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Wu Y, Li D, Vermund SH. Advantages and Limitations of the Body Mass Index (BMI) to Assess Adult Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:757. [PMID: 38929003 PMCID: PMC11204233 DOI: 10.3390/ijerph21060757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
Obesity reflects excessive fat deposits. At-risk individuals are guided by healthcare professionals to eat fewer calories and exercise more, often using body mass index (BMI; weight/height2) thresholds for screening and to guide progress and prognosis. By conducting a mini-narrative review of original articles, websites, editorials, commentaries, and guidelines, we sought to place BMI in the context of its appropriate use in population health, clinical screening, and monitoring in clinical care. The review covers studies and publications through 2023, encompassing consensus reviews and relevant literature. Recent consensus reviews suggest that BMI is a valuable tool for population surveys and primary healthcare screening but has limitations in predicting the risk of chronic diseases and assessing excess fat. BMI can guide nutritional and exercise counseling, even if it is inadequate for reliable individual risk prediction. BMI cut-offs must be reconsidered in populations of varying body build, age, and/or ethnicity. Since BMI-diagnosed overweight persons are sometimes physically and physiologically fit by other indicators, persons who are overweight on BMI should be more fully evaluated, diagnosed, and monitored with combined anthropometric and performance metrics to better clarify risks. The use of combined anthropometric and performance metrics involves integrating measurements of body composition with assessments of physical function and fitness to provide a more comprehensive evaluation of an individual's health and fitness status. Eligibility for bariatric surgery or semaglutide satiety/appetite-reduction medications should not be determined by BMI alone. Awareness of the advantages and limitations of using BMI as a tool to assess adult obesity can maximize its appropriate use in the context of population health and in rapid clinical screening and evaluation.
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Affiliation(s)
- Yilun Wu
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA;
| | - Dan Li
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA;
| | - Sten H. Vermund
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA;
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2
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Poltronieri TS, Pérsico RS, Viana LV. Body adipose tissue depots and treatment outcomes for women with breast cancer: A systematic review. Clin Nutr 2024; 43:1033-1042. [PMID: 38547637 DOI: 10.1016/j.clnu.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 02/14/2024] [Accepted: 03/16/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND & AIMS Excessive adipose tissue is associated with poorer prognosis in women with breast cancer (BC). However, several body adiposity depots, such as visceral (VAT), subcutaneous (SAT), intermuscular (IMAT), and gluteofemoral adipose tissues (GFAT) may have heterogeneous metabolic roles and health effects in these patients. This systematic review aims to evaluate the impact of different body adipose tissue depots, assessed via computed tomography (CT), on treatment outcomes for women with BC. We hypothesize that distinct body adipose tissue depots may be associated differently with outcomes in patients with BC. METHODS A comprehensive bibliographical search was conducted using PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases (until January 2024). The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. RESULTS The final sample comprised 23 retrospective studies (n = 12,462), with fourteen presenting good quality. A lack of standardization in CT body adipose tissue depots measurement and outcome presentation precluded quantitative analysis. Furthermore, most included studies had heterogeneous clinical characteristics. Survival and treatment response were the most prevalent outcomes. VAT (n = 19) and SAT (n = 17) were the most frequently evaluated depots and their increase was associated with worse outcomes, mainly in terms of survival. IMAT (n = 4) presented contradictory findings and a higher GFAT (n = 1) was associated with better outcomes. CONCLUSION This systematic review found an association between increased VAT and SAT with worse outcomes in patients with BC. However, due to the heterogeneity of the included studies, further research with homogeneous methodologies is necessary to better understand the impact of body adipose tissue depots on treatment outcomes. Such knowledge could lead to improved care for this patient population.
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Affiliation(s)
- Taiara Scopel Poltronieri
- Programa de Pós-Graduação em Ciências Médicas, Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Raquel Stocker Pérsico
- Programa de Pós-Graduação em Ciências Médicas, Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Luciana Verçoza Viana
- Programa de Pós-Graduação em Ciências Médicas, Endocrinologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
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3
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Haidar A, Srikanthan P, Watson K, Allison M, Kronmal R, Horwich T. Associations Between Visceral Fat, Abdominal Muscle, and Coronary Artery Calcification: A Cross-Sectional Analysis of the Multi-Ethnic Study of Atherosclerosis. Am J Cardiol 2024; 217:77-85. [PMID: 38432335 PMCID: PMC11005919 DOI: 10.1016/j.amjcard.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/07/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
The associations of body composition components, including muscle and adipose tissue, and markers of subclinical coronary artery disease are unclear. We examined the relation between abdominal computed tomography (CT)-derived measures of the area and density of fat and muscle with coronary artery calcification (CAC), using data from the Multi-Ethnic Study of Atherosclerosis (MESA). A total of 1,974 randomly selected MESA participants free of coronary heart disease underwent abdominal CT scans at examinations 2 or 3, with the resulting images interrogated for abdominal body composition. Using 6 cross-sectional slices spanning L2 to L5, the Medical Imaging Processing Analysis and Visualization software was used to determine abdominal muscle and fat composition using appropriate Hounsfield units ranges. CT chest scans were used to obtain CAC scores, calculated using the Agatston method and spatially weighted calcium score. Multivariable linear and logistic regression analyses were performed to assess the relation between abdominal visceral fat and muscle area and density to prevalent CAC. A total of 1,089 participants had a CAC >0, with an average CAC score of 310. In the fully adjusted model, for every 10-cm2 increase in visceral fat area, the likelihood of having a CAC greater than 0 increased by 0.60% (p <0.001). In the minimally adjusted model, abdominal muscle area was significantly associated with CAC >0, which became nonsignificant in the fully adjusted model. For the density of visceral fat, every 1-Hounsfield unit increase (less lipid-dense fat tissue), the likelihood of having a CAC score >0 decreased by 0.29% (p <0.05). No significant relation was observed between density of abdominal muscle and CAC >0. A greater area and higher lipid density of abdominal visceral fat were associated with an increased likelihood of having CAC, whereas there was no significant relation between abdominal muscle area or density and CAC. The quantity and the quality of fat have associations, with an important marker of subclinical atherosclerosis, CAC, and their significance with respect to cardiovascular outcomes, require further evaluation.
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Affiliation(s)
- Amier Haidar
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Preethi Srikanthan
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Karol Watson
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Matthew Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Richard Kronmal
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Tamara Horwich
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California.
