Association between dietary supplement use and mortality in cancer survivors with different body mass index and frailty status: a cohort study

Mengqi Zhang; Jia Wang; Xiaoxuan Li; Lihua Zhang; Yixuan Zhang; Zengjin Wen; Jiaqi Zhang; Yuchen Fan; Zhenkang Qiu

doi:10.3389/fnut.2024.1395362

Association between dietary supplement use and mortality in cancer survivors with different body mass index and frailty status: a cohort study

Front Nutr. 2024 May 1:11:1395362. doi: 10.3389/fnut.2024.1395362. eCollection 2024.

Authors

Mengqi Zhang^#¹, Jia Wang^#², Xiaoxuan Li¹, Lihua Zhang³, Yixuan Zhang³, Zengjin Wen³, Jiaqi Zhang³, Yuchen Fan³, Zhenkang Qiu⁴

Affiliations

¹ Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
² Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
³ Department of Medicine, Qingdao University, Qingdao, China.
⁴ Interventional Medical Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.

^# Contributed equally.

Abstract

Background: The association between Body Mass Index (BMI), frailty index (FI), and dietary supplement in cancer survivors has been a subject of growing interest. This study investigates the relationship of BMI and FI with mortality in American cancer survivors and explores the impact of dietary supplement usage on different BMI and FI groups.

Methods: Three thousand nine hundred and thirty-two cancer patients from the National Health and Nutrition Examination Survey (NHANES) database were included in the analyses. BMI, FI, and supplement usage were obtained through the NHANES structured survey and the 49-item FI tool. Weighted logistic and Cox proportional hazards models, Kaplan-Meier survival analyses, and propensity score matching (PSM) were used to elucidate the relationships between BMI, FI, dietary supplement, and mortality outcomes.

Results: The study found significant associations between higher BMI and increased frailty (Odds ratio [OR] = 1.04, 95% confidence interval [95% CI], 1.02-1.06). BMI < 25 kg/m² and FI > 0.2 are associated with an increased mortality rate. Dietary supplement use can reduce all-cause and cancer mortality in cancer patients with BMI < 25 kg/m² (Hazard ratio [HR] = 0.63, 95% CI, 0.47-0.84; HR = 0.48, 95% CI, 0.29-0.80) or FI ≤ 0.2 (HR = 0.77, 95% CI, 0.60-0.99; HR = 0.59, 95% CI, 0.39-0.89). In cancer patients with BMI < 25 kg/m² and FI ≤ 0.2, dietary supplement users had lower all-cause and cancer mortality (HR = 0.49, 95% CI, 0.30-0.79; HR = 0.25, 95% CI, 0.10-0.60).

Conclusion: The study revealed a negative correlation between BMI and the FI among the cancer patient cohort as well as their complex impact on mortality and highlighted the role of dietary supplement in cancer prognosis, indicating benefits for non-frail patients with BMI < 25 kg/m².

Keywords: National Health and Nutrition Examination Survey; body mass index; cancer; dietary supplement; frailty index; mortality.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by the Natural Science Foundation of Shandong Province (ZR2023QH190).