Abstract 1379: Age-related differences in predicted basal metabolic rate and survival outcomes after colorectal cancer in the ColoCare Study.

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Abstract BACKGROUND Basal Metabolic Rate (BMR), a key indicator of resting energy expenditure, reflects overall metabolism and varies by age, sex, weight, and height. Younger and overweight/obese individuals exhibit a higher BMR, which has been linked to an increased risk of obesity-related cancers, including colorectal cancer (CRC). The role of BMR in survival after CRC remains unexplored. This study investigates the association between BMR at CRC diagnosis and overall (OS) and CRC-specific survival, evaluating differences by age of onset and obesity status. METHODS We analysed 3876 patients with stage I-IV CRC from seven ColoCare Study sites. Baseline BMR was estimated using the WHO/FAO/UNU Schofield equation and categorized into sex-specific tertiles. Anthropometric measurements (height, weight) and vital status were obtained through medical records, follow-up mailings and linkage with cancer and death registries. Covariates (demographic, lifestyle, and clinical characteristics) were collected via baseline questionnaires. Cox proportional hazards regression models estimated hazard ratios (HR) and 95% confidence intervals (CI), stratified by age (<50, 50-65, >65 yrs) and BMI (normal weight, overweight, obese) for 5- and 10-year survival. Multivariate models were adjusted for age at diagnosis, study center, sex, BMI, clinical and lifestyle factors. RESULTS Overall, 25% of participants were <50 yrs old, 43% were 50-65 yrs and 32% were ≥65 yrs; 44% were female. Colon cancer accounted for 51% of the diagnoses and 20% had stage III CRC. Mean BMR was 1673±304 kcal/day with higher values observed among men compared to women (3rd tertile: 2136 ± 202 vs. 1670 ± 156 kcal/day). 74% of participants in the 3rd tertile of BMR were obese compared to only 2% normal weight. BMR declined with age (3rd tertile: 34% in <50 yrs vs.16% in ≥65 yrs). At 5-years post-diagnosis, higher BMR was associated with significantly improved OS [HR (95%CI): 0.84(0.65-1.08)], independent of BMI. This association varied by sex and age, younger men in the 3rd tertile had better survival [HR (95% CI): 0.34 (0.12-0.95)] compared to younger women and older men [HR (95% CI): 0.51 (0.15-1.74)) and 1.46 (0.82-2.61), respectively]. Similar patterns were observed for CRC-specific survival. No significant associations were observed for OS or CRC-specific survival at 10-years post-diagnosis, suggesting that BMR may influence short- rather than long-term survival. CONCLUSION In the ColoCare Study cohort, BMR varied substantially by sex, age and obesity status. Higher BMR, particularly among younger men, was associated with improved short-term OS, independent of BMI, but not for long-term follow-up. These findings highlight the potential of BMR for early risk stratification in CRC. Incorporating metabolic assessment at diagnosis could inform personalized interventions and targeted survivorship strategies. Citation Format: Ranran Ji, Patricia Erickson, Tengda Lin, Yuxin Zhao, Jessica Van Onselen, Mmadili N. Ilozumba, Ildiko Strehli, Megan Mclaws, Lyen Huang, Jessica Cohan, Erin Siegel, Martine Extermann, Adetunji T. Toriola, David Shibata, Christopher I. Li, Jane C. Figueiredo, Doratha Armenthus Byrd, Victoria Damerell, Biljana Gigic, Cornelia M. Ulrich, Sheetal Hardikar. Age-related differences in predicted basal metabolic rate and survival outcomes after colorectal cancer in the ColoCare Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 1379.

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