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4
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Kubrak C, Martin L, Grossberg AJ, Olson B, Ottery F, Findlay M, Bauer JD, Jha N, Scrimger R, Debenham B, Chua N, Walker J, Baracos V. Quantifying the severity of sarcopenia in patients with cancer of the head and neck. Clin Nutr 2024; 43:989-1000. [PMID: 38484528 DOI: 10.1016/j.clnu.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS Existing skeletal muscle index (SMI) thresholds for sarcopenia are inconsistent, and do not reflect severity of depletion. In this study we aimed to define criterion values for moderate and severe skeletal muscle depletion based on the risk of mortality in a population of patients with head and neck cancer (HNC). Additionally, we aimed to identify clinical and demographic predictors of skeletal muscle depletion, evaluate the survival impact of skeletal muscle depletion in patients with minimal nutritional risk or good performance status, and finally, benchmarking SMI values of patients with HNC against healthy young adults. METHODS Population cohort of 1231 consecutive patients and external validation cohorts with HNC had lumbar SMI measured by cross-sectional imaging. Optimal stratification determined sex-specific thresholds for 2-levels of SMI depletion (Class I and II) based on overall survival (OS). Adjusted multivariable regression analyses (tumor site, stage, performance status, age, sex, dietary intake, weight loss) determined relationships between 2-levels of SMI depletion and OS. RESULTS Mean SMI (cm2/m2) was 51.7 ± 9.9 (males) and 39.8 ± 7.1 (females). The overall and sex-specific population demonstrated an increased risk of mortality associated with decreasing SMI. Sex-specific SMI (cm2/m2) depletion thresholds for 2-levels of muscle depletion determined by optimal stratification for males and females, respectively (male: 45.2-37.5, and <37.5; female: 40.9-34.2, and <34.2). In the overall population, Normal SMI, Class I and II SMI depletion occurred in 65.0%, 24.0%, and 11.0%, respectively. Median OS was: Normal SMI (114 months, 95% CI, 97.1-130.8); Class I SMI Depletion (42 months, 95% CI, 28.5-55.4), and Class II SMI Depletion (15 months, 95% CI, 9.8-20.1). Adjusted multivariable analysis compared with Normal SMI (reference), Class I SMI Depletion (HR, 1.49; 95% CI, 1.18-1.88; P < .001), Class II SMI Depletion (HR, 1.91; 95% CI, 1.42-2.58; P < .001). CONCLUSIONS Moderate and severe SMI depletion demonstrate discrimination in OS in patients with HNC. Moderate and severe SMI depletion is prevalent in patients with minimal nutrition risk and good performance status. Benchmarking SMI values against healthy young adults exemplifies the magnitude of SMI depletion in patients with HNC and may be a useful method in standardizing SMI assessment.
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Affiliation(s)
- Catherine Kubrak
- Department of Oncology, Division of Palliative Medicine, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
| | - Lisa Martin
- Research and Evaluation Lead, Nutrition Services, Provincial Strategy, Standards and Practice, Alberta Health Services, Alberta, Canada.
| | - Aaron J Grossberg
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, United States.
| | - Brennan Olson
- Mayo Clinic Department of Otolaryngology-Head and Neck Surgery, Rochester, MN, United States.
| | - Faith Ottery
- President, Ottery & Associates, LLC, Deerfield, IL, United States.
| | - Merran Findlay
- Cancer Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, 2050 Australia.
| | - Judith D Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria 3800 Australia.
| | - Naresh Jha
- Department of Oncology, Division of Radiation Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
| | - Rufus Scrimger
- Department of Oncology, Division of Radiation Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
| | - Brock Debenham
- Department of Oncology, Division of Radiation Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
| | - Neil Chua
- Department Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
| | - John Walker
- Department Oncology, Division of Medical Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
| | - Vickie Baracos
- Department of Oncology, Division of Palliative Medicine, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, T6G 1Z2, Canada.
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Machado MAD, Moraes TF, Anjos BHL, Alencar NRG, Chang TMC, Santana BCRF, Menezes VO, Vieira LO, Brandão SCS, Salvino MA, Netto EM. Association between increased Subcutaneous Adipose Tissue Radiodensity and cancer mortality: Automated computation, comparison of cancer types, gender, and scanner bias. Appl Radiat Isot 2024; 205:111181. [PMID: 38244325 DOI: 10.1016/j.apradiso.2024.111181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 12/17/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024]
Abstract
PURPOSE Body composition analysis using computed tomography (CT) is proposed as a predictor of cancer mortality. An association between subcutaneous adipose tissue radiodensity (SATr) and cancer-specific mortality was established, while gender effects and equipment bias were estimated. METHODS 7,475 CT studies were selected from 17 cohorts containing CT images of untreated cancer patients who underwent follow-up for a period of 2.1-118.8 months. SATr measures were collected from published data (n = 6,718) or calculated according to CT images using a deep-learning network (n = 757). The association between SATr and mortality was ascertained for each cohort and gender using the p-value from either logistic regression or ROC analysis. The Kruskal-Wallis test was used to analyze differences between gender distributions, and automatic segmentation was evaluated using the Dice score and five-point Likert quality scale. Gender effect, scanner bias and changes in the Hounsfield unit (HU) to detect hazards were also estimated. RESULTS Higher SATr was associated with mortality in eight cancer types (p < 0.05). Automatic segmentation produced a score of 0.949 while the quality scale measurement was good to excellent. The extent of gender effect was 5.2 HU while the scanner bias was 10.3 HU. The minimum proposed HU change to detect a patient at risk of death was between 5.6 and 8.3 HU. CONCLUSIONS CT imaging provides valuable assessments of body composition as part of the staging process for several cancer types, saving both time and cost. Gender specific scales and scanner bias adjustments should be carried out to successfully implement SATr measures in clinical practice.
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Affiliation(s)
- Marcos A D Machado
- Department of Radiology, Complexo Hospitalar Universitário Prof. Edgard Santos/ Ebserh, Universidade Federal da Bahia, Salvador, Bahia, Zip code: 40.110-040, Brazil; Nuclear Medicine Department, São Rafael Hospital/ Rededor, Salvador, Bahia, Zip code: 41.253-190, Brazil; Nuclearis Corporation, Recife, Pernambuco, Zip code: 50.030-200, Brazil.
| | - Thauan F Moraes
- Northeast Center for Strategic Technologies, Universidade Federal de Pernambuco, Recife, Pernambuco, Zip code: 50.740-545, Brazil
| | - Bruno H L Anjos
- Nuclearis Corporation, Recife, Pernambuco, Zip code: 50.030-200, Brazil
| | - Nadja R G Alencar
- Radiology and Nuclear Medicine Department, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Zip code: 50.670-901, Brazil
| | - Tien-Man C Chang
- Nuclear Medicine Department, Instituto de Medicina Integrada Fernandes Figueira, Recife, Pernambuco, Zip code: 50.070-902, Brazil
| | - Bruno C R F Santana
- Nuclear Medicine Department, São Rafael Hospital/ Rededor, Salvador, Bahia, Zip code: 41.253-190, Brazil
| | - Vinicius O Menezes
- Nuclear Medicine Department, São Rafael Hospital/ Rededor, Salvador, Bahia, Zip code: 41.253-190, Brazil; Nuclearis Corporation, Recife, Pernambuco, Zip code: 50.030-200, Brazil; Radiology and Nuclear Medicine Department, Hospital das Clínicas, Federal University of Pernambuco/ Ebserh, Recife, Pernambuco, Zip code: 50.670-901, Brazil
| | - Lucas O Vieira
- Nuclear Medicine Department, São Rafael Hospital/ Rededor, Salvador, Bahia, Zip code: 41.253-190, Brazil
| | - Simone C S Brandão
- Radiology and Nuclear Medicine Department, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Zip code: 50.670-901, Brazil
| | - Marco A Salvino
- Complexo Hospitalar Universitário Prof. Edgard Santos/ Ebserh, Universidade Federal da Bahia, Salvador, Bahia, Zip code: 40.110-040, Brazil; Hemathology Department, São Rafael Hospital, Salvador, Bahia, Zip code: 41.253-190, Brazil
| | - Eduardo M Netto
- Infectious Disease Research Laboratory, Complexo Hospitalar Universitário Prof. Edgard Santos/ Ebserh, Universidade Federal da Bahia, Salvador, Bahia, Zip code: 40.110-040, Brazil
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Bradshaw PT. Body composition and cancer survival: a narrative review. Br J Cancer 2024; 130:176-183. [PMID: 37891197 PMCID: PMC10803330 DOI: 10.1038/s41416-023-02470-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 10/07/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Interest in understanding the relationship between body composition and cancer survival has remained strong for decades, with a number of recent systematic reviews on the topic. However, the current state of evidence is based on heterogeneous exposure definitions based on anthropometry, yielding inconsistent findings with regard to this association. Recently the field has taken an exciting direction with the application of radiological assessments to measure specific aspects of body composition, yet reconciliation of findings from these modern assessment tools with those from the historic use of anthropometric data proves challenging. In this paper, I briefly review the biological basis for a link between body composition and cancer survival and summarize the epidemiological evidence with consideration to specific exposure measures. As enthusiasm is building around novel assessments, I conclude with a discussion of issues that researchers should be aware of when interpreting results from these new modalities.
