BACKGROUND:Stomach cancer remains a significant public health concern in China, with dietary factors, particularly high sodium intake, being major contributors. This study aimed to quantify the trends, demographic disparities, and contributing factors to this burden from 1990 to 2021. METHODS:Data from the Global Burden of Disease Study (GBD) 2021 were used to assess the burden of stomach cancer attributable to high sodium intake. The study included age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Joinpoint regression and age-period-cohort (APC) analysis were performed to identify significant trends and changes. Decomposition analysis was used to identify the impacts of aging, epidemiological changes, and population growth. RESULTS:In 2021, stomach cancer attributable to high sodium intake resulted in 36,958 deaths in China, with males (26,171) being more affected than females (10,786). The ASMR was significantly higher in males (2.71 per 100,000) than in females (0.99 per 100,000). DALYs totaled 883,435, with males contributing 643,008 and females 240,427. Age-standardized DALY rates were 62.16 for males and 22.15 for females. The age-standardized rates for YLDs and YLLs were also higher in males than females. Although ASMR and age-standardized DALYs rates declined overall (AAPC: -2.45% and -2.76%, respectively), absolute burden increased due to aging and population growth. Compared to global averages, China's age-standardized rates remained higher, despite notable improvements since 1990. APC analysis showed elevated risks in older age groups, declining period effects, and lower burden among recent birth cohorts. Decomposition analysis indicated that aging and population growth contributed to increased deaths, while epidemiological changes led to a reduction. CONCLUSIONS:Despite declining age-standardized rates, the absolute burden of stomach cancer linked to high sodium remains substantial in China. Males and older adults are disproportionately affected. Population aging and growth are key contributors, while public health interventions have mitigated the burden to some extent. Sustained, gender-sensitive strategies focused on sodium reduction are essential to further lower disease impact.

Background:Occupational exposure to asbestos remains a major public health concern in China, particularly due to the long latency of asbestos-related diseases and the persistent use of asbestos in male-dominated industries. However, the long-term trends and drivers of asbestos-related cancer burden have not been fully quantified. Methods:This study used data from the Global Burden of Disease Study 2021 to estimate the burden of total cancer attributable to occupational asbestos exposure in China from 1990 to 2021. Key indicators included deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs), disaggregated by age, sex, cancer type, and time period. Joinpoint regression and age-period-cohort analyses were conducted to explore temporal dynamics, while decomposition analysis assessed the contributions of population growth, aging, and epidemiological changes. Results:In 2021, occupational asbestos exposure led to 29,020 deaths and 535,732 DALYs in China, with a significantly higher burden among males. The number of cases rose steadily from 1990, with sharp increases between 2000 and 2010, plateauing thereafter and rising again after 2017. Age-standardized rates showed dynamic trends: increasing until 2010-2011, declining until 2018, and rebounding modestly, particularly among females. The burden was highest among individuals aged 85-94 and showed a rightward shift over time. Lung cancer accounted for over 85% of asbestos-related DALYs, followed by mesothelioma, ovarian, and laryngeal cancers. Joinpoint and age-period-cohort analyses highlighted long-latency effects and generational shifts, while decomposition showed that aging and epidemiological changes were the dominant drivers of increased deaths, whereas DALYs were primarily driven by epidemiological factors and population growth. Conclusion:The burden of asbestos-related cancers in China remains substantial and is rising due to demographic aging and persistent exposure risks. Stronger occupational safety regulations, exposure surveillance, and asbestos bans are urgently needed to curb future disease burden.

Cancer cachexia (CCx) is a complex, multifactorial syndrome associated with poor outcomes, yet its clinical identification is often hindered by unreliable recall of historical body weight. We developed an interpretable machine learning (ML) framework to detect CCx by integrating routinely collected metabolic and inflammatory hematological features from the nationwide multicenter INSCOC cohort in China (N = 16,858). Using a systematic, data-driven strategies, we identified a stable and biologically coherent set of features that collectively characterize a cachexia-associated phenotype. The final model demonstrates consistent predictive discrimination for CCx in both test cohort (AUC: 0.758, 95% CI: 0.742-0.775) and validation cohort (AUC: 0.748, 95% CI: 0.730-0.766). Importantly, this phenotype-based model generalizes under strict temporal validation and enables objective identification of CCx in real-world clinical settings without reliance on recalled body weight. Together, our findings support a conceptual shift from a purely weight-based syndrome of CCx toward an integrative metabolic-inflammatory phenotype.

