{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T16:18:27Z","timestamp":1769012307770,"version":"3.49.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T00:00:00Z","timestamp":1717027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Nutritional intervention prior to the occurrence of cachexia will significantly improve the survival rate of lung cancer patients. This study aimed to establish an ensemble learning model based on anthropometry and blood indicators without information on body weight loss to identify the risk factors of cachexia for early administration of nutritional support and for preventing the occurrence of cachexia in lung cancer patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This multicenter study included 4,712 lung cancer patients. The least absolute shrinkage and selection operator (LASSO) method was used to obtain the key indexes. The characteristics excluded weight loss information, and the study data were randomly divided into a training set (70%) and a test set (30%). The training set was used to select the optimal model among 18 models and verify the model performance. A total of 18 machine learning models were evaluated to predict the occurrence of cachexia, and their performance was determined using area under the curve (AUC), accuracy, precision, recall, F1 score, and Matthews correlation coefficient (MCC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 4,712 patients, 1,392 (29.5%) patients were diagnosed with cachexia based on the framework of Fearon et al. A 17-variable gradient boosting classifier (GBC) model including body mass index (BMI), feeding situation, tumor stage, neutrophil-to-lymphocyte ratio (NLR), and some gastrointestinal symptoms was selected among the 18 machine learning models. The GBC model showed good performance in predicting cachexia in the training set (AUC = 0.854, accuracy = 0.819, precision = 0.771, recall = 0.574, F1 score = 0.658, MCC = 0.549, and kappa = 0.538). The abovementioned indicator values were also confirmed in the test set (AUC = 0.859, accuracy = 0.818, precision = 0.801, recall = 0.550, F1 score = 0.652, and MCC = 0.552, and kappa = 0.535). The learning curve, decision boundary, precision recall (PR) curve, the receiver operating curve (ROC), the classification report, and the confusion matrix in the test sets demonstrated good performance. The feature importance diagram showed the contribution of each feature to the model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The GBC model established in this study could facilitate the identification of cancer cachexia in lung cancer patients without weight loss information, which would guide early implementation of nutritional interventions to decrease the occurrence of cachexia and improve the overall survival (OS).<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2024.1380949","type":"journal-article","created":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T12:07:29Z","timestamp":1717070849000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Identification of cachexia in lung cancer patients with an ensemble learning approach"],"prefix":"10.3389","volume":"11","author":[{"given":"Pingping","family":"Jia","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qianqian","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoxiao","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fangqi","family":"Shen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaolin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,5,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3322\/caac.21551","article-title":"Cancer statistics, 2019","volume":"69","author":"Siegel","year":"2019","journal-title":"CA Cancer J Clin."},{"key":"B2","doi-asserted-by":"publisher","first-page":"17105","DOI":"10.1038\/nrdp.2017.105","article-title":"Cancer-associated cachexia","volume":"4","author":"Baracos","year":"2018","journal-title":"Nat Rev Dis Primers."},{"key":"B3","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1038\/nrc3829","article-title":"Cancer cachexia: understanding the molecular basis","volume":"14","author":"Argil\u00e9s","year":"2014","journal-title":"Nat Rev Cancer."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1002\/jcsm.12633","article-title":"Cancer cachexia and skeletal muscle atrophy in clinical studies: what do we really know?","volume":"11","author":"Dolly","year":"2020","journal-title":"J Cachexia Sarcopenia Muscle."},{"key":"B5","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1007\/s00535-013-0787-0","article-title":"Cancer cachexia\u2013pathophysiology and management","volume":"48","author":"Suzuki","year":"2013","journal-title":"J Gastroenterol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1016\/j.clnu.2016.12.003","article-title":"Association between cachexia, chemotherapy and outcomes in older cancer patients: a systematic review","volume":"36","author":"Caillet","year":"2017","journal-title":"Clin Nutr."},{"key":"B7","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/S0149-2918(05)80001-3","article-title":"Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group","volume":"69","author":"Dewys","year":"1980","journal-title":"Am J Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1871","DOI":"10.1007\/s00520-017-4022-z","article-title":"A cross-sectional study examining the prevalence of cachexia and areas of unmet need in patients with cancer","volume":"26","author":"Vagnildhaug","year":"2018","journal-title":"Support Care Cancer."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1200\/JOP.2016.016832","article-title":"Cancer cachexia: beyond weight loss","volume":"12","author":"Bruggeman","year":"2016","journal-title":"J Oncol Pract."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s13539-010-0002-6","article-title":"Cachexia as a major underestimated and unmet medical need: facts and numbers","volume":"1","author":"von Haehling","year":"2010","journal-title":"J Cachexia Sarcopenia Muscle."