Multimorbidity and the risk of malnutrition, frailty and sarcopenia in adults with cancer in the UK Biobank

Abstract

Background: Malnutrition, sarcopenia and frailty are distinct, albeit interrelated, conditions associated with adverse outcomes in adults with cancer, but whether they relate to multimorbidity, which affects up to 90% of people with cancer, is unknown. This study investigated the relationship between multimorbidity with malnutrition, sarcopenia and frailty in adults with cancer from the UK Biobank.

Methods: This was a cross-sectional study including 4122 adults with cancer (mean [SD] age 59.8 [7.1] years, 50.7% female). Malnutrition was determined using the Global Leadership Initiative on Malnutrition criteria. Probable sarcopenia and sarcopenia were defined using the European Working Group on Sarcopenia in Older People 2 criteria. (Pre-)frailty was determined using the Fried frailty criteria. Multimorbidity was defined as ≥2 long-term conditions with and without the cancer diagnosis included. Logistic regression models were fitted to estimate the odds ratios (ORs) of malnutrition, sarcopenia and frailty according to the presence of multimorbidity.

Results: Genitourinary (28.9%) and breast (26.1%) cancers were the most common cancer diagnoses. The prevalence of malnutrition, (probable-)sarcopenia and (pre-)frailty was 11.1%, 6.9% and 51.2%, respectively. Of the 11.1% of participants with malnutrition, the majority (9%) also had (pre-)frailty, and 1.1% also had (probable-)sarcopenia. Of the 51.2% of participants with (pre-)frailty, 6.8% also had (probable-)sarcopenia. No participants had (probable-)sarcopenia alone, and 1.1% had malnutrition, (probable-)sarcopenia plus (pre-)frailty. In total, 33% and 65% of participants had multimorbidity, including and excluding the cancer diagnosis, respectively. The most common long-term conditions, excluding the cancer diagnosis, were hypertension (32.5%), painful conditions such as osteoarthritis or sciatica (17.6%) and asthma (10.4%). Overall, 80% of malnourished, 74% of (probable-)sarcopenia and 71.5% of (pre-)frail participants had multimorbidity. Participants with multimorbidity, including the cancer diagnosis, had higher odds of malnutrition (OR 1.72 [95% confidence interval, CI, 1.31-2.30; P < 0.0005]) and (pre-)frailty (OR 1.43 [95% CI 1.24-1.68; P < 0.0005]). The odds increased further in people with ≥2 long-term conditions in addition to their cancer diagnosis (malnutrition, OR 2.41 [95% CI 1.85-3.14; P < 0.0005]; (pre-)frailty, OR 2.03 [95% CI 1.73-2.38; P < 0.0005]). There was little evidence of an association of multimorbidity with sarcopenia.

Conclusions: In adults with cancer, multimorbidity was associated with increased odds of having malnutrition and (pre-)frailty but not (probable-)sarcopenia. This highlights that multimorbidity should be considered a risk factor for these conditions and evaluated during nutrition and functional screening and assessment to support risk stratification within clinical practice.

Keywords: cancer; frailty; malnutrition; multimorbidity; sarcopenia.

Figure 1

Study flow chart. ^aExcludes participants who have requested their data be removed from the UK Biobank. ^bExcludes non‐melanoma skin cancer and benign tumours. ^cParticipants may have had more than one of these conditions, and therefore, these numbers add up to more than the total number of participants.

Figure 2

Proportion of participants with cancer meeting the underlying components of malnutrition (A), (pre‐)frailty (B) and (probable‐)sarcopenia (C) in those classified as having the condition. BMI, body mass index.

Figure 3

Venn diagram representing the overlap between the prevalence of malnutrition, probable sarcopenia/sarcopenia and pre‐frailty/frailty. Malnutrition only = 2.1%, malnutrition + (probable‐)sarcopenia = 0.0%, malnutrition + (pre‐)frailty = 7.9%, (probable‐)sarcopenia only = 0.0%, (probable‐)sarcopenia + (pre‐)frailty = 5.7% and malnutrition + (probable‐)sarcopenia + (pre‐)frailty = 1.1%. The number outside the figure represents the proportion of participants (46.7%) with none of these conditions.

Figure 4

Prevalence of (A) malnutrition, (B) sarcopenia and (C) frailty by number of long‐term conditions (N = 4122).