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Affiliation(s)
- Patrick T Bradshaw
- School of Public Health, Division of Epidemiology, University of California Berkeley, Berkeley, CA, USA.
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7
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Khristenko E, Sinitsyn V, Rieden T, Girod P, Kauczor HU, Mayer P, Klauss M, Lyadov V. CT-based screening of sarcopenia and its role in cachexia syndrome in pancreatic cancer. PLoS One 2024; 19:e0291185. [PMID: 38271373 PMCID: PMC10810529 DOI: 10.1371/journal.pone.0291185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 08/23/2023] [Indexed: 01/27/2024] Open
Abstract
Since computed tomography (CT) is a part of standard diagnostic protocol in pancreatic ductal adenocarcinoma (PDAC), we have evaluated the value of CT for sarcopenia screening in patients with PDAC, intending to expand the diagnostic value of tomographic studies. In our study, we included 177 patients with available CT images. Two groups were formed: Group 1 consisted of 117 patients with PDAC in various locations and stages and Group 2, or the control group, consisted of 60 "nominally healthy" patients with other somatic non-oncological diseases. The body mass index (BMI) was defined as a ratio of patient's weight to the square of their height (kg/m2). CT-based body composition analysis was performed using commercially available software with evaluation of sarcopenia using skeletal muscle index (SMI, cm2/m2). Based on the SMI values, sarcopenia was found in 67.5% of patients (79 out of 117) in the first patient group. It was found more frequently in males (42 out of 56; 75%) than in females (37 out of 61; 60.6%). Additionally, we observed a decrease in muscle mass (hidden sarcopenia) in 79.7% in patients with a normal BMI. Even in overweight patients, sarcopenia was found in 50% (sarcopenic obesity). In patients with reduced BMI sarcopenia was found in all cases (100%). Statistically significant difference of SMI between two groups was revealed for both sexes (p = 0,0001), with no significant difference between groups in BMI. BMI is an inaccurate value for the assessment of body composition as it does not reflect in the details the human body structure. As SMI may correlate with the prognosis, decreased muscle mass- especially "hidden" sarcopenia or sarcopenic obesity- should be reported. The use of CT-based evaluation of sarcopenia and sarcopenic obesity will allow for a better treatment response assessment in patients with cancer cachexia.
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Affiliation(s)
- Ekaterina Khristenko
- Department of Diagnostical and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Valentin Sinitsyn
- Department of Radiology at Medical Educational and Scientific Center University Hospital, Lomonosov Moscow State University, Moscow, Russia
| | - Tatiana Rieden
- Institute for Diagnostical and Interventional Radiology, Ludwigshafen Clinical Hospital, Ludwigshafen am Rhein, Germany
| | - Parker Girod
- University College Dublin School of Chemistry, Dublin, Ireland
| | - Hans-Ulrich Kauczor
- Department of Diagnostical and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Philipp Mayer
- Department of Diagnostical and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Miriam Klauss
- Department of Diagnostical and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Vladimir Lyadov
- Moscow City Clinical Cancer Hospital No. 1, Oncology No. 4, Moscow, Russia
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8
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Callaway CS, Mouchantat LM, Bitler BG, Bonetto A. Mechanisms of Ovarian Cancer-Associated Cachexia. Endocrinology 2023; 165:bqad176. [PMID: 37980602 PMCID: PMC10699881 DOI: 10.1210/endocr/bqad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023]
Abstract
Cancer-associated cachexia occurs in 50% to 80% of cancer patients and is responsible for 20% to 30% of cancer-related deaths. Cachexia limits survival and treatment outcomes, and is a major contributor to morbidity and mortality during cancer. Ovarian cancer is one of the leading causes of cancer-related deaths in women, and recent studies have begun to highlight the prevalence and clinical impact of cachexia in this population. Here, we review the existing understanding of cachexia pathophysiology and summarize relevant studies assessing ovarian cancer-associated cachexia in clinical and preclinical studies. In clinical studies, there is increased evidence that reduced skeletal muscle mass and quality associate with worse outcomes in subjects with ovarian cancer. Mouse models of ovarian cancer display cachexia, often characterized by muscle and fat wasting alongside inflammation, although they remain underexplored relative to other cachexia-associated cancer types. Certain soluble factors have been identified and successfully targeted in these models, providing novel therapeutic targets for mitigating cachexia during ovarian cancer. However, given the relatively low number of studies, the translational relevance of these findings is yet to be determined and requires more research. Overall, our current understanding of ovarian cancer-associated cachexia is insufficient and this review highlights the need for future research specifically aimed at exploring mechanisms of ovarian cancer-associated cachexia by using unbiased approaches and animal models representative of the clinical landscape of ovarian cancer.
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Affiliation(s)
- Chandler S Callaway
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Lila M Mouchantat
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Benjamin G Bitler
- Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Comprehensive Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Andrea Bonetto
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Comprehensive Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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Gortan Cappellari G, Guillet C, Poggiogalle E, Ballesteros Pomar MD, Batsis JA, Boirie Y, Breton I, Frara S, Genton L, Gepner Y, Gonzalez MC, Heymsfield SB, Kiesswetter E, Laviano A, Prado CM, Santini F, Serlie MJ, Siervo M, Villareal DT, Volkert D, Voortman T, Weijs PJ, Zamboni M, Bischoff SC, Busetto L, Cederholm T, Barazzoni R, Donini LM. Sarcopenic obesity research perspectives outlined by the sarcopenic obesity global leadership initiative (SOGLI) - Proceedings from the SOGLI consortium meeting in rome November 2022. Clin Nutr 2023; 42:687-699. [PMID: 36947988 DOI: 10.1016/j.clnu.2023.02.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 02/26/2023]
Abstract
The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched the Sarcopenic Obesity Global Leadership Initiative (SOGLI) to reach expert consensus on a definition and diagnostic criteria for Sarcopenic Obesity (SO). The present paper describes the proceeding of the Sarcopenic Obesity Global Leadership Initiative (SOGLI) meeting that was held on November 25th and 26th, 2022 in Rome, Italy. This consortium involved the participation of 50 researchers from different geographic regions and countries. The document outlines an agenda advocated by the SOGLI expert panel regarding the pathophysiology, screening, diagnosis, staging and treatment of SO that needs to be prioritized for future research in the field.