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e00020","DOI":"10.1097\/PN9.0000000000000020","article-title":"From value-based medicine to value-based nutrition","volume":"1","author":"Tang","year":"2022","journal-title":"Precis Nutr."},{"key":"B12","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1016\/S1470-2045(10)70218-7","article-title":"Definition and classification of cancer cachexia: an international consensus","volume":"12","author":"Fearon","year":"2011","journal-title":"Lancet Oncol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"8491","DOI":"10.3390\/ijms22168491","article-title":"Cancer cachexia: its mechanism and clinical significance","volume":"22","author":"Nishikawa","year":"2021","journal-title":"Int J Mol Sci"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1824","DOI":"10.1016\/j.cell.2023.03.028","article-title":"Cachexia: a systemic consequence of progressive, unresolved disease","volume":"186","author":"Ferrer","year":"2023","journal-title":"Cell."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e00014","DOI":"10.1097\/PN9.0000000000000014","article-title":"Extension protocol for the Investigation on Nutrition Status and Clinical Outcome of Patients with Common Cancers in China (INSCOC) study: 2021 update","volume":"1","author":"Xu","year":"2022","journal-title":"Precis Nutr."},{"key":"B16","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.clnu.2016.07.015","article-title":"ESPEN guidelines on nutrition in cancer patients","volume":"36","author":"Arends","year":"2017","journal-title":"Clin Nutr."},{"key":"B17","doi-asserted-by":"publisher","first-page":"551","DOI":"10.6133\/APJCN.2011.20.4.08","article-title":"Anthropometric equation for estimation of appendicular skeletal muscle mass in Chinese adults","volume":"20","author":"Wen","year":"2011","journal-title":"Asia Pac J Clin Nutr."},{"key":"B18","doi-asserted-by":"publisher","first-page":"7344","DOI":"10.3390\/ijerph18147344","article-title":"Myostatin\/appendicular skeletal muscle mass (ASM) ratio, not myostatin, is associated with low handgrip strength in community-dwelling older women","volume":"18","author":"Choi","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B19","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1002\/jcsm.12383","article-title":"GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community","volume":"10","author":"Cederholm","year":"2019","journal-title":"J Cachexia Sarcopenia Muscle."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e00048","DOI":"10.1097\/PN9.0000000000000048","article-title":"Anthropometric measurements as nutritional indicators and association with sociodemographic factors among the Idoma ethnic group in Nigeria","volume":"2","author":"Obaje","year":"2023","journal-title":"Precis Nutr."},{"key":"B21","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1097\/PN9.0000000000000008","article-title":"Cancer cachexia statistics in China","volume":"1","author":"Li","year":"2022","journal-title":"Precision Nutrition"},{"key":"B22","doi-asserted-by":"publisher","first-page":"7535","DOI":"10.1038\/s41598-020-64282-z","article-title":"An elevated neutrophil-to-lymphocyte ratio associates with weight loss and cachexia in cancer","volume":"10","author":"Barker","year":"2020","journal-title":"Sci Rep."},{"key":"B23","doi-asserted-by":"publisher","first-page":"17511","DOI":"10.1007\/s00432-023-05465-9","article-title":"Emerging markers of cancer cachexia and their relationship to sarcopenia","volume":"149","author":"Lipshitz","year":"2023","journal-title":"J Cancer Res Clin Oncol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1016\/j.healun.2015.05.027","article-title":"Nutritional Risk Index predicts mortality in hospitalized advanced heart failure patients","volume":"34","author":"Adejumo","year":"2015","journal-title":"J Heart Lung Transplant."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2504","DOI":"10.1002\/jcsm.13032","article-title":"The advanced lung cancer inflammation index is the optimal inflammatory biomarker of overall survival in patients with lung cancer","volume":"13","author":"Song","year":"2022","journal-title":"J Cachexia Sarcopenia Muscle."},{"key":"B26","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1111\/j.2517-6161.1996.tb02080.x","article-title":"Regression shrinkage and selection via the lasso","volume":"58","author":"Tibshirani","year":"1996","journal-title":"J R Stat Soc Ser A Stat Soc."},{"key":"B27","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1177\/0148607110389335","article-title":"ASPEN clinical guidelines: nutrition screening, assessment, and intervention in adults","volume":"35","author":"Mueller","year":"2011","journal-title":"JPEN J Parenter Enteral Nutr ."},{"key":"B28","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/S0261-5614(02)00214-5","article-title":"Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials","volume":"22","author":"Kondrup","year":"2003","journal-title":"Clin Nutr."},{"key":"B29","doi-asserted-by":"publisher","first-page":"936","DOI":"10.1038\/s41430-018-0120-3","article-title":"Different risk scores consider different types of risks: the deficiencies of the 2015 ESPEN consensus on diagnostic criteria for malnutrition","volume":"72","author":"Xu","year":"2018","journal-title":"Eur J Clin Nutr."},{"key":"B30","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.clnu.2016.09.004","article-title":"ESPEN guidelines on definitions and terminology of clinical nutrition","volume":"36","author":"Cederholm","year":"2017","journal-title":"Clin Nutr."},{"key":"B31","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1093\/jnci\/85.5.365","article-title":"The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology","volume":"85","author":"Aaronson","year":"1993","journal-title":"J Natl Cancer Inst."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1074672","DOI":"10.3389\/fphys.2023.1074672","article-title":"Advanced lung cancer inflammation index is associated with long-term cardiovascular death in hypertensive patients: national health and nutrition examination study, 1999-2018","volume":"14","author":"Tu","year":"2023","journal-title":"Front Physiol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"2731","DOI":"10.2147\/OTT.S90875","article-title":"Prognostic role of neutrophil to lymphocyte ratio in lung cancers: a meta-analysis including 7,054 patients","volume":"8","author":"Zhao","year":"2015","journal-title":"Onco Targets Ther."},{"key":"B34","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/j.ipm.2009.03.002","article-title":"A systematic analysis of performance measures for classification tasks","volume":"45","author":"Sokolova","year":"2009","journal-title":"Inf Process Manag."},{"key":"B35","doi-asserted-by":"publisher","first-page":"27","DOI":"10.5121\/ijdkp.2013.3402","article-title":"Evaluation measures for models assessment over imbalanced data sets","volume":"3","author":"Bekkar","year":"2013","journal-title":"J Inf Eng Appl."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1635","DOI":"10.1093\/annonc\/mdu086","article-title":"Validation of the Consensus-Definition for Cancer Cachexia and evaluation of a classification model\u2013a study based on data from an international multicentre project (EPCRC-CSA)","volume":"25","author":"Blum","year":"2014","journal-title":"Ann Oncol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1038\/sj.ijo.802195","article-title":"The accuracy of long-term recall of past body weight in Japanese adult men","volume":"27","author":"Tamakoshi","year":"2003","journal-title":"Int J Obes Relat Metab Disord."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1200\/JCO.2012.45.2722","article-title":"Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index","volume":"31","author":"Martin","year":"2013","journal-title":"J Clin Oncol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1038\/s41574-018-0062-9","article-title":"Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies","volume":"14","author":"Batsis","year":"2018","journal-title":"Nat Rev Endocrinol."},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdx810","article-title":"Sarcopenic obesity: hidden muscle wasting and its impact for survival and complications of cancer therapy","author":"Baracos","year":"2018","journal-title":"Ann Oncol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"2493","DOI":"10.3390\/nu13082493","article-title":"The utility of body composition assessment in nutrition and clinical practice: an overview of current methodology","volume":"13","author":"Holmes","year":"2021","journal-title":"Nutrients"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.clnu.2019.02.033","article-title":"GLIM criteria for the diagnosis of malnutrition - a consensus report from the global clinical nutrition community","volume":"38","author":"Cederholm","year":"2019","journal-title":"Clin Nutr."},{"key":"B43","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1038\/s12276-022-00752-w","article-title":"Understanding the molecular basis of anorexia and tissue wasting in cancer cachexia","volume":"54","author":"Yeom","year":"2022","journal-title":"Exp Mol Med."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1002\/jcsm.12756","article-title":"Diagnostic criteria for cancer cachexia: reduced food intake and inflammation predict weight loss and survival in an international, multi-cohort analysis","volume":"12","author":"Martin","year":"2021","journal-title":"J Cachexia Sarcopenia Muscle."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1466","DOI":"10.1002\/jcsm.12761","article-title":"Association of systemic inflammation with survival in patients with cancer cachexia: results from a multicentre cohort study","volume":"12","author":"Zhang","year":"2021","journal-title":"J Cachexia Sarcopenia Muscle."},{"key":"B46","doi-asserted-by":"publisher","first-page":"12493","DOI":"10.1038\/srep12493","article-title":"Prognostic significance of neutrophil-to-lymphocyte ratio in non-small cell lung cancer: a meta-analysis","volume":"5","author":"Gu","year":"2015","journal-title":"Sci Rep"},{"key":"B47","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1186\/s12885-017-3122-y","article-title":"Relationships between longitudinal neutrophil to lymphocyte ratios, body weight changes, and overall survival in patients with non-small cell lung cancer","volume":"17","author":"Derman","year":"2017","journal-title":"BMC Cancer."},{"key":"B48","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment","volume":"21","author":"Chen","year":"2020","journal-title":"J Am Med Dir Assoc"},{"key":"B49","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/S1470-2045(08)70153-0","article-title":"Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study","volume":"9","author":"Prado","year":"2008","journal-title":"Lancet Oncol."},{"key":"B50","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1007\/s00520-007-0367-z","article-title":"Biomarkers for cancer cachexia: is there also a genetic component to cachexia?","volume":"16","author":"Tan","year":"2008","journal-title":"Support Care Cancer."}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2024.1380949\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T12:07:32Z","timestamp":1717070852000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2024.1380949\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,30]]},"references-count":50,"alternative-id":["10.3389\/fnut.2024.1380949"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2024.1380949","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,30]]},"article-number":"1380949"}}