC) Group

Collaborators

Investigation on Nutrition Status and Its Clinical Outcome of Common Cancers (INSCOC) Group:
Zengqing Guo, Zhenming Fu, Chang Wang, Min Weng, Jingjing Cao, Fuxiang Zhou, Yuan Lin, Suyi Li, Yi Ba, Kaitao Yuan, Ming Liu, Wen Hu, Lan Zhou, Hu Ma, Qinghua Yao, Minghua Cong, Tao Li, Zihua Chen, Gongyan Chen, Qingchuan Zhao, Changyan Feng, Ying He, Jing Wu, Jiajun Yang, Xinxia Song, Yaying Yu, Wenjun Ma, Suxia Luo, Jin Zheng, Junqiang Chen, Qi Luo, Wei Wang, Qiuge Qiao, Yongmei Shi, Yumei Qi, Yongdong Feng, Haiping Jiang, Wenxian Guan, Jiaxin Chen, He Huang, Zheng Yu, Yu Fang

Affiliations

¹ Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China.
² Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang, China.
³ Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴ Department of Gastrointestinal Surgery, Institute of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
⁵ Cancer Center, The First Hospital of Jilin University, Changchun, China.
⁶ Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China.
⁷ Department of Nutrition, Daping Hospital and Research Institute of Surgery, Third Military Medical University, Chongqing, China.
⁸ Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
⁹ Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Chinese Society of Nutritional Oncology, Beijing, China.

Abstract

Objective: We aimed to investigate the association between fat mass to lean body mass ratio (RFL), percentage of body fat (PBF), and fat mass (FM) with mortality among middle-aged and elderly cancer patients without obesity.

Methods: This prospective hospital-based cohort study comprised 3,201 patients with stage I to IV cancer aged 40 years or above (mean age: 58 years for female patients and 61 years for male patients; mean length of follow-up was 1.67 years; the maximal follow-up length was 6.42 years). FM and PBF were measured by bioelectrical impedance analysis (BIA). Cox proportional hazard models were used, and adjusted hazard ratios (HRs) were estimated.

Results: We revealed a significant association between RFL and all-cause mortality among men aged ≥60 years after adjusting for confounders. Compared with those in the lowest tertile of RFL, elderly men in the medium and highest tertile had a 35 and 34% lower hazard of death from any cause, respectively. After additionally adjusted for C-reaction protein (CRP), HRs of medium and high tertile of RFL became short of statistical significance [medium tertile: adjusted HRs (95% CI) = 0.74 (0.46, 1.20); highest tertile: adjusted HRs (95% CI) = 0.84 (0.53, 1.33)]. Among elderly women, RFL was significantly related to all-cause mortality only when the additional adjustment for CRP [medium tertile: adjusted HRs (95% CI) = 2.08 (1.08, 4.01); highest tertile: adjusted HRs (95% CI) = 0.90 (0.45, 1.81)]. No significant association between RFL and all-cause mortality was observed among female participants or male participants aged less than 60 years.

Conclusion: Our findings showed a significant non-linear association between RFL and all-cause mortality, which was observed only in elderly men, and might be attenuated by their inflammation state.

Keywords: all-cause mortality; elderly cancer patients; fat mass; fat mass to lean body mass ratio; percentage of body fat.