Background:Colon and rectum cancer (CRC) poses a major public health challenge in China, with dietary risks identified as key modifiable contributors to its incidence and mortality. Quantifying the current burden, long-term trends, and the impact of specific dietary factors is essential to inform effective prevention strategies. Methods:Data on CRC burden attributable to dietary risks in China from 1990 to 2021 were extracted from the Global Burden of Disease Study 2021. We examined all-age numbers and age-standardized rates of CRC deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Temporal trends and generational patterns were explored using joinpoint regression, age-period-cohort, and decomposition analyses. Results:In 2021, dietary risks accounted for over 102,000 CRC-related deaths and 2.55 million DALYs in China, with a significantly higher burden among males. Although age-standardized mortality, DALY, and YLL rates declined modestly over the past three decades, YLD rates increased. Diets low in milk, whole grains, and calcium were the predominant contributors, while the burden associated with processed meat showed the largest relative increase. The highest burden occurred among those aged 65-74, with notable sex disparities. Joinpoint analysis revealed fluctuating trends, including recent plateaus or increases, particularly in males. Age-period-cohort analysis indicated elevated burden in earlier birth cohorts, with improvements in more recent generations. Decomposition analysis identified population aging as the primary driver of burden growth, whereas epidemiological changes contributed modest reductions, especially among women. Conclusion:The burden of CRC attributable to dietary risks remains considerable in China, underscoring the need for targeted, gender- and age-sensitive dietary interventions to reduce premature mortality and long-term disability.

Background:Colorectal cancer (CRC) represents a significant public health challenge in China. With the rising prevalence of metabolic disorders such as obesity and diabetes, it is essential to understand the long-term burden of CRC attributable to metabolic risks. Methods:This study utilized data from the Global Burden of Disease (GBD) 2021 to estimate the burden of CRC attributable to metabolic risks in China from 1990 to 2021. Metrics analyzed included deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs), stratified by age, sex, and year. Joinpoint regression, age-period-cohort analysis, and decomposition methods were employed to explore temporal trends and underlying drivers. Results:In 2021, CRC attributable to metabolic risks caused 36,462 deaths and 902,557 DALYs in China, with significantly higher burdens among men. The age-standardized death and DALY rates were 2.36 and 56.09 per 100,000 in men, respectively, nearly double those in women. Between 1990 and 2021, age-standardized rates of mortality, DALYs, YLDs, and YLLs increased significantly (AAPC > 0; p < 0.05), especially in males and older adults. High body mass index (BMI) showed a significantly steeper rise in ASRs than high fasting plasma glucose (HFPG) (p < 0.05), although HFPG exhibited smaller-and in some strata non-significant-changes (p ≥ 0.05). Compared to global trends, China experienced a sharper rise in CRC burden, particularly in YLDs. Joinpoint regression identified significant increases in mortality and DALYs (p < 0.05), with an acceleration after ~2007, while age-period-cohort analysis showed a pronounced increase in mortality and DALY rates among older age groups and more recent birth cohorts. Decomposition analysis indicated that in men, epidemiological changes primarily drove the increased burden, while in women, population aging and growth were dominant contributors. Conclusion:The burden of CRC attributable to metabolic risks has grown substantially in China, especially among men and older adults, with high BMI as the primary contributor. These findings highlight the urgent need for targeted prevention strategies addressing metabolic risk factors and sex-specific health interventions.