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Affiliation(s)
| | - Christelle Guillet
- University of Clermont Auvergne, INRA, CRNH, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - John A Batsis
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yves Boirie
- University of Clermont Auvergne, INRA, CRNH, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Irene Breton
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Stefano Frara
- Università Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | | | | | - Eva Kiesswetter
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | | | | | | | | | - Dorothee Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Trudy Voortman
- Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter Jm Weijs
- Amsterdam University Medical Centers, Amsterdam, the Netherlands; Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | | | | | | | - Tommy Cederholm
- Uppsala University and Karolinska University Hospital, Stockholm, Sweden
| | - Rocco Barazzoni
- Department of Medical Sciences, University of Trieste, Trieste, Italy
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Edwards A, Hughes BGM, Brown T, Bauer J. Prevalence and Impact of Computed Tomography-Defined Sarcopenia on Survival in Patients with Human Papillomavirus-Positive Oropharyngeal Cancer: A Systematic Review. Adv Nutr 2022; 13:2433-2444. [PMID: 35876662 PMCID: PMC9776633 DOI: 10.1093/advances/nmac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 01/29/2023] Open
Abstract
Sarcopenia is a known independent prognostic factor for decreased survival in patients with head and neck cancer; yet, its importance for the growing number of younger patients diagnosed with human papillomavirus (HPV)-positive oropharyngeal carcinoma (OPC+) has not been established. This systematic literature review aimed to determine the prevalence and impact of computed tomography (CT)-defined sarcopenia on survival outcomes for adult OPC+ patients (>18 y) undergoing any treatment modality. Prospective studies were searched using PubMed, Embase, CENTRAL, CINAHL, and Web of Science up until and including February 2022. Bias was assessed using the Quality In Prognosis Studies (QUIPS) tool, and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. In total, 9 studies (total pooled OPC+ patients, n = 744) were identified and included in this review; 2 at low, 6 at moderate, and 1 at high risk of bias. All studies varied in sarcopenia assessment methods and skeletal muscle index threshold cutoff values. These studies demonstrated the cumulative prevalence of sarcopenia for OPC+ patients to be 42.9% (95% CI: 37.8%, 47.9%). While overall survival (3 studies, n = 253) and progression-free survival (1 study, n = 117) was lower in sarcopenic OPC+ patients, this was not statistically significant. GRADE certainty of evidence for impact of pretreatment sarcopenia on overall survival was low and progression-free survival was very low. Although these studies showed there to be a high prevalence of pretreatment sarcopenia in patients with OPC+, which may decrease survival, the impact on progression-free survival is very uncertain. Further, high-quality research utilizing consistent sarcopenia definitions and assessment methods that are conducted specifically in OPC+ is required to strengthen evidence certainty and determine if sarcopenia is an independent prognostic factor for this population.
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Affiliation(s)
| | - Brett G M Hughes
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Teresa Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Judith Bauer
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Department of Nutrition, Dietetics, and Food, Monash University, Melbourne, Victoria, Australia
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11
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Kong M, Xu M, Zhou Y, Geng N, Lin N, Song W, Li S, Piao Y, Han Z, Guo R, Yang C, Luo N, Wang Z, Ma L, Xu Q, Wang L, Qiu W, Li J, Shi D, Cheung EC, Li R, Chen Y, Duan Z. Assessing Visceral Obesity and Abdominal Adipose Tissue Distribution in Healthy Populations Based on Computed Tomography: A Large Multicenter Cross-Sectional Study. Front Nutr 2022; 9:871697. [PMID: 35548570 PMCID: PMC9082940 DOI: 10.3389/fnut.2022.871697] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/21/2022] [Indexed: 12/21/2022] Open
Abstract
Objective Abdominal adipose is closely related to many endocrine and metabolic diseases. The aim of this study was to analyze the distribution of abdominal adipose tissue in a healthy population in northern China determined by abdominal computed tomography (CT). Methods Data for this study were obtained from a multicenter, retrospective, cross-sectional study that collected abdominal CT scans of 1787 healthy individuals from 4 representative cities in northern China. Areas of visceral adipose tissue (VATA) and subcutaneous adipose tissue (SATA) were obtained by measuring CT images at the level of the 3rd lumbar vertebra. Visceral adipose tissue index (VATI) and subcutaneous adipose index (SATI) were obtained by normalizing the square of height to analyze the distribution of the above indexes and visceral obesity among different body mass index (BMI), gender and age. Results The mean age of this healthy population was 45.3 ± 15.2 years and the mean BMI was 23.5 ± 3.2 kg/m2, with 902 men and 885 women. Compared with women, men had a significantly higher median VATA (120.9 vs. 67.2 cm2), VATI (39.1 vs. 25.6 cm2/m2) and a significantly higher percentage of visceral adiposity (VATA ≥ 100 cm2) (60.8 vs. 30.4%), while women had significantly higher SATA (116.9 vs. 146.7 cm2) and SATI (38.8 vs. 55.8 cm2/m2) than men. Whether men or women, VATI was positively correlated with age. Interestingly, SATI was weakly positively correlated with age in women, while SATI was weakly negatively correlated with age in men. In persons with a normal BMI, the proportion of visceral adiposity increases with age, whereas in men with a normal BMI, the proportion of visceral adiposity decreases after the age of 60 years but remains >50%. Conclusions The distribution of abdominal visceral and subcutaneous adipose tissue parameters measured by CT differed among gender, age, and BMI. Even men and women with normal BMI have a high proportion of visceral obesity.
