Alex F. Bullock, Michael J. Patterson, Lewis W. Paton, David C. Currow, Miriam J. Johnson
{"title":"营养不良、肌肉疏松症和恶病质:探讨癌症老年患者的患病率、重叠率和看法","authors":"Alex F. Bullock, Michael J. Patterson, Lewis W. Paton, David C. Currow, Miriam J. Johnson","doi":"10.1038/s41430-024-01433-9","DOIUrl":null,"url":null,"abstract":"Older adults with cancer are a growing population requiring tailored care to achieve optimum treatment outcomes. Their care is complicated by under-recognised and under-treated wasting disorders: malnutrition, sarcopenia, and cachexia. We aimed to investigate the prevalence, overlap, and patients’ views and experiences of malnutrition, sarcopenia, and cachexia, in older adults with cancer. Mixed-methods study with cross-sectional study and qualitative interviews. Interviews were thematically analysed through a phenomenological lens, with feedback loop analysis investigating relationships between themes and findings synthesised using modified critical interpretative synthesis. n = 30 were screened for malnutrition, sarcopenia, and cachexia, n = 8 completed semi-structured interviews. Eighteen (60.0%) were malnourished, 16 (53.3%) sarcopenic, and 17 (56.7%) cachexic. One or more condition was seen in 80%, and all three in 30%. In univariate analysis, Rockwood clinical frailty score (OR 2.94 [95% CI: 1.26–6.89, p = 0.013]) was associated with sarcopenia, reported percentage meal consumption (OR 2.28 [95% CI: 1.24–4.19, p = 0.008]), and visible wasting (OR 8.43 [95% CI: 1.9–37.3] p = 0.005) with malnutrition, and percentage monthly weight loss (OR 8.71 [95% CI: 1.87–40.60] p = 0.006) with cachexia. Screening tools identified established conditions rather than ‘risk’. Nutritional and functional problems were often overlooked, overshadowed, and misunderstood by both patients and (in patients’ perceptions) by clinicians; misattributed to ageing, cancer, or comorbidities. Patients viewed these conditions as both personal impossibilities, yet accepted inevitabilities. Perceptions, identification, and management of these conditions needs to improve, and their importance recognised by clinicians and patients so those truly ‘at risk’ are identified whilst conditions are more remediable to interventions.","PeriodicalId":11927,"journal":{"name":"European Journal of Clinical Nutrition","volume":null,"pages":null},"PeriodicalIF":3.6000,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41430-024-01433-9.pdf","citationCount":"0","resultStr":"{\"title\":\"Malnutrition, sarcopenia and cachexia: exploring prevalence, overlap, and perceptions in older adults with cancer\",\"authors\":\"Alex F. Bullock, Michael J. Patterson, Lewis W. Paton, David C. Currow, Miriam J. Johnson\",\"doi\":\"10.1038/s41430-024-01433-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Older adults with cancer are a growing population requiring tailored care to achieve optimum treatment outcomes. Their care is complicated by under-recognised and under-treated wasting disorders: malnutrition, sarcopenia, and cachexia. We aimed to investigate the prevalence, overlap, and patients’ views and experiences of malnutrition, sarcopenia, and cachexia, in older adults with cancer. Mixed-methods study with cross-sectional study and qualitative interviews. Interviews were thematically analysed through a phenomenological lens, with feedback loop analysis investigating relationships between themes and findings synthesised using modified critical interpretative synthesis. n = 30 were screened for malnutrition, sarcopenia, and cachexia, n = 8 completed semi-structured interviews. Eighteen (60.0%) were malnourished, 16 (53.3%) sarcopenic, and 17 (56.7%) cachexic. One or more condition was seen in 80%, and all three in 30%. In univariate analysis, Rockwood clinical frailty score (OR 2.94 [95% CI: 1.26–6.89, p = 0.013]) was associated with sarcopenia, reported percentage meal consumption (OR 2.28 [95% CI: 1.24–4.19, p = 0.008]), and visible wasting (OR 8.43 [95% CI: 1.9–37.3] p = 0.005) with malnutrition, and percentage monthly weight loss (OR 8.71 [95% CI: 1.87–40.60] p = 0.006) with cachexia. Screening tools identified established conditions rather than ‘risk’. Nutritional and functional problems were often overlooked, overshadowed, and misunderstood by both patients and (in patients’ perceptions) by clinicians; misattributed to ageing, cancer, or comorbidities. Patients viewed these conditions as both personal impossibilities, yet accepted inevitabilities. Perceptions, identification, and management of these conditions needs to improve, and their importance recognised by clinicians and patients so those truly ‘at risk’ are identified whilst conditions are more remediable to interventions.