Background: Immunotherapy combined with chemotherapy has improved outcomes in advanced gastric cancer (GC), but reliable biomarkers to predict clinical benefit remain limited. Metabolomics provides a comprehensive assessment of systemic metabolic changes and may yield prognostic indicators to guide treatment selection. Methods: We performed untargeted liquid chromatography-tandem mass spectrometry (LC-MS/MS) metabolomics on baseline plasma from 40 patients with advanced GC receiving first-line programmed cell death protein-1 (PD-1) inhibitor plus chemotherapy. Patients were stratified into long-term survivors (LTS) and short-term survivors (STS) based on median overall survival (OS). Differential metabolites were identified using multivariate statistics, followed by univariate Cox regression and least absolute shrinkage and selection operator (LASSO) analysis to construct a metabolite-based risk score. Prognostic performance was evaluated using Kaplan-Meier analysis, time-dependent receiver operating characteristic (ROC) curves, and multivariate Cox models. Comparisons with conventional clinical factors were conducted, and a prognostic nomogram was developed. Proportional-hazards assumptions were assessed with Schoenfeld residuals; discrimination was optimism-corrected using 1,000-bootstrap resampling; Harrell's concordance index (C-index), time-dependent area under the curve (AUC), and bootstrap-corrected calibration curves were reported. Twelve-month decision-curve analysis (DCA) quantified net clinical benefit compared with clinicopathologic baselines. Results: A total of 4,298 metabolites were detected, including 830 Level 1 and 1,321 Level 2 identifications. Principal component analysis and orthogonal partial least squares discriminant analysis showed clear separation between LTS and STS groups. Differential analysis revealed metabolites enriched in bile acid, amino acid, and retinol metabolism pathways. Cox and LASSO analyses identified six independent prognostic metabolites. The resulting metabolite-based risk score significantly stratified OS and progression-free survival (p < 0.01) and demonstrated stable predictive accuracy over 6-24 months. Compared with age, sex, tumor grade, and programmed death-ligand 1 combined positive score (PD-L1 CPS), the risk score showed superior discrimination. A nomogram integrating risk score, grade, and PD-L1 CPS yielded accurate OS predictions with strong calibration and higher net benefit in DCA. Internal validation supports the robustness of findings within this single-center, 40-patient cohort. Conclusions: A plasma metabolite-based risk score derived from six biomarkers independently predicts survival in advanced GC treated with PD-1-based immunotherapy and offers a practical tool for individualized prognosis.

BackgroundNutritional deficiencies remain a pressing public health concern, especially in countries undergoing rapid demographic and epidemiologic transitions. In China, understanding the long-term trends and sex- and age-specific burden of nutritional deficiencies is crucial for designing targeted prevention and intervention strategies.MethodsWe used data from the Global Burden of Disease Study 2021 to estimate the burden of nutritional deficiencies in China from 1990 to 2021. Indicators included incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs), stratified by age, sex, and type of malnutrition. We applied Joinpoint regression to examine temporal trends and conducted age-period-cohort (APC) and decomposition analyses to explore underlying drivers. Projections through 2030 were generated using Bayesian APC modeling.ResultsIn 2021, nutritional deficiencies led to 46.0 million incident and 146.1 million prevalent cases in China, with a significantly higher burden among women. While males had higher mortality and YLL rates, females showed higher prevalence, YLDs, and DALYs. The age-standardized burden declined substantially from 1990 to 2021, particularly for protein-energy malnutrition. DALYs declined by 92.8% for protein-energy malnutrition, and vitamin A deficiency incidence dropped by 81.2%. APC analysis revealed that younger cohorts experienced dramatically lower burdens, especially among children under 5, although older adults continued to carry a growing burden due to aging. Decomposition analysis identified epidemiologic improvements as the primary driver of reduced burden, but demographic factors like population aging mitigated these gains. Forecasts indicate further declines in disease burden through 2030, with consistently higher prevalence and DALY rates projected among females.ConclusionDespite substantial progress in reducing the burden of nutritional deficiencies in China over the past three decades, disparities persist by sex and age. Continued surveillance, alongside interventions targeting women and older adults, is essential to sustain progress and address residual gaps.

Pancreatic cancer is one of the most lethal malignancies globally, with increasing incidence and mortality trends. In China, the disease burden has escalated over the past three decades, yet comprehensive national assessments remain limited. This study aims to evaluate the long-term trends, driving factors, and future projections of pancreatic cancer burden in China from 1990 to 2021. Data on incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were extracted from the Global Burden of Disease (GBD) Study 2021. Temporal trends were analyzed using Joinpoint regression and age-period-cohort models, while decomposition analysis quantified the contributions of population aging, growth, and epidemiological change. Bayesian age-period-cohort (BAPC) models were applied to project disease burden trends through 2030. In 2021, pancreatic cancer accounted for 118,665 new cases and over 2.9 million DALYs in China, with a significantly higher burden among males. Age-standardized rates of incidence, prevalence, and DALYs increased markedly between 1990 and 2021, outpacing global trends. The burden was concentrated in older age groups and driven primarily by years of life lost. Joinpoint regression identified periods of accelerated increase after 2015. Age-period-cohort analysis revealed that disease burden rises sharply after age 50 and is highest among more recent birth cohorts. Decomposition analysis showed that population aging and epidemiological transitions were the main contributors to increased burden. Projections using BAPC models indicate that incidence, prevalence, and DALY rates will continue to rise through 2030. The burden of pancreatic cancer in China has increased substantially over the past three decades and is projected to rise further. These findings highlight the need for intensified public health interventions focused on prevention, early detection, and effective treatment strategies.