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Affiliation(s)
- Ming Kong
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Manman Xu
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ying Zhou
- Postgraduate Training Base of Jinzhou Medical University, Department of Gastroenterology and Hepatology, The Chinese People's Liberation Army Rocket Force Characteristic Medical Center, Beijing, China
| | - Nan Geng
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Ning Lin
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wenyan Song
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Shanshan Li
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yuetong Piao
- Department of Infection, Dalian Medical University, Dalian, China
| | - Zuoqing Han
- Department of Infection, Dalian Medical University, Dalian, China
| | - Rong Guo
- Department of Infection, Dalian Medical University, Dalian, China
| | - Chao Yang
- Department of Radiology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Nan Luo
- Department of Infection, The Second Hospital of Dalian Medical University, Dalian, China
| | - Zhong Wang
- Diagnosis and Treatment Center of Hepatobiliary Diseases, Nanyang First People's Hospital, Nanyang, China
| | - Lei Ma
- Diagnosis and Treatment Center of Hepatobiliary Diseases, Nanyang First People's Hospital, Nanyang, China
| | - Quanxiao Xu
- Diagnosis and Treatment Center of Hepatobiliary Diseases, Nanyang First People's Hospital, Nanyang, China
| | - Lili Wang
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Wanchun Qiu
- Department of Infection, The First Clinical Medical School of Lanzhou University, Lanzhou, China
| | - Junfeng Li
- Department of Infectious Diseases, Institute of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou, China
| | - Daimeng Shi
- Diagnosis and Treatment Center of Hepatobiliary Diseases, Nanyang First People's Hospital, Nanyang, China
| | - Eddie C Cheung
- Division of Gastroenterology, School of Medicine, University of California, Davis, Davis, CA, United States.,Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Rongkuan Li
- Department of Infection, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yu Chen
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Zhongping Duan
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Fourth Department of Liver Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China
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12
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Van Erck D, Moeskops P, Schoufour JD, Weijs PJM, Scholte Op Reimer WJM, Van Mourik MS, Janmaat YC, Planken RN, Vis M, Baan J, Hemke R, Išgum I, Henriques JP, De Vos BD, Delewi R. Evaluation of a Fully Automatic Deep Learning-Based Method for the Measurement of Psoas Muscle Area. Front Nutr 2022; 9:781860. [PMID: 35634380 PMCID: PMC9133929 DOI: 10.3389/fnut.2022.781860] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/14/2022] [Indexed: 01/06/2023] Open
Abstract
Background Manual muscle mass assessment based on Computed Tomography (CT) scans is recognized as a good marker for malnutrition, sarcopenia, and adverse outcomes. However, manual muscle mass analysis is cumbersome and time consuming. An accurate fully automated method is needed. In this study, we evaluate if manual psoas annotation can be substituted by a fully automatic deep learning-based method. Methods This study included a cohort of 583 patients with severe aortic valve stenosis planned to undergo Transcatheter Aortic Valve Replacement (TAVR). Psoas muscle area was annotated manually on the CT scan at the height of lumbar vertebra 3 (L3). The deep learning-based method mimics this approach by first determining the L3 level and subsequently segmenting the psoas at that level. The fully automatic approach was evaluated as well as segmentation and slice selection, using average bias 95% limits of agreement, Intraclass Correlation Coefficient (ICC) and within-subject Coefficient of Variation (CV). To evaluate performance of the slice selection visual inspection was performed. To evaluate segmentation Dice index was computed between the manual and automatic segmentations (0 = no overlap, 1 = perfect overlap). Results Included patients had a mean age of 81 ± 6 and 45% was female. The fully automatic method showed a bias and limits of agreement of -0.69 [-6.60 to 5.23] cm2, an ICC of 0.78 [95% CI: 0.74-0.82] and a within-subject CV of 11.2% [95% CI: 10.2-12.2]. For slice selection, 84% of the selections were on the same vertebra between methods, bias and limits of agreement was 3.4 [-24.5 to 31.4] mm. The Dice index for segmentation was 0.93 ± 0.04, bias and limits of agreement was -0.55 [1.71-2.80] cm2. Conclusion Fully automatic assessment of psoas muscle area demonstrates accurate performance at the L3 level in CT images. It is a reliable tool that offers great opportunities for analysis in large scale studies and in clinical applications.
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Affiliation(s)
- Dennis Van Erck
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | | | - Josje D. Schoufour
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Science, Amsterdam, Netherlands
| | - Peter J. M. Weijs
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Wilma J. M. Scholte Op Reimer
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- HU University of Applied Sciences, Research Group Chronic Diseases, Utrecht, Netherlands
| | - Martijn S. Van Mourik
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Yvonne C. Janmaat
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - R. Nils Planken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherslands
| | - Marije Vis
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jan Baan
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherslands
| | - Ivana Išgum
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherslands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - José P. Henriques
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Bob D. De Vos
- Quantib-U, Rotterdam, Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ronak Delewi
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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13
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Arribas L, Sabaté-Llobera A, Domingo MC, Taberna M, Sospedra M, Martin L, González-Tampán AR, Pallarés N, Mesía R, Baracos VE. Assessing dynamic change in muscle during treatment of patients with cancer: precision testing standards. Clin Nutr 2022; 41:1059-1065. [DOI: 10.1016/j.clnu.2022.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 11/24/2022]
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14
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Martin L, Tom M, Basualdo-Hammond C, Baracos V, Gramlich L. Piloting a training program in computed tomography (CT) skeletal muscle assessment for Registered Dietitians. JPEN J Parenter Enteral Nutr 2022; 46:1317-1325. [PMID: 35147237 DOI: 10.1002/jpen.2348] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Consensus definitions for disease-associated malnutrition and sarcopenia include reduced skeletal muscle mass as a diagnostic criterion. There is a need to develop and validate techniques to assess skeletal muscle in clinical practice. Skeletal muscle mass can be precisely quantified from computed tomography (CT) images. This pilot study aimed to train Registered Dietitians (RD) to complete precise skeletal muscle measurements using CT. METHODS Purposive sampling identified RDs employed in clinical areas where CT scans are routinely performed. CT training included: 1) a 3-day training session focused on manual segmentation of skeletal muscle cross-sectional areas (cm2 ) from abdominal CT images at the third lumber (L3) vertebra, using SliceOmatic® software, and 2) a precision assessment to quantify the intra- and inter-observer precision error of repeated skeletal muscle measurements (30 images in duplicate). Precision error is reported as the root mean standard deviation (cm2 ) and % coefficient of variation (%CV), our primary performance indicator was defined as a precision error <2%. RESULTS Five RDs completed CT training. RDs were from three clinical areas (cancer care (N=1), surgery (N=2), and critical care (N=1). RDs precision error was low and below the minimal acceptable error of <2%; intra-observer error was ≤1.8 cm2 (range 0.8 - 1.8 cm2 ) or ≤1.5% (range 0.8 - 1.5%) and inter-observer error was 1.2 cm2 or 1.1%. CONCLUSION RDs can be trained to perform precise CT skeletal muscle measurements. Increasing capacity to assess skeletal muscle is a first step toward developing this technique for use in clinical practice. CLINICAL RELEVANCE STATEMENT There is significant interest from both researchers and clinicians to undertake the measurement of skeletal muscle. Reduced skeletal muscle mass places individuals at risk of experiencing adverse outcomes and is a diagnostic criterion for disease-associated malnutrition and sarcopenia. In this study we piloted a training program in computed tomography (CT)-skeletal muscle assessments for RDs, and demonstrated after completion of the program RDs were able to perform CT skeletal muscle measurements with high precision. The addition of new tools to the comprehensive nutrition assessment tool box may benefit clinical practice in multiple ways including improved identification of patients with reduced skeletal muscle mass, individualization of interventions, and monitoring effectiveness of interventions over time. Other clinicians may also benefit from knowing about their patients' skeletal muscle mass to help identify risk and make treatment decisions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lisa Martin
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mei Tom
- Alberta Health Services, Edmonton, Alberta, Canada
| | | | - Vickie Baracos
- Department of Oncology, University of Alberta. Edmonton, Alberta, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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15
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Donini LM, Busetto L, Bischoff SC, Cederholm T, Ballesteros-Pomar MD, Batsis JA, Bauer JM, Boirie Y, Cruz-Jentoft AJ, Dicker D, Frara S, Frühbeck G, Genton L, Gepner Y, Giustina A, Gonzalez MC, Han HS, Heymsfield SB, Higashiguchi T, Laviano A, Lenzi A, Nyulasi I, Parrinello E, Poggiogalle E, Prado CM, Salvador J, Rolland Y, Santini F, Serlie MJ, Shi H, Sieber CC, Siervo M, Vettor R, Villareal DT, Volkert D, Yu J, Zamboni M, Barazzoni R. Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement. Clin Nutr 2022; 41:990-1000. [DOI: 10.1016/j.clnu.2021.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 02/08/2023]
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16
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Donini LM, Busetto L, Bischoff SC, Cederholm T, Ballesteros-Pomar MD, Batsis JA, Bauer JM, Boirie Y, Cruz-Jentoft AJ, Dicker D, Frara S, Frühbeck G, Genton L, Gepner Y, Giustina A, Gonzalez MC, Han HS, Heymsfield SB, Higashiguchi T, Laviano A, Lenzi A, Nyulasi I, Parrinello E, Poggiogalle E, Prado CM, Salvador J, Rolland Y, Santini F, Serlie MJ, Shi H, Sieber CC, Siervo M, Vettor R, Villareal DT, Volkert D, Yu J, Zamboni M, Barazzoni R. Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement. Obes Facts 2022; 15:321-335. [PMID: 35196654 PMCID: PMC9210010 DOI: 10.1159/000521241] [Citation(s) in RCA: 237] [Impact Index Per Article: 118.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 11/26/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases) and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of a universally established SO definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes. AIMS AND METHODS The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into stage I in the absence of clinical complications or stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. CONCLUSIONS ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing data sets, to study the predictive value, treatment efficacy and clinical impact of this SO definition.
