PP099 - UNDERNUTRITION OUTWEIGHS THE BMI PARADOX IN HOSPITALIZED PATIENTS WITH CANCER

PP099

UNDERNUTRITION OUTWEIGHS THE BMI PARADOX IN HOSPITALIZED PATIENTS WITH CANCER

J. P. Costa-Pereira^1,*, M. C. Gonzalez², C. M. Prado³, N. C. Souza⁴, R. F. Tartari⁵, S. F. Mauricio⁶, A. P. T. Fayh⁷

¹Nutrition, UFPE, Recife, ²Nutrition, UFPEL, Pelotas, Brazil, ³HNRU, University of Alberta, Edmonton, Canada, ⁴Nutrition, INCA, Rio de Janeiro, ⁵Unisinos, Porto Alegre, ⁶Nutrition, UFMG, Belo Horizonte, ⁷Nutrition, UFCSPA, Porto Alegre, Brazil

Rationale: Undernutrition coexisting with excess weight is a double malnutrition burden. Although higher body mass index (BMI) has been associated with lower mortality in patients with cancer, this “BMI paradox” may be confounded by the absence of undernutrition. We hypothesized that the protective effect of higher BMI would disappear when excess weight coexists with undernutrition.

Methods: Secondary pooled analysis from multicenter cohorts (6 hospitals; N=919; 54% females; mean age 59±13y; 32% colorectal cancer). Excess weight was defined by BMI > 25kg/m². Undernutrition was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA, undernutrition if B or C). Analyses were adjusted for tumor site, age, and TNM stage.

Results: Almost half of the patients (47%) had excess weight, and among these, 36.1% were undernourished. Restricted cubic spline Cox models showed a higher mortality risk at BMI < 25kg/m², whereas BMI ≥ 25 kg/m² was associated with a lower mortality risk. After adjustment, higher BMI remained independently associated with a lower 6-mo mortality risk (HR 0.98, 95% CI 0.97-0.99, p<.001). When PG-SGA classifications were included in the model, this BMI “protective” effect disappeared (HR 0.97, 95% CI 0.93-1.01, p=0.16). In contrast, malnutrition remained independently associated with increased mortality risk: moderately undernourished patients had a HR of 2.02 (95% CI 1.35-3.02, p=.001), and severely undernourished patients had a HR of 3.22 (95% CI 1.92-5.39, p<.001). Among patients with excess weight, mortality rates were significantly higher among undernourished patients (55.4% vs 44.6%, p<.001).

Conclusion: Our study demonstrates the clinical relevance of undernutrition coexisting with higher BMIs in patients with cancer, outweighing the so-called BMI paradox. These findings highlight the need for appropriate tools to assess undernutrition in clinical practice.

Disclosure of Interest: J. P. Costa-Pereira Speakers Bureau of: Fresenius Kabi Br; Danone Nutricia Br; Prodiet Medical Nutrition Br, M. C. Gonzalez Consultant for: Nestlé Health Science; Nutricia, Speakers Bureau of: Nestlé Health Science; Nutricia, C. Prado Consultant for: Abbott Nutrition; Nutricia; Nestlé Health Science; Novo Nordisk. , Speakers Bureau of: Abbott Nutrition; Nutricia; Nestlé Health Science; Novo Nordisk. , N. Souza: None declared, R. Tartari: None declared, S. Mauricio: None declared, A. Fayh Grant / Research Support from: Prodiet Medical Nutrition