Liver cancer remains a significant public health issue in China, exhibiting high incidence, mortality, and burden. Understanding its temporal trends and projections is essential for designing targeted prevention and treatment strategies. This study analyzes long-term trends in liver cancer incidence, prevalence, mortality, and burden from 1990 to 2021, assessing age, period, and cohort effects, and projecting future trends. Data on liver cancer incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were analyzed from 1990 to 2021. Joinpoint regression analysis, age-period-cohort (APC) analysis, and BAPC modeling were applied to examine trends and project future trends. Decomposition analysis examined contributions of aging, epidemiological changes, and population growth. The study also compared China’s liver cancer trends with global data. From 1990 to 2021, China experienced a decrease in age-standardized rates for liver cancer incidence, prevalence, mortality, and burden. Notably, Age-standardized incidence rates (ASIR) exhibited a decline after 2016, with a significant reduction in the male population. In 2021, there were 196,637 new cases of liver cancer in China, with a higher burden in males. ASIR were 14.34 per 100,000 for males and 4.89 per 100,000 for females. Mortality also followed a declining trend, with a notable decrease in age-standardized mortality rates. The age-standardized mortality rate (ASMR) for males was 12.4 per 100,000, significantly higher than for females (4.57 per 100,000) in 2021. Additionally, the age-standardized prevalence rate (ASPR) was 20.0 for males and 6.64 for females, with 265,539 total cases. The burden, measured by DALYs, YLDs, and YLLs, also showed a notable decline in age-standardized rates and significant gender disparities. Despite this, the absolute number of cases, deaths, and DALYs has continued to rise due to population growth and aging, with males bearing a significantly higher burden than females. The study also highlights the impact of aging, population growth, and epidemiological changes on liver cancer incidence and mortality in China. Projections for 2030 suggest a continued decrease in liver cancer incidence, especially among females, reflecting the effectiveness of public health interventions and medical advancements. However, gender disparities remain significant, and further efforts are needed to reduce the overall liver cancer burden, with an emphasis on early detection and prevention strategies.

Stomach cancer continues to be a major public health concern in China, with its incidence, prevalence, mortality, and overall burden showing notable changes over time. This study set out to analyze the long-term trends of stomach cancer from 1990 to 2021, figure out the effects of aging, epidemiological changes, and population growth, and also make projections for the future. To conduct the study, data from the Global Burden of Disease Study 2021 was used. This data allowed for the analysis of various aspects such as age-standardized incidence, prevalence, mortality rates, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) related to stomach cancer in China. Joinpoint regression analysis was carried out to spot significant trends and turning points. Decomposition analysis was done to assess how much aging, epidemiological changes, and population growth contributed. Additionally, the Bayesian age-period-cohort (BAPC) model was employed to predict what the trends might be from 2021 to 2030. In 2021, there were 611,799 new cases of stomach cancer in China. The age-standardized incidence rate was 29.05 per 100,000 people, with males having a much higher rate of 44.48 compared to females at 15.23. The age-standardized prevalence and mortality rates were 57.22 and 21.51 per 100,000 respectively, and both were higher in males as well. There were also significant gender differences in DALYs, YLDs, and YLLs, with males shouldering a greater burden. From 1990 to 2021, the incidence and mortality rates went down, especially after 2004. Through decomposition analysis, it was found that aging led to a decrease in incidence but an increase in mortality, especially among males. Epidemiological changes caused both the incidence and mortality rates to drop, and the effect was more pronounced in males. The BAPC model forecasts that the incidence and mortality rates will continue to decline for both genders from 2021 to 2030, with a more rapid decrease in males. Overall, this study emphasizes the changing trends of the stomach cancer burden in China, the significant gender differences, and the impacts of aging, epidemiological changes, and population growth. It's crucial to keep monitoring and implement targeted public health strategies to further reduce the burden of stomach cancer.