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Affiliation(s)
| | | | | | | | | | - John A. Batsis
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Yves Boirie
- University of Clermont Auvergne, INRA, CRNH, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Dror Dicker
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Stefano Frara
- San Raffaele, Vita-Salute University and IRCCS Hospital, Milan, Italy
| | - Gema Frühbeck
- Clínica Universidad de Navarra, CIBEROBN, IdiSNA, Pamplona, Spain
| | | | | | - Andrea Giustina
- San Raffaele, Vita-Salute University and IRCCS Hospital, Milan, Italy
| | | | - Ho-Seong Han
- Seoul National University Bundang Hospital (SNUBH), Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | | | | - Yves Rolland
- Gerontopole of Toulouse, INSERM 1027, Toulouse University Hospital, Toulouse, France
| | | | | | - Hanping Shi
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Cornel C. Sieber
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Mario Siervo
- University of Nottingham, Nottingham, United Kingdom
| | | | | | - Dorothee Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Jianchun Yu
- Peking Union Medical College Hospital, Beijing, China
| | | | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- **Rocco Barazzoni,
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Ajith MM, Ghosh AK, Jansz J. Contributing effects of individual characteristics, behavioural and job-related factors on occurrence of mining-related injuries: A systematic review. Work 2021; 71:87-117. [PMID: 34924421 DOI: 10.3233/wor-205227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Occupational health and safety (OHS) is a complex system due to its three components, namely human, technological and organizational factors. The interplay between the three systems causes workplace accidents and, subsequently, injuries. The body of research currently available demonstrates a disparity in the focus on contributors that cause mining-related injuries beyond the presence of hazards. OBJECTIVE The aim of this paper was to systematically review and synthesise peer-reviewed published studies that have investigated whether certain individual characteristics, behavioural factors and job-related factors predict mining-related injuries. METHODS Databases were searched and peer-reviewed publications from 2004 to 2020 were retrieved and analysed. Only 24 from 3073 identified articles were retained for review and synthesis following careful screening. Most identified studies were either cross-sectional or case-control studies, and they were rated as moderate-to-good quality. RESULTS The review results showed that there is a diverging view in relation to risk factors that cause mining-related injuries. Some publications suggested that old age, male miners, married miners, less educated miners, less experienced miners, alcohol and drug usage, poor working conditions, poor management or supervision, job dissatisfaction and job stress predict injury events while other studies found contradictory relationships or insignificant statistical associations. CONCLUSIONS Despite the fact that studied risk factors have been well-established in other industries, there is a significant gap in mining that needs further examination. It is imperative that health and safety intervention strategies are devised and implemented for vulnerable groups.
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Affiliation(s)
- Michael Mayom Ajith
- Department of Mining Engineering and Metallurgical Engineering, Western Australia School of Mines: Minerals, Energy and Chemical Engineering, Curtin University, Australia
| | - Apurna Kumar Ghosh
- Department of Mining Engineering and Metallurgical Engineering, Western Australia School of Mines: Minerals, Energy and Chemical Engineering, Curtin University, Australia
| | - Janis Jansz
- Western Australia School of Mines: Minerals, Energy and Chemical Engineering, Curtin University, Australia
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18
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Findlay M, White K, Brown C, Bauer JD. Nutritional status and skeletal muscle status in patients with head and neck cancer: Impact on outcomes. J Cachexia Sarcopenia Muscle 2021; 12:2187-2198. [PMID: 34676673 PMCID: PMC8718020 DOI: 10.1002/jcsm.12829] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 09/05/2021] [Accepted: 09/11/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Computed tomography (CT)-defined skeletal muscle depletion and malnutrition are demonstrated as poor prognostic factors in patients with head and neck cancer (HNC), however to date, have only been explored in isolation. We aimed to describe body composition profile and examine the impact of nutritional status as well as independently and concurrently occurring body composition features on overall survival, treatment completion, unplanned admissions and length of stay (LOS) in patients undergoing radiotherapy (RT) or chemoradiotherapy (CRT) of curative intent for HNC. METHODS This work is a retrospective, observational study of patients who had completed treatment of curative intent for HNC. Scored Patient-Generated Subjective Global Assessment (PG-SGA) was used to determine nutritional status. Tissue-density data were derived at the third lumbar vertebra (L3) with sarcopenia and myosteatosis defined by published, sex-specific threshold values stratified by body mass index for skeletal muscle index (cm2 /m2 ) and skeletal muscle radiodensity (SMR, Hounsfield Unit). RESULTS Pre-treatment data (n = 277: 78% male, mean (SD) age 60 (13) years) revealed the prevalence of malnutrition (24.9%), sarcopenia (52.3%), myosteatosis (82.3%), and concurrently occurring sarcopenia and myosteatosis (39.7%). Malnutrition was independently associated with reduced OS for patients with moderate [hazard ratio (HR) 2.57; 95% confidence interval (CI) 1.45-4.55, P = 0.001] and severe (HR 3.19; 95% CI 1.44-7.07, P = 0.004) malnutrition on multivariable analysis but not sarcopenia (HR 1.09; 95% CI 0.70-1.71), P = 0.700 or myosteatosis (HR 1.28; 95% CI 0.57-2.84), P = 0.500). Malnutrition was associated with treatment discontinuation (P < 0.001), not completing RT as planned (P < 0.001), unplanned hospital admission (P = 0.021), and greater LOS (P < 0.001). Skeletal muscle status features were associated with unplanned hospital admissions for those with no features (32%), with sarcopenia only (50%), myosteatosis only (25%), and concurrent sarcopenia and myosteatosis (50%), P < 0.001. Similarly, a clinically relevant greater median (Q1, Q3) LOS was observed for those with sarcopenia only [5 (3, 32)], myosteatosis only [10 (5, 30)], concurrent sarcopenia, and myosteatosis [14 (4, 33)] days vs. those with no features [3 (2, 11)] days, P = 0.2. CONCLUSIONS Malnutrition was a more powerful prognostic indicator than CT-defined skeletal muscle depletion and was independently associated with reduced OS in patients undergoing RT or CRT of curative intent for HNC. CT-defined skeletal muscle depletion studies should recognize the multifaceted nature of human body composition and also measure nutritional status using validated methods in order to move towards developing a typology of high risk criteria for this complex patient group.
