In a groundbreaking population-based cohort study recently published in BMC Cancer, researchers have illuminated the complex and synergistic relationship between nutritional and inflammatory status, sedentary lifestyle, and mortality among adult cancer survivors in the United States. Drawing from over a decade of data in the National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2018, the study meticulously investigated how these interlinked factors jointly influence long-term survival outcomes following cancer diagnosis.
Cancer survivorship has increasingly become a focal point in oncology research, as growing numbers of individuals live well beyond initial treatment phases. Understanding factors that affect survival in this demographic is critical for developing targeted interventions that extend quality life spans. Among these factors, two have garnered intensified attention: systemic inflammation coupled with nutritional deficits, and patterns of physical inactivity, particularly sedentary behavior.
The study utilized the Naples Prognostic Score (NPS), a validated composite index integrating markers of systemic inflammation and nutritional health, as a pivotal metric. NPS encompasses a panel of hematologic and biochemical indicators that reflect the patient’s inflammatory milieu and nutritional reserves, thereby serving as a holistic marker of biological resilience or vulnerability. Concurrently, sedentary behavior was operationalized by self-reported daily sitting time, an accessible but impactful lifestyle measure increasingly implicated in adverse health outcomes.
Over the median follow-up period of nearly six years, among 2,411 adult cancer survivors, the researchers recorded 554 deaths, subdivided into 190 cancer-specific and 364 non-cancer-specific mortalities. Statistical analyses employing multivariable Cox proportional hazards models revealed compelling independent and combined effects of elevated NPS and prolonged sedentary time on mortality risk. Specifically, cancer survivors with higher NPS scores displayed significantly increased hazard ratios for all-cause, cancer-specific, and non-cancer mortality, underscoring the prognostic relevance of systemic inflammation and nutritional deficits.
Sedentary lifestyle independently contributed to excess mortality, particularly affecting all-cause and non-cancer deaths. Notably, each additional hour of daily sitting was associated with an incremental increase in mortality risk, emphasizing the dose-response nature of inactivity-related harm. This finding aligns with mounting evidence in broader population studies linking sedentary behavior to metabolic dysregulation, chronic inflammation, and impaired physiological recovery.
Crucially, the study highlights a synergistic interplay when both risk factors co-occurred. Cancer survivors exhibiting both high NPS and six or more hours of daily sedentary behavior experienced the highest mortality hazards: a staggering 4.44-fold increase for all-cause death, nearly doubling the risk of cancer-specific mortality, and an almost threefold elevation in non-cancer mortality risk. These data underscore the compounded vulnerabilities arising from physiological derangements and lifestyle factors that may jointly accelerate disease progression and mortality.
Mechanistically, systemic inflammation is recognized as a promoter of tumor growth, metastatic potential, and cachexia, while poor nutritional status compromises immunologic defense and tissue repair processes. Sedentary behavior, conversely, exacerbates inflammatory pathways and diminishes cardiometabolic health, creating a biologically hostile environment for recovery and resilience. Thus, the convergence of these factors potentiates a feedback loop detrimental to survivor health.
The implications of this research are profound for clinical management and survivorship care planning. Routine evaluation of inflammatory and nutritional status using accessible biomarkers like the Naples Prognostic Score, combined with detailed assessment of physical activity patterns, could enable risk stratification and tailored interventions. Encouraging behavioral modifications to reduce sitting time and improve nutritional intake may substantially mitigate mortality risks.
Moreover, this integrative approach advocates for multidisciplinary survivorship programs that transcend cancer treatment to address systemic physiological health and lifestyle modification. Nutritionists, physical therapists, and oncologists working collaboratively can design personalized regimens that simultaneously ameliorate inflammation, optimize nutrition, and promote active lifestyles.
Future research is warranted to explore intervention studies that strategically target inflammation and sedentary behavior in concert, evaluating their capacity to enhance survival and quality of life. Additionally, investigating molecular pathways mediating these associations may unveil novel therapeutic targets for mitigating elevated mortality in cancer survivors burdened by poor nutritional-inflammatory profiles and sedentary habits.
In summary, this study provides the first comprehensive evidence that the joint influence of nutritional and inflammatory status, alongside sedentary behavior, profoundly impacts mortality among US adult cancer survivors. It challenges the oncology field to broaden focus beyond tumor-centric metrics to encompass holistic patient health in striving toward improved long-term outcomes.
Recognizing that cancer survivorship encompasses a vulnerable yet modifiable phase, this research sparks renewed urgency to integrate lifestyle and biological assessments into survivorship care frameworks. Ultimately, mitigating systemic inflammation, enhancing nutritional status, and curbing prolonged sedentary behavior should be prioritized as actionable strategies to reduce both cancer-related and non-cancer mortalities.
As cancer prevalence continues to rise with global aging populations, insights from this landmark cohort study offer a clear call to action: sustaining life beyond cancer mandates addressing the intertwined biological and behavioral determinants of health, with individualized, multifaceted interventions paving the path forward.
Subject of Research: Joint effects of inflammatory and nutritional status and sedentary behavior on mortality in adult cancer survivors.
Article Title: Joint association of nutritional and inflammatory status, and sedentary behavior on mortality in US adult cancer survivors: a population-based cohort study.
Article References:
Zhao, T., Yang, C., Yang, X. et al. Joint association of nutritional and inflammatory status, and sedentary behavior on mortality in US adult cancer survivors: a population-based cohort study. BMC Cancer 25, 1722 (2025). https://doi.org/10.1186/s12885-025-15176-8
Image Credits: Scienmag.com
DOI: 05 November 2025
