利用生物电阻抗分析改进头颈部癌症患者的营养评估：不仅相位角重要

IF 8.9 1区医学

Journal of Cachexia, Sarcopenia and Muscle Pub Date : 2024-10-24 DOI:10.1002/jcsm.13577

Aura D. Herrera‐Martínez, Inmaculada Prior‐Sánchez, María Luisa Fernández‐Soto, María García‐Olivares, Cristina Novo‐Rodríguez, María González‐Pacheco, María José Martínez‐Ramirez, Alba Carmona‐Llanos, Andrés Jiménez‐Sánchez, Concepción Muñoz‐Jiménez, Fátima Torres‐Flores, Rocío Fernández‐Jiménez, Hatim Boughanem, María Carmen del Galindo‐Gallardo, Luis Miguel Luengo‐Pérez, María Josefa Molina‐Puerta, José Manuel García‐Almeida

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引用次数: 0

摘要

背景营养不良和肌肉疏松症在头颈癌（HNC）患者中非常普遍。准确的早期诊断对于开始营养支持非常必要，因为营养不良和肌肉疏松明显与临床结果和死亡率相关。我们的目的是评估使用生物电阻抗矢量分析（BIVA）进行身体成分分析的适用性和准确性，以诊断正在接受化疗或放疗的 HNC 癌症患者的营养不良和肌肉疏松症。结果接受化疗的患者营养不良的发生率更高（59.2% 对 40.8%，P < 0.001）；营养不良患者的死亡率增加（33.3% 对 20.1%，P < 0.001）；营养不良患者的 ECOG 状态（1-4）也更差（59.2% 对 22.8%，P < 0.001）。体细胞质量（BCM）和脂肪质量是与营养不良最显著相关的参数[OR 分别为 0.88 (0.84-0.93) 和 0.98 (0.95-1.01)]；BCM 和无脂肪质量指数（FFMI）与多个方面相关，包括（1）患者产生的主观总体评估[OR 0.93（0.84-0.98）和 0.86（0.76-0.97）]，(2) 肌肉疏松症的存在[OR 分别为 0.81（0.76-0.87）和 0.78（0.66-0.92）]。将 BCM 指数（BCMI）< 7.8 与其他参数（包括 FFMI 和 BCM）相结合，可准确预测营养不良患者[准确率 95% CI：0.803 (0.763-0.839)；卡帕指数：0.486；AUC：0.486]：0.486；AUC：0.618 (P < 0.01)]。结论 BIVA测定的身体成分参数能准确识别HNC和营养不良患者。相位角以及 BCMI、FFMI 和 BCM 等其他参数可提供有关 HNC 患者营养状况的重要信息。

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Improving the nutritional evaluation in head neck cancer patients using bioelectrical impedance analysis: Not only the phase angle matters

BackgroundMalnutrition and sarcopenia are highly prevalent in patients with head neck cancer (HNC). An accurate early diagnosis is necessary for starting nutritional support, as both are clearly associated with clinical outcomes and mortality. We aimed to evaluate the applicability and accuracy of body composition analysis using electrical bioimpedance vectorial analysis (BIVA) for diagnosing malnutrition and sarcopenia in patients with HNC cancer undergoing systemic treatment with chemotherapy or radiotherapy.MethodsCross‐sectional, observational study that included 509 HNC patients. A comprehensive nutritional evaluation that included BIVA was performed.ResultsThe prevalence of malnutrition was higher in patients that received treatment with chemotherapy (59.2% vs. 40.8%, P < 0.001); increased mortality was observed in malnourished patients (33.3% vs. 20.1%; P < 0.001); ECOG status (1–4) was also worse in malnourished patients (59.2% vs. 22.8% P < 0.001). Body cell mass (BCM) and fat mass were the most significantly associated parameters with malnutrition [OR 0.88 (0.84–0.93) and 0.98 (0.95–1.01), respectively]; BCM and fat free mass index (FFMI) were associated with several aspects including (1) the patient‐generated subjective global assessment [OR 0.93 (0.84–0.98) and 0.86 (0.76–0.97), respectively], (2) the presence of sarcopenia [OR 0.81 (0.76–0.87) and 0.78 (0.66–0.92), respectively]. A BCM index (BCMI) < 7.8 in combination with other parameters including FFMI and BCM accurately predicted patients with malnutrition [accuracy 95% CI: 0.803 (0.763–0.839); kappa index: 0.486; AUC: 0.618 (P < 0.01)]. A BCMI cutoff of 7.6 was enough for identifying males with malnutrition (P < 0.001), while it should be combined with other parameters in females.ConclusionsBody composition parameters determined by BIVA accurately identify patients with HNC and malnutrition. Phase angle, but other parameters including BCMI, FFMI and BCM provide significant information about nutritional status in patients with HNC.

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来源期刊

Journal of Cachexia, Sarcopenia and Muscle Medicine-Orthopedics and Sports Medicine

自引率

12.40%

发文量

期刊介绍： The Journal of Cachexia, Sarcopenia, and Muscle is a prestigious, peer-reviewed international publication committed to disseminating research and clinical insights pertaining to cachexia, sarcopenia, body composition, and the physiological and pathophysiological alterations occurring throughout the lifespan and in various illnesses across the spectrum of life sciences. This journal serves as a valuable resource for physicians, biochemists, biologists, dieticians, pharmacologists, and students alike.