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Affiliation(s)
- Merran Findlay
- Cancer ServicesRoyal Prince Alfred HospitalCamperdownNSWAustralia
- Chris O'Brien Lifehouse, New South WalesCamperdownNSWAustralia
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and HealthUniversity of SydneyCamperdownNSWAustralia
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer CouncilNSWAustralia
| | - Kathryn White
- Cancer ServicesRoyal Prince Alfred HospitalCamperdownNSWAustralia
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and HealthUniversity of SydneyCamperdownNSWAustralia
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer CouncilNSWAustralia
| | - Chris Brown
- National Health and Medical Research Council Clinical Trials CentreThe University of SydneyCamperdownNSWAustralia
| | - Judith D. Bauer
- School of Human Movement and Nutrition SciencesUniversity of QueenslandSt LuciaQLDAustralia
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19
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Scopel Poltronieri T, de Paula NS, Chaves GV. Skeletal muscle radiodensity and cancer outcomes: A scoping review of the literature. Nutr Clin Pract 2021; 37:1117-1141. [PMID: 34752653 DOI: 10.1002/ncp.10794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patients with cancer are more prone to experience myosteatosis than healthy individuals. The aim of this review was to summarize the methodologies applied for low skeletal muscle radiodensity (SMD) assessment in oncology patients, as well as to describe the major findings related to SMD and cancer outcomes. This scoping review included studies that were published until November 2020 in English, Portuguese, or Spanish; were performed in humans diagnosed with cancer, adult and/or elderly, of both sexes; investigated SMD through computed tomography of the region between the third and fifth lumbar vertebrae, considering at least two muscular groups; and evaluated clinical and/or surgical outcomes. Eighty-eight studies met the inclusion criteria (n = 37,583 patients). Survival was the most evaluated outcome. Most studies reported a significant association between low SMD and unfavorable outcomes. However, this relationship was not clear for survival, antineoplastic treatment, and surgical complications, potentially because of the unstandardized approaches for the assessment of SMD and inadequate study design. Future studies should address these issues to provide an in-depth understanding of the clinical relevance of SMD in cancer outcomes as well as how SMD is influenced by individuals and tumor-related characteristics in patients with cancer.
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Affiliation(s)
- Taiara Scopel Poltronieri
- Department of Nutrition, Cancer Hospital II, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Rio de Janeiro, Brazil.,Postgraduate Program in Medical Sciences, Endocrinology, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Nathália Silva de Paula
- Department of Nutrition, Cancer Hospital II, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gabriela Villaça Chaves
- Department of Nutrition, Cancer Hospital II, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
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20
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Sartori R, Hagg A, Zampieri S, Armani A, Winbanks CE, Viana LR, Haidar M, Watt KI, Qian H, Pezzini C, Zanganeh P, Turner BJ, Larsson A, Zanchettin G, Pierobon ES, Moletta L, Valmasoni M, Ponzoni A, Attar S, Da Dalt G, Sperti C, Kustermann M, Thomson RE, Larsson L, Loveland KL, Costelli P, Megighian A, Merigliano S, Penna F, Gregorevic P, Sandri M. Perturbed BMP signaling and denervation promote muscle wasting in cancer cachexia. Sci Transl Med 2021; 13:eaay9592. [PMID: 34349036 DOI: 10.1126/scitranslmed.aay9592] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 03/18/2021] [Indexed: 02/05/2023]
Abstract
Most patients with advanced solid cancers exhibit features of cachexia, a debilitating syndrome characterized by progressive loss of skeletal muscle mass and strength. Because the underlying mechanisms of this multifactorial syndrome are incompletely defined, effective therapeutics have yet to be developed. Here, we show that diminished bone morphogenetic protein (BMP) signaling is observed early in the onset of skeletal muscle wasting associated with cancer cachexia in mouse models and in patients with cancer. Cancer-mediated factors including Activin A and IL-6 trigger the expression of the BMP inhibitor Noggin in muscle, which blocks the actions of BMPs on muscle fibers and motor nerves, subsequently causing disruption of the neuromuscular junction (NMJ), denervation, and muscle wasting. Increasing BMP signaling in the muscles of tumor-bearing mice by gene delivery or pharmacological means can prevent muscle wasting and preserve measures of NMJ function. The data identify perturbed BMP signaling and denervation of muscle fibers as important pathogenic mechanisms of muscle wasting associated with tumor growth. Collectively, these findings present interventions that promote BMP-mediated signaling as an attractive strategy to counteract the loss of functional musculature in patients with cancer.
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Affiliation(s)
- Roberta Sartori
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- Veneto Institute of Molecular Medicine, 35129 Padova, Italy
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
| | - Adam Hagg
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- Centre for Muscle Research, Department of Anatomy and Physiology, University of Melbourne, Melbourne, VIC 3010, Australia
- Biomedicine Discovery Institute, Department of Physiology, Monash University, Melbourne, VIC 3800, Australia
| | - Sandra Zampieri
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padova, 35128 Padua, Italy
- Myology Center, University of Padova, 35122 Padua, Italy
| | - Andrea Armani
- Veneto Institute of Molecular Medicine, 35129 Padova, Italy
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
| | | | - Laís R Viana
- Centre for Muscle Research, Department of Anatomy and Physiology, University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Structural and Functional Biology, Biology Institute, University of Campinas, Campinas, São Paulo 13083-97, Brazil
| | - Mouna Haidar
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3052, Australia
| | - Kevin I Watt
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- Centre for Muscle Research, Department of Anatomy and Physiology, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Hongwei Qian
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- Centre for Muscle Research, Department of Anatomy and Physiology, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Camilla Pezzini
- Veneto Institute of Molecular Medicine, 35129 Padova, Italy
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
| | - Pardis Zanganeh
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3052, Australia
| | - Bradley J Turner
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3052, Australia
| | - Anna Larsson
- Theme Cancer, Karolinska University Hospital, Solna 171 76, Sweden
| | - Gianpietro Zanchettin
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padova, 35128 Padua, Italy
| | - Elisa S Pierobon
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padova, 35128 Padua, Italy
| | - Lucia Moletta
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padova, 35128 Padua, Italy
| | - Michele Valmasoni
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padova, 35128 Padua, Italy
| | - Alberto Ponzoni
- Department of Radiology, Padova General Hospital, 35121 Padova, Italy
| | - Shady Attar
- Department of Medicine, University Hospital of Padova, 35121 Padova, Italy
| | - Gianfranco Da Dalt
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padova, 35128 Padua, Italy
| | - Cosimo Sperti
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padova, 35128 Padua, Italy
| | - Monika Kustermann
- Center for Anatomy and Cell Biology, Medical University of Vienna, 1090 Vienna, Austria
| | - Rachel E Thomson
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
- Centre for Muscle Research, Department of Anatomy and Physiology, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Lars Larsson
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, USA
| | - Kate L Loveland
- Centre for Reproductive Health. Hudson Institute of Medical Research, Clayton, VIC 3168, Australia
- Department of Molecular and Translational Sciences, and Anatomy and Developmental Biology, Monash University, VIC 3800, Australia
| | - Paola Costelli
- Department of Clinical and Biological Sciences, University of Turin, 10125 Turin, Italy
| | - Aram Megighian
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
| | - Stefano Merigliano
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padova, 35128 Padua, Italy
| | - Fabio Penna
- Department of Clinical and Biological Sciences, University of Turin, 10125 Turin, Italy
| | - Paul Gregorevic
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia.
