title: The diversity of nutritional status in cancer: new insights.
abstract: OBJECTIVE
  Nutritional status in cancer has been mostly biased toward undernutrition, an issue now in dispute. We aimed to characterize nutrition status, to analyze associations between nutritional and clinical/cancer-related variables, and to quantify the relative weights of nutritional and cancer-related features.
  
  
  METHODS
  The cross-sectional study included 450 nonselected cancer patients (ages 18-95 years) at referral for radiotherapy. Nutritional status assessment included recent weight changes, body mass index (BMI) categorized by World Health Organization's age/sex criteria, and Patient-Generated Subjective Global Assessment (PG-SGA; validated/specific for oncology).
  
  
  RESULTS
  BMI identified 63% as >or=25 kg/m(2) (43% overweight, 20% obese) and 4% as undernourished. PG-SGA identified 29% as undernourished and 71% as well nourished. Crossing both methods, among the 319 (71%) well-nourished patients according to PG-SGA, 75% were overweight/obese and only 25% were well nourished according to BMI. Concordance between BMI and PG-SGA was evaluated and consistency was confirmed. More aggressive/advanced stage cancers were more prevalent in deficient and excessive nutritional status: in 83% (n = 235/282) of overweight/obese patients by BMI and in 85% (n = 111/131) of undernourished patients by PG-SGA. Results required adjustment for diagnoses: greater histological aggressiveness was found in overweight/obese prostate and breast cancer; undernutrition was associated with aggressive lung, colorectal, head-neck, stomach, and esophageal cancers (p < .005). Estimates of effect size revealed that overweight/obesity was associated with advanced stage (24%), aggressive breast (10%), and prostate (9%) cancers, whereas undernutrition was associated with more aggressive lung (6%), colorectal (6%), and head-neck (6%) cancers; in both instances, age and longer disease duration were of significance.
  
  
  CONCLUSIONS
  Undernutrition and overweight/obesity have distinct implications and bear a negative prognosis in cancer. This study provides novel data on the prevalence of overweight/obesity and undernutrition in cancer patients and their potential role in cancer histological behavior.
authors.affiliation: Unidade de Nutrição e Metabolismo, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal.
authors.forename: Mariana
authors.initials: M
authors.lastname: Ramos Chaves
authors.forename: Carolina
authors.initials: C
authors.lastname: Boléo-Tomé
authors.forename: Isabel
authors.initials: I
authors.lastname: Monteiro-Grillo
authors.forename: Maria
authors.initials: M
authors.lastname: Camilo
authors.forename: Paula
authors.initials: P
authors.lastname: Ravasco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology*; D009752:Nutritional Status; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology*; D011174:Portugal / Q000453:epidemiology; D015995:Prevalence; D055815:Young Adult
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