BackgroundProtein-energy malnutrition (PEM) remains a critical public health challenge, particularly in aging populations and early childhood. Understanding long-term trends in PEM burden is essential for guiding nutritional policy and targeted interventions in China.MethodsData were derived from the Global Burden of Disease (GBD) Study 2021 for the period 1990–2021. Age-standardized incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs) rate were analyzed using joinpoint regression and age-period-cohort (APC) models to assess temporal trends. Decomposition analysis was employed to attribute changes to population aging, population growth, and epidemiological shifts. Bayesian APC (BAPC) modeling was used to project the PEM burden through 2030 by sex.ResultsIn 2021, PEM resulted in over 22 million incident cases and 213,682 DALYs in China, with males exhibiting higher age-standardized rates across all indicators. A bimodal age distribution was observed, with peaks in children under 5 and adults over 80. From 1990 to 2021, incidence and prevalence increased until 2015 and then declined, while mortality and DALYs steadily decreased, particularly among females. Compared to global trends, China demonstrated greater reductions in age-standardized mortality and DALYs, but a slight increase in incidence. Joinpoint analysis revealed critical shifts in trend periods, with marked rises between 2010 and 2015 and subsequent declines. APC modeling indicated increasing burden among recent cohorts aged ≥5 years, despite improvements in young children. Decomposition analysis showed that population growth and epidemiological change were key drivers of incidence and DALYs, while aging reduced both incidence and prevalence in males but increased prevalence in females. BAPC projections suggest continued reductions in all burden indicators through 2030, with a steeper decline in females, although males are expected to maintain a higher burden.ConclusionsAlthough the overall health burden of PEM in China has improved, rising incidence and prevalence among older adults highlight the need for age- and sex-targeted nutritional interventions. Proactive strategies are essential to sustain progress and address emerging demographic risks.

BACKGROUND:Gallbladder and biliary tract cancer (GBTC) poses a growing public health challenge in China, with considerable disparities across age and sex. Understanding long-term epidemiological patterns is essential for informing cancer control strategies and future projections. METHODS:Data from the Global Burden of Disease Study 2021 were used to assess GBTC burden in China from 1990 to 2021. Indicators analyzed included incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Joinpoint regression, age-period-cohort (APC) analysis, decomposition analysis, and Bayesian APC (BAPC) models were employed to explore temporal trends and project future burden through 2030. RESULTS:In 2021, China reported 51,720 new GBTC cases, with an age-standardized incidence rate (ASIR) of 2.49 per 100,000. Males exhibited higher burden than females across all indicators. Incidence, prevalence, mortality, and DALYs were highest in older age groups. From 1990 to 2021, China experienced increasing trends in incidence and prevalence, while age-standardized mortality rates (ASMR) declined. Compared to global trends, China's ASIR rose while global rates declined. DALYs decreased in both contexts but more steeply globally. Joinpoint regression revealed sex-specific shifts, with males showing consistent increases in incidence and females experiencing periods of both decline and rise. APC analysis highlighted increasing incidence among post-1950 birth cohorts and decreasing mortality in recent cohorts. Decomposition analysis indicated that rising incidence was driven by epidemiological changes and population growth, while mortality reduction was linked to medical improvements. BAPC models projected a continued rise in incidence, particularly among males. CONCLUSIONS:The burden of GBTC in China is rising, especially among men and older adults. While mortality has improved, incidence continues to grow, highlighting the need for targeted prevention, early detection, and gender-specific public health policies.