\",\"PeriodicalId\":11927,\"journal\":{\"name\":\"European Journal of Clinical Nutrition\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2024-04-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.nature.com/articles/s41430-024-01433-9.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Clinical Nutrition\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.nature.com/articles/s41430-024-01433-9\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"NUTRITION & DIETETICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Clinical Nutrition","FirstCategoryId":"3","ListUrlMain":"https://www.nature.com/articles/s41430-024-01433-9","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"NUTRITION & DIETETICS","Score":null,"Total":0}
Malnutrition, sarcopenia and cachexia: exploring prevalence, overlap, and perceptions in older adults with cancer
Older adults with cancer are a growing population requiring tailored care to achieve optimum treatment outcomes. Their care is complicated by under-recognised and under-treated wasting disorders: malnutrition, sarcopenia, and cachexia. We aimed to investigate the prevalence, overlap, and patients’ views and experiences of malnutrition, sarcopenia, and cachexia, in older adults with cancer. Mixed-methods study with cross-sectional study and qualitative interviews. Interviews were thematically analysed through a phenomenological lens, with feedback loop analysis investigating relationships between themes and findings synthesised using modified critical interpretative synthesis. n = 30 were screened for malnutrition, sarcopenia, and cachexia, n = 8 completed semi-structured interviews. Eighteen (60.0%) were malnourished, 16 (53.3%) sarcopenic, and 17 (56.7%) cachexic. One or more condition was seen in 80%, and all three in 30%. In univariate analysis, Rockwood clinical frailty score (OR 2.94 [95% CI: 1.26–6.89, p = 0.013]) was associated with sarcopenia, reported percentage meal consumption (OR 2.28 [95% CI: 1.24–4.19, p = 0.008]), and visible wasting (OR 8.43 [95% CI: 1.9–37.3] p = 0.005) with malnutrition, and percentage monthly weight loss (OR 8.71 [95% CI: 1.87–40.60] p = 0.006) with cachexia. Screening tools identified established conditions rather than ‘risk’. Nutritional and functional problems were often overlooked, overshadowed, and misunderstood by both patients and (in patients’ perceptions) by clinicians; misattributed to ageing, cancer, or comorbidities. Patients viewed these conditions as both personal impossibilities, yet accepted inevitabilities. Perceptions, identification, and management of these conditions needs to improve, and their importance recognised by clinicians and patients so those truly ‘at risk’ are identified whilst conditions are more remediable to interventions.
期刊介绍:
The European Journal of Clinical Nutrition (EJCN) is an international, peer-reviewed journal covering all aspects of human and clinical nutrition. The journal welcomes original research, reviews, case reports and brief communications based on clinical, metabolic and epidemiological studies that describe methodologies, mechanisms, associations and benefits of nutritional interventions for clinical disease and health promotion.
Topics of interest include but are not limited to:
Nutrition and Health (including climate and ecological aspects)
Metabolism & Metabolomics
Genomics and personalized strategies in nutrition
Nutrition during the early life cycle
Health issues and nutrition in the elderly
Phenotyping in clinical nutrition
Nutrition in acute and chronic diseases
The double burden of ''malnutrition'': Under-nutrition and Obesity
Prevention of Non Communicable Diseases (NCD)