Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis.
Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis.
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DOI：
10.1038/s41430-020-0629-0
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发表时间：
2020-11
影响因子：
4.7
通讯作者：
Johnson MJ
中科院分区：
文献类型：
--
作者：
Bullock AF;Greenley SL;McKenzie GAG;Paton LW;Johnson MJ
营养不良预测癌症患者的临床结果较差。患有癌症的老年人是一个复杂的，不断增长的人群，处于减肥状况的高风险中。存在一些营养不良筛查工具，但对这一群体最好的筛查工具是未知的。目的是系统地回顾已发表的关于老年癌症患者（年龄≥ 70岁）营养状况标志物和指标的证据。在奥维德Medline、EMBASE、Web of Science、CINAHL、英国护理数据库和科克伦中心进行了系统检索;检索词与营养不良、癌症、老年人相关。对标题、摘要和论文进行了筛选和质量评价。对评估营养状态标志物预测患者结局能力的数据进行荟萃分析或叙述性综合。纳入了42项研究，描述了15种标记物。荟萃分析发现，在单变量分析中，食物摄入量减少与死亡率相关（OR 2.15 [2.03 - 4.20] p =<0.00001）。预后营养指数（PNI）与总生存率相关（HR 1.89 [1.03 - 3.48] p = 0.04）。PNI标志物（白蛋白、总淋巴细胞计数）可被视为炎症而非营养的标志物。极低的体重指数（BMI）（<18 kg/m2）与临床结局之间存在相关性。没有工具被确定为适当的筛选营养不良，以区别于炎症原因的体重减轻。癌症恶病质和肌肉减少症的风险在老年癌症患者限制了分析的工具。食物摄入量的措施预测死亡率，并应包括在临床调查。需要一种筛查工具来区分老年癌症患者的营养不良、恶病质和肌肉减少症。
Malnutrition predicts poorer clinical outcomes for people with cancer. Older adults with cancer are a complex, growing population at high risk of weight-losing conditions. A number of malnutrition screening tools exist, however the best screening tool for this group is unknown. The aim was to systematically review the published evidence regarding markers and measures of nutritional status in older adults with cancer (age ≥ 70). A systematic search was performed in Ovid Medline, EMBASE, Web of Science, CINAHL, British Nursing Database and Cochrane CENTRAL; search terms related to malnutrition, cancer, older adults. Titles, abstracts and papers were screened and quality-appraised. Data evaluating ability of markers of nutritional status to predict patient outcomes were subjected to meta-analysis or narrative synthesis. Forty-two studies, describing 15 markers were included. Meta-analysis found decreased food intake was associated with mortality (OR 2.15 [2.03–4.20] p = < 0.00001) in univariate analysis. Prognostic Nutritional Index (PNI) was associated with overall survival (HR 1.89 [1.03–3.48] p = 0.04). PNI markers (albumin, total lymphocyte count) could be seen as markers of inflammation rather than nutrition. There a suggested relationship between very low body mass index (BMI) (<18 kg/m2) and clinical outcomes. No tool was identified as appropriate to screen for malnutrition, as distinct from inflammatory causes of weight-loss. Risk of cancer-cachexia and sarcopenia in older adults with cancer limits the tools analysed. Measures of food intake predicted mortality and should be included in clinical enquiry. A screening tool that distinguishes between malnutrition, cachexia and sarcopenia in older adults with cancer is needed.
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影响因子：
7.1
作者：
Bouillanne, O;Morineau, G;Aussel, C
通讯作者：
Aussel, C
影响因子：
6.2
作者：
Extermann, Martine;Boler, Ivette;Balducci, Lodovico
通讯作者：
Balducci, Lodovico
影响因子：
6.3
作者：
Cederholm, T.;Barazzoni, R.;Singer, P.
通讯作者：
Singer, P.
影响因子：
0.2
作者：
Aziz EF;Javed F;Alviar CL;Herzog E
通讯作者：
Herzog E
影响因子：
50.5
作者：
Falandry, C.;Weber, B.;Freyer, G.
通讯作者：
Freyer, G.