Appetite loss, malnutrition, and mortality: a significant association in need of urgent recognition?

Despite its high prevalence among older adults, appetite loss is underrecognized in clinical practice. Explanations for this underrecognition include the lack of uniform terminology for the condition paired with an absence of defined, standardised approaches to assessing it. Moreover, appetite loss is commonly misconstrued as a normal and irreversible part of the ageing process. Together, these reasons create heterogeneity across anorexia of ageing studies, thereby hindering the recognition and management of appetite loss among older adults. To overcome this gap, a better understanding of appetite loss’ effects on morbidity and mortality in older adults is needed.

This systematic literature review aimed to investigate the relationship between appetite loss and negative outcomes in older adults aged ≥ 65 years.

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Sarcopenia and its prognostic value in advanced gastroesophageal cancer

Esophageal, gastroesophageal, and gastric cancers make up a significant proportion of the global cancer burden. Associated with a poor prognosis and 5-year survival rate, up to half of patients present with an advanced stage of disease upon diagnosis, hindering the success of curative treatments. Fluorine-18-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) is a standard test with great diagnostic and prognostic value amongst patients with esophageal, gastroesophageal, and gastric cancers. Its inclusion of computed tomography facilitates the assessment of skeletal muscle, and thus, sarcopenia, in this patient population. Although sarcopenia has been shown to influence postoperative complications, its prognostic value for patients with advanced disease has not yet been characterised.

The aim of this study was to ascertain the prognostic value sarcopenia measurements and metabolic activity parameters of primary gastroesophageal cancer in patients with advanced metastatic disease.

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Metabolic dysfunction and candidate biomarkers: an overview of anorexia of ageing

Anorexia of ageing is characterised by an age-associated reduction in appetite and food intake. With a prevalence of 20% in older adults, this syndrome may engender malnutrition and metabolic impairments, both of which are associated with increased negative health outcomes. Indeed, elderly individuals with anorexia of ageing possess higher risks of sarcopenia, disability, hospitalisation, and mortality. Importantly, malnutrition has also been identified as a major risk factor for frailty.

This article aims to summarise the state of research on anorexia of ageing in the context of age-related metabolic changes, with a focus on its candidate biomarkers.

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Cancer cachexia risk score for digestive tract cancer: a review

Cancer cachexia, a form of malnutrition, can be viewed as a determinant of prognosis. However, there are no effective therapies or treatments for this condition. Hence, the identification of high-risk patients remains crucial for the assessment and management of cancer cachexia. The cancer cachexia risk score was validated to show good performance; it successfully identified at-risk digestive tract cancer patients before abdominal surgery. This risk score can provide vital help to clinicians in their cancer cachexia screening process, allowing them to understand a patient’s prognosis and build better-informed decisions for abdominal surgery.
This review by Tan S et al. aimed to discuss the cancer cachexia risk score in relation to digestive tract cancer patients, to understand whether survival risks can be identified prior to surgery.

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Nutrition in nasopharyngeal carcinoma: a review

Locoregionally advanced nasopharyngeal carcinoma is a type of head and neck cancer. Induction chemotherapy and concurrent chemoradiotherapy is the most common standard of care. However, due to the toxicity and intensity of these treatments, patients’ nutritional statuses are often negatively impacted. Weight loss and malnutrition are often overlooked in head and neck cancer patients, despite the fact that around half of all head and neck cancer patients suffer from malnutrition. This negatively affects their quality of life, affecting physical functioning, nausea and vomiting and can even affect emotional and cognitive functioning. This study supports the need to monitor patients’ nutritional statuses during the later phase of treatments and work on nutritional interventions.
This review by Miao J et al. aimed to explore the need for nutritional interventions in nasopharyngeal carcinoma.

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Inflammatory burden index for the prognosis of non-small cell lung cancer: a review

There is an urgent need to find predictive biomarkers for the prognosis of non-small cell lung cancer for survival assessment. Tumour-related factors, such as the pathological stage or histological subtype, are used widely but often vary in patient outcome. Hence, haematological inflammatory parameters, such as neutrophils, lymphocytes and platelets have been used to reflect the inflammation found in cancer. These biomarkers demonstrate prognostic value in cancers such as non-small cell lung cancer. However, it remains unclear which specific combination of biomarkers may help in assessing prognosis, so this study used the newly developed inflammatory burden index (IBI). It was found to be associated with survival, 90-day outcomes, length of hospitalisation and cachexia in non-small cell lung cancer patients. Hence, this may be an advantageous tool for prognosis prediction.
This review by Xie H et al. aimed to compare the prognostic value of inflammation biomarkers in patients with non-small cell lung cancer.

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