Background:High body mass index (BMI) is a well-established modifiable risk factor for multiple cancer types. However, the long-term trends and demographic patterns of total cancer burden attributable to high BMI in China have not been fully characterized. This study aimed to assess the magnitude, temporal trends, and demographic drivers of BMI-related cancer burden in China from 1990 to 2021. Methods:Data on total cancer burden attributable to high BMI were obtained from the Global Burden of Disease Study 2021. Key indicators included deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Age-standardized rates (ASRs) were estimated by sex and age group. Joinpoint regression and age-period-cohort (APC) analyses were performed to assess trends, and decomposition analysis was used to quantify the contributions of population growth, population aging, and epidemiological changes. Results:In 2021, high BMI accounted for 58,745 cancer deaths and 1.66 million DALYs in China. Compared with 1990, age-standardized death and DALY rates increased by approximately 1.7-fold and 1.6-fold, respectively. Males had higher age-standardized rates of deaths, DALYs, and YLLs, while females exhibited higher YLD rates. The burden peaked in the 50-69 age group and varied by sex across age strata. Colorectal, liver, kidney, and breast cancers were the largest contributors to the BMI-related cancer burden. APC analysis revealed growing burden across age and period dimensions, with higher DALY and mortality rates observed in more recent birth cohorts. Decomposition analysis showed that the increase in deaths was mainly driven by epidemiological change and population growth, while DALY increases were influenced by all three components, with a stronger impact in males. Conclusion:The burden of cancer attributable to high BMI in China has risen substantially over the past three decades, with clear sex, age, and cohort-specific differences. Comprehensive public health strategies targeting obesity prevention and cancer control are urgently needed.

Malnutrition is a prevalent condition among patients with gastric cancer and is associated with poor survival outcomes. This study aimed to evaluate the clinical utility of the Global Leadership Initiative on Malnutrition (GLIM) criteria in predicting survival among patients with gastric cancer. The multicenter retrospective cohort study (INSCOC study) included 1406 patients enrolled between December 2012 and April 2020, with follow-up data collected until June 2023. Various indices for muscle evaluation, such as calf circumference (CC) and body weight-standardized hand grip strength (HGS/W), were used to diagnose malnutrition. Kaplan-Meier curves were used to analyze the relationship between nutrition status, as defined by GLIM criteria, and survival outcomes in these patients. The analysis revealed that using CC or HGS/W as positive indicators of malnutrition effectively identified patients with survival-related malnutrition. The incidence of malnutrition was 54.5%, with patients' median overall survival times of 1169 days for stage I and 575 days for stage II cancer (P < 0.001). Malnutrition was identified as an independent risk factor for survival. Additionally, a nomogram developed through Cox regression analysis demonstrated precise predictive capability, incorporating factors such as tumor node metastasis staging, Karnofsky Performance Status Scale, direct bilirubin levels, and nutrition intervention. The study concludes that the GLIM criteria are effective in diagnosing malnutrition and predicting survival in patients with gastric cancer. Nutrition interventions significantly enhance survival outcomes, underscoring the importance of standardized nutrition treatments in improving patient prognosis.

BACKGROUND:Gallbladder and biliary tract cancer (GBTC) is a significant health burden in China, exacerbated by the rising prevalence of high body mass index (BMI). Understanding the trends and factors contributing to mortality and disability associated with GBTC is crucial for targeted public health interventions. METHODS:We utilized data from the Global Burden of Disease (GBD) Study to assess the burden of GBTC attributable to high BMI in China from 1990 to 2021. Age-standardized rates of deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were analyzed. Joinpoint regression and decomposition analyses were conducted to evaluate trends and identify contributing factors, including aging, population growth, and epidemiological changes. Gender-specific differences were also assessed. RESULTS:In 2021, GBTC deaths attributable to high BMI in China reached 4,053, with males experiencing a higher overall burden than females, particularly in older age groups. While females showed a higher mortality and overall burden in the 60 to 79 age range, this trend reversed in older age brackets, with males experiencing steeper increases in mortality and disability-related indicators beyond age 80. The age-standardized DALYs rate mirrored this pattern, with higher rates in males in advanced age groups. From 1990 to 2021, China saw a steady increase in GBTC burden attributable to high BMI, contrasting with a global decline. Joinpoint analysis indicated marked rises in mortality and DALYs rates after 2005, especially in males. Decomposition analysis identified population growth and aging as major drivers of increased deaths, while epidemiological changes primarily contributed to rising DALYs, with a stronger impact observed in males. CONCLUSIONS:The burden of GBTC attributable to high BMI in China has increased substantially over the last three decades, driven by population growth, aging, and epidemiological shifts. The trends highlight a growing gender disparity, with males experiencing a greater rise in mortality and disability. Public health strategies targeting obesity and metabolic risk factors are critical to mitigating the increasing GBTC burden.