- Centre for Muscle Research, Department of Anatomy and Physiology, University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Biochemistry and Molecular Biology, Monash University, VIC 3800, Australia
- Department of Neurology, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Marco Sandri
- Veneto Institute of Molecular Medicine, 35129 Padova, Italy.
- Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
- Myology Center, University of Padova, 35122 Padua, Italy
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
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21
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Lee SA, Jang IY, Park SY, Kim KW, Park DW, Kim HJ, Kim JB, Jung SH, Choo SJ, Chung CH, Kang DH, Lee JW, Kim DH. Benefit of Sarcopenia Screening in Older Patients Undergoing Surgical Aortic Valve Replacement. Ann Thorac Surg 2021; 113:2018-2026. [PMID: 34332995 DOI: 10.1016/j.athoracsur.2021.06.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/01/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sarcopenia, known as physical frailty, is highly prevalent in older patients and is related to adverse outcomes post-cardiac surgery. However, whether sarcopenia assessment can reclassify an individual patients' risk, which is estimated by Society of Thoracic Surgeons-predicted risk of mortality scores in patients who undergo surgical aortic valve replacement, is unclear. METHODS This retrospective, single center, cohort study comprised 874 patients aged ≥65 years who underwent surgical aortic valve replacement between 2009 and 2016. Total skeletal muscle area was calculated using height-squared and was measured by preoperative computed tomography at the third lumbar vertebra inferior border using machine learning-based analysis. Sex-specific Z-scores were calculated and patients in the lowest Z-score tertile were considered to have sarcopenia. The primary endpoint was 30-day mortality, and secondary endpoints were in-hospital events, 1-year mortality, and long-term mortality. RESULTS Thirty-day mortality, 30-day in-hospital events, and one-year mortality rates were 4.7%, 17.6%, and 8.0%, respectively. As the Z-score decreased, early adverse event odds showed a stepwise increase. Sarcopenia were independently associated with higher 30-day mortality, 30-day in-hospital events, and 1-year mortality. Reclassification analyses showed improvements in the ability to predict early adverse events after adding the Z-scores over and above the Society of Thoracic Surgeons-predicted risk of mortality scores (All, p <0.005). CONCLUSIONS Sarcopenic patients had significantly higher risks of early adverse events and long-term mortality after undergoing surgical aortic valve replacement than non-sarcopenic patients. Sarcopenia determined by preoperative computed tomography can enhance the prediction of postoperative outcome risk.
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Affiliation(s)
- Seung-Ah Lee
- Department of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Il-Young Jang
- Department of Geriatrics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Seo-Young Park
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Kyung-Won Kim
- Department of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Cheol-Hyun Chung
- Department of Thoracic and Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Duk-Hyun Kang
- Department of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Jae-Won Lee
- Department of Thoracic and Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Dae-Hee Kim
- Department of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
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22
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Zhou Y, Hao N, Duan Z, Kong M, Xu M, Zhang D, Xu X, Yuan Q, Li C. Assessment of Acute Pancreatitis Severity and Prognosis with CT-Measured Body Composition. Int J Gen Med 2021; 14:3971-3980. [PMID: 34349546 PMCID: PMC8326933 DOI: 10.2147/ijgm.s322589] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/19/2021] [Indexed: 01/11/2023] Open
Abstract
Objective The aim of this study was to investigate the possible association of muscle and adipose parameters with the severity and prognosis of patients hospitalized with acute pancreatitis (AP). Methods A total of 392 hospitalized patients and 309 controls were enrolled in the study analysis from April 1, 2016, to February 1, 2021. The computed tomography scans of each population were evaluated for muscle and adipose parameters. The effects of parameters on developing moderately severe acute pancreatitis (MSAP) or severe acute pancreatitis (SAP) were evaluated using univariate and multivariate logistic regression analyses. Associations with disease recurrence and death were analyzed through Cox regression analysis. Results The AP patients had higher levels of visceral adipose tissue (144.25 vs 97.81 cm2, p < 0.001) and subcutaneous adipose tissue (135 vs 120 cm2, p < 0.001) but lower levels of adipose tissue attenuation (visceral and subcutaneous) and skeletal muscle attenuation (SMA) than the controls (p < 0.05, respectively). Visceral adipose tissue (VAT) and SMA differed significantly with p-values of 0.014 and 0.003 in the different severity groups of AP. In multivariate analysis, VAT and SMA were associated with MSAP or SAP, with odds ratios of 1.003 and 0.973, respectively (95% CI 1.000-1.006, p = 0.041; 95% CI 0.953-0.993, p = 0.010). Cox regression analysis showed that low SMA was strongly associated with an increased mortality in MSAP and SAP patients (HR 10.500, 95% CI 1.344-82.025, p = 0.025). Regression analysis also showed an association of VAT loss of more than 17% with reduced 1-year recurrence of acute pancreatitis (HR 0.427, 95% CI 0.189-0.967, p = 0.041). Conclusion VAT and SMA were influential factors for the severity and prognosis of patients with AP. Patients should proper diet and exercise after discharge to reduce VAT and strengthen muscle function to improve prognosis.
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Affiliation(s)
- Ying Zhou
- Postgraduate Training Base of Jinzhou Medical University, Jinzhou, People's Republic of China.,Department of Gastroenterology and Hepatology, The PLA Rocket Force Characteristic Medical Center, Beijing, People's Republic of China
| | - Ningbo Hao
- Department of Gastroenterology and Hepatology, The PLA Rocket Force Characteristic Medical Center, Beijing, People's Republic of China
| | - Zhongping Duan
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, You'an Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Ming Kong
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, You'an Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Manman Xu
- Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, You'an Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Dan Zhang
- Department of Gastroenterology and Hepatology, The PLA Rocket Force Characteristic Medical Center, Beijing, People's Republic of China
| | - Xiangxiang Xu
- Department of Gastroenterology and Hepatology, The PLA Rocket Force Characteristic Medical Center, Beijing, People's Republic of China
| | - Qingwen Yuan
- Postgraduate Training Base of Jinzhou Medical University, Jinzhou, People's Republic of China.,Department of Gastroenterology and Hepatology, The PLA Rocket Force Characteristic Medical Center, Beijing, People's Republic of China
| | - Changzheng Li
- Department of Gastroenterology and Hepatology, The PLA Rocket Force Characteristic Medical Center, Beijing, People's Republic of China
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23
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The Utility of Body Composition Assessment in Nutrition and Clinical Practice: An Overview of Current Methodology. Nutrients 2021; 13:nu13082493. [PMID: 34444653 PMCID: PMC8399582 DOI: 10.3390/nu13082493] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 12/31/2022] Open
Abstract
Body composition is a key component for maintaining good general health and longevity. It can be influenced by a variety of factors, including genetics, environment, and lifestyle choices. The assessment of body composition is an essential tