AUTHOR=Xue Hongmei , Du Hongzhen , Xie Ying , Zhai Yijing , Song Shiming , Luo Bin , Qiu Hong , Wang Kunhua , Cui Jiuwei , Song Chunhua , Xu Hongxia , Li Wei , Shi Hanping , Li Zengning ,  The Investigation on Nutrition Status and Its Clinical Outcome of Common Cancers (INSCOC) Group , Guo Zengqing , Fu Zhenming , Wang Chang , Weng Min , Cao Jingjing , Zhou Fuxiang , Lin Yuan , Li Suyi , Ba Yi , Yuan Kaitao , Liu Ming , Hu Wen , Zhou Lan , Ma Hu , Yao Qinghua , Cong Minghua , Li Tao , Chen Zihua , Chen Gongyan , Zhao Qingchuan , Feng Changyan , He Ying , Wu Jing , Yang Jiajun , Song Xinxia , Yu Yaying , Ma Wenjun , Luo Suxia , Zheng Jin , Chen Junqiang , Luo Qi , Wang Wei , Qiao Qiuge , Shi Yongmei , Qi Yumei , Feng Yongdong , Jiang Haiping , Guan Wenxian , Chen Jiaxin , Huang He , Yu Zheng , Fang Yu 

TITLE=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

JOURNAL=Frontiers in Nutrition

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2022.914020

DOI=10.3389/fnut.2022.914020

ISSN=2296-861X

ABSTRACT=Objective: We aimed to investigate the association of ratio between fat mass to lean body mass ratio (RFL), percentage of body fat (PBF), fat mass (FM) with mortality among middle-aged and elderly cancer patients without obesity.
Methods: This prospective hospital-based cohort study comprised 3201 patients with stage I to IV cancer aged 40 years or above (mean age: 58 years old for female and 61 years old for male; mean length of follow-up was 1.67 years; the maximal follow-up length was 6.42 years). Fat mass, and percentage of body fat were measured by bio-electrical 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 CRP, HR 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 females or males aged less than 60 years. 
Conclusion: Our findings showed a significant non-linear association between RFL and all-cause mortality, which were observed only in elderly men, independent of body mass index and might be attenuated by their inflammation state.