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Liu X, Zhang X, Ruan G, Zheng X, Chen Y, Zhang X, Liu T, Ge Y, Shi H. Relationship between educational level and survival of patients with cancer: A multicentre cohort study. Cancer Med 2024; 13:e7141. [PMID: 38545856 PMCID: PMC10974719 DOI: 10.1002/cam4.7141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Although socioeconomic factors are important determinants of population mortality, the effect of educational level on the survival of patients with cancer in China is unclear. This study aimed to assess whether educational level is associated with the prognosis of patients with cancer and to explore the mediators of this association. METHODS This multicentre cohort study included 18,251 patients diagnosed with cancer between May 2013 and December 2018. The main parameters measured were overall survival (OS) and all-cause mortality. The relationship between educational level and all-cause mortality was assessed using multifactor-corrected Cox survival analysis. Logistic regression was used to analyze the association between educational level and patient-generated subjective global assessment (PG-SGA). RESULTS The mean age of the 18,251 participants (men, 9939 [54.4%]) was 57.37 ± 11.66 years. Multifactorial survival analysis showed that patients survived longer with increasing education (university and above vs. elementary school and below; p = p = <0.001, HR = 0.84, 95% CI: 0.77-0.92), and the differences were statistically significant in different subgroups. The potential impact factors included sex, age, TNM stage, and PG-SGA score. Logistic regression showed a significant negative association between educational level and the modifiable factor PG-SGA (secondary vs. primary and below; p = 0.004, HR = 0.90, 95% CI: 0.83-0.97; university and above vs. primary and below; p < 0.001, HR = 0.79, 95% CI: 0.71-0.88). CONCLUSIONS Educational level was a significant prognostic factor for patients with cancer, independent of other known prognostic factors. This association was further improved by modifying the nutritional status.
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Affiliation(s)
- Xiao‐Yue Liu
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Xi Zhang
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Guo‐Tian Ruan
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Xin Zheng
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Yue Chen
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Xiao‐Wei Zhang
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Tong Liu
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Yi‐Zhong Ge
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
| | - Han‐Ping Shi
- Department of Gastrointestinal SurgeryBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- Department of Clinical NutritionBeijing Shijitan Hospital, Capital Medical UniversityBeijingChina
- National Clinical Research Center for Geriatric DiseasesXuanwu Hospital, Capital Medical UniversityBeijingChina
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Xie H, Ruan G, Zhang H, Ge Y, Zhang Q, Lin S, Song M, Zhang X, Liu X, Li X, Zhang K, Yang M, Tang M, Deng L, Gan J, Shi H. Sex differences in the association of triceps skinfold thickness and colorectal cancer mortality. Nutrition 2022; 103-104:111811. [DOI: 10.1016/j.nut.2022.111811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/17/2022] [Accepted: 08/02/2022] [Indexed: 12/03/2022]
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Xue H, Du H, Xie Y, Zhai Y, Song S, Luo B, Qiu H, Wang K, Cui J, Song C, Xu H, Li W, Shi H, Li Z. 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; 9:914020. [PMID: 35789967 PMCID: PMC9249599 DOI: 10.3389/fnut.2022.914020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Hongmei Xue
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang, China
| | - Hongzhen Du
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang, China
| | - Ying Xie
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang, China
| | - Yijing Zhai
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang, China
| | - Shiming Song
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang, China
| | - Bin Luo
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang, China
| | - Hong Qiu
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kunhua Wang
- Department of Gastrointestinal Surgery, Institute of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiuwei Cui
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Chunhua Song
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Hongxia Xu
- Department of Nutrition, Daping Hospital and Research Institute of Surgery, Third Military Medical University, Chongqing, China
| | - Wei Li
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Hanping Shi
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.,Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Chinese Society of Nutritional Oncology, Beijing, China
| | - Zengning Li
- Department of Clinical Nutrition, The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Province Key Laboratory of Nutrition and Health, Shijiazhuang, China
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Effects of age and gender on body composition indices as predictors of mortality in middle-aged and old people. Sci Rep 2022; 12:7912. [PMID: 35551227 PMCID: PMC9098413 DOI: 10.1038/s41598-022-12048-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/26/2022] [Indexed: 11/08/2022] Open
Abstract
To determine whether body composition indices interact with age and gender as a predictor of all-cause mortality, 1200 participants at least 40 years of age were recruited in 2009 and 2010. A multi-frequency bioelectrical impedance analysis device was used to measure each participant's body composition indices, including the fat mass index (FMI), fat free mass index (FFMI), skeletal muscle mass index (SMMI), and visceral fat area index (VFAI). A baseline questionnaire was used to collect demographic information about lifestyle habits, socioeconomic status, and medical conditions. All claimed records of death from 2009 to 2018 in the National Health Insurance Research Databank were identified. The all-cause mortality rate was 8.67% after a mean follow-up period of 5.86 ± 2.39 person-years. The Cox proportional hazard model analysis showed significantly negative associations between FFMI or SMMI with all-cause mortality in the total group and those aged ≥ 65 y/o. The FFMI and SMMI were negative predictors of mortality in both genders. The FMI and VFAI were positive predictors of mortality exclusively in females. In conclusion, the SMMI is a better predictor of mortality than the BMI, FMI, and FFMI, especially in older adults. A higher fat mass or visceral fat distribution may predict higher mortality in females.
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A healthy dietary pattern with a low inflammatory potential reduces the risk of gestational diabetes mellitus. Eur J Nutr 2021; 61:1477-1490. [PMID: 34846602 PMCID: PMC8921111 DOI: 10.1007/s00394-021-02749-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
Purpose An optimal diet for lowering the risk of gestational diabetes mellitus (GDM) is still to be defined, but may comprise of nutrient intakes, dietary patterns, diet quality, and eating frequency. This study was designed to investigate the contribution of diet in developing GDM in a comprehensive way. Methods The dietary intake of overweight or obese women, a risk group for GDM (n = 351), was assessed using 3-day food diaries and diet quality questionnaires in early pregnancy. Eating frequency and nutrient intakes were calculated, and dietary patterns identified using principal component analysis. The inflammatory potential of the diet was determined by calculating the dietary inflammatory index (DII®) and energy-adjusted DII (E-DII™). GDM was diagnosed with an oral glucose tolerance test at 24–28 gestational weeks. Results Higher adherence to ‘healthier dietary pattern’ characterized by consumptions of vegetables and rye bread associated with a reduced risk of GDM (adjusted OR 0.27, 95% CI 0.11–0.70). Higher E-DII score, indicating pro-inflammatory diet, was associated with a 27% higher risk of GDM (adjusted OR 1.27; 95% CI 1.08–1.49) for each E-DII point. In the evaluation of nutrient intakes, total fat, saturated fatty acids (SFAs), and trans fatty acids were higher and fiber lower in women developing GDM compared to women not developing GDM (all p < 0.05). Intakes of total fat, SFAs, and trans fatty acids were also significant predictors for GDM (all p < 0.05). Conclusions The results emphasize the importance of an overall healthy diet and limitation of foods with SFAs, and other nutrients with a high inflammatory potential in reducing the risk of GDM. Trial registration ClinicalTrials.gov Identifier: NCT01922791, August 14, 2013. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-021-02749-z.
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