Background Gastric cancer consists of solid tumors with a tendency for disseminated intravascular coagulation (DIC). DIC is rare in patients with stomach cancer, and there have been few studies on this condition. We aimed to perform comprehensive analyses of the prognosis and clinicopathologic characteristics of stomach cancer patients with DIC. Methods Between June 2006 and March 2020, 14,016 patients at Fujian Cancer Hospital were diagnosed with stomach cancer. We reviewed their medical records and found that 105 of these patients were diagnosed with DIC. After excluding patients who were lost to follow-up, 71 patients with DIC remained. The clinical data were retrospectively analyzed to observe clinical characteristics and prognostic factors, and the Kaplan–Meier survival analysis was performed. Prognostic variables were investigated by the Cox proportional hazards method. Results The median age was 54 (range, 21–83) years, and 38 patients (53.5%) were male. The histological category was poorly differentiated gastric cancer in 58 patients (81.7%). Eleven patients (15.5%) developed DIC after curative gastric resection. Sixty patients (84.5%) had DIC at the initial presentation of gastric cancer or developed DIC when the tumor progressed during treatment. Fifty-one patients (71.8%) had bleeding symptoms, and 43 (60.6%) patients had comorbidities at the time of DIC diagnosis. Among the 71 patients, 42 (59.2%) had multiple metastatic patterns. Twenty-one (29.6%) patients received chemotherapy. The median overall survival (OS) was 57.0 days (95% confidence interval [CI] [33.1–80.9] days). Tumor status (P = 0.000) and treatment (P = 0.003) were found to be significant variables associated with OS by univariate analysis. Multivariate analysis showed that tumor status (P = 0.000) and treatment (P = 0.000) had independent effects on OS. Conclusions Gastrointestinal bleeding, multiple metastatic patterns and comorbidities at diagnosis with DIC are common in patients with gastric cancer complicated with DIC. Patients with poorly differentiated gastric cancer are more likely to develop DIC. Treatment and tumor status are separate risk variables for the survival of gastric cancer patients with DIC.DIC patients without tumors have a good prognosis and can be cured by appropriate etiological correction and symptomatic treatment. Chemotherapy can improve the prognosis of DIC patients with tumors.

Abstract Background: Malnutrition is associated with poor prognosis and prevalent in gastric cancer patients. However, there is no standardized method for evaluating malnutrition; the Global Leadership Initiative on Malnutrition (GLIM) aimed to establish a standard criteria for evaluating malnutrition. However, the cutoff point for muscle reduction remains unclear, and its clinical value has not yet been verified. Hence, we aimed to examine the relationship between combinations of different muscle measurement indices and the survival of gastric cancer patients to determine the accurate method for diagnosing sarcopenia, establish the standard GLIM criteria, and explore its clinical value. Methods: This multicenter and observational cohort study included 1,406 gastric cancer patients. The accurate prediction combination was determined using the cutoff point for muscle loss by predicting the survival risk according to the GLIM criteria established using a combination of muscle mass indicators. Least absolute shrinkage and selection operator regression analysis was used to screen the independent risk factors for survival with the construction of a Cox regression model. The R software was used to establish the nomogram of individual survival prediction and to verify the clinical significance of malnutrition diagnosed based on the GLIM criteria. Results: The risk ratio of patients with malnutrition based on the leg circumference and weight-corrected grip strength was the highest (hazard ratio [HR]=2.159, 95% confidence interval [CI]=1.800, 2.588 in severely malnourished patients). Malnutrition occurred in 54.5% of patients diagnosed with gastric cancer based on the GLIM criteria. Malnutrition is an independent risk factor for unfavorable survival in gastric cancer patients; its nomogram model can accurately predict the survival of gastric cancer. Conclusion: Muscle loss is one of the components of the GLIM criteria and is determined by measuring the leg circumference and weight-corrected grip strength. The GLIM criteria are effective in diagnosing malnutrition and predicting the survival in gastric cancer patients.

The fat mass and nutritional status play important roles in the onset and progression of cancer cachexia. The present study evaluated the joint prognostic value of the fat mass, as indicated by the triceps skinfold thickness (TSF), and the serum albumin level, for mortality in patients with cancer cachexia. We performed a multicentre cohort study including 5134 patients with cancer cachexia from January 2013 to April 2019. The sum of the TSF (mm) and serum albumin (g/L) was defined as the triceps skinfold–albumin index (TA). Harrell's C index, a time-dependent receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) were used to evaluate the prognostic performance of the TA and other indices. Optimal stratification was used to identify the thresholds to define a low TA, and the association of the TA with all-cause mortality was evaluated using Kaplan–Meier analysis and Cox proportional hazard regression models. The study enrolled 2408 women and 2726 men with a median age of 58.6 years and a median follow-up of 44 months. A total of 607 women (TA < 49.9) and 817 men (TA < 45.6) were classified as having a low TA. The TA showed better discrimination performance ( C index = 0.621, 95% confidence interval [CI] = 0.607–0.636) to predict mortality in patients with cancer cachexia than the handgrip strength, the nutritional risk index, the prognostic nutritional index, the controlling nutritional status index, the systemic immune-inflammation index, the modified Glasgow prognostic score, and the TSF or albumin alone in the study population (all P  < 0.05). The 1-, 3- and 5-year time-dependent ROC analyses (AUC = 0.647, 0.625 and 0.630, respectively) showed that the TA had the highest prognostic value among all indices investigated (all P  < 0.05). Univariate analysis showed that a lower TA was associated with an increased death hazard (hazard ratio [HR] = 1.859, 95% CI = 1.677–2.062), regardless of the sex and cancer type. Multivariable survival analysis showed that a lower TA was independently associated with an increased death hazard (HR = 1.381, 95% CI = 1.223–1.560). This association was significantly strengthened in patients who did not receive curative chemotherapy (HR = 1.491, 95% CI = 1.298–1.713), those who had higher serum total protein levels (HR = 1.469, 95% CI = 1.284–1.681) and those with better physical performance (HR = 1.453, 95% CI = 1.271–1.662). This study defined and evaluated a new prognostic index, the TA, which may improve the selection of intervention strategies to optimize the survival of patients with cancer cachexia.

AbstractBackgroundThe fat mass and nutritional status play important roles in the onset and progression of cancer cachexia. The present study evaluated the joint prognostic value of the fat mass, as indicated by the triceps skinfold thickness (TSF), and the serum albumin level, for mortality in patients with cancer cachexia.MethodsWe performed a multicentre cohort study including 5134 patients with cancer cachexia from January 2013 to April 2019. The sum of the TSF (mm) and serum albumin (g/L) was defined as the triceps skinfold–albumin index (TA). Harrell's C index, a time‐dependent receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) were used to evaluate the prognostic performance of the TA and other indices. Optimal stratification was used to identify the thresholds to define a low TA, and the association of the TA with all‐cause mortality was evaluated using Kaplan–Meier analysis and Cox proportional hazard regression models.ResultsThe study enrolled 2408 women and 2726 men with a median age of 58.6 years and a median follow‐up of 44 months. A total of 607 women (TA < 49.9) and 817 men (TA < 45.6) were classified as having a low TA. The TA showed better discrimination performance (C index = 0.621, 95% confidence interval [CI] = 0.607–0.636) to predict mortality in patients with cancer cachexia than the handgrip strength, the nutritional risk index, the prognostic nutritional index, the controlling nutritional status index, the systemic immune‐inflammation index, the modified Glasgow prognostic score, and the TSF or albumin alone in the study population (all P < 0.05). The 1‐, 3‐ and 5‐year time‐dependent ROC analyses (AUC = 0.647, 0.625 and 0.630, respectively) showed that the TA had the highest prognostic value among all indices investigated (all P < 0.05). Univariate analysis showed that a lower TA was associated with an increased death hazard (hazard ratio [HR] = 1.859, 95% CI = 1.677–2.062), regardless of the sex and cancer type. Multivariable survival analysis showed that a lower TA was independently associated with an increased death hazard (HR = 1.381, 95% CI = 1.223–1.560). This association was significantly strengthened in patients who did not receive curative chemotherapy (HR = 1.491, 95% CI = 1.298–1.713), those who had higher serum total protein levels (HR = 1.469, 95% CI = 1.284–1.681) and those with better physical performance (HR = 1.453, 95% CI = 1.271–1.662).ConclusionsThis study defined and evaluated a new prognostic index, the TA, which may improve the selection of intervention strategies to optimize the survival of patients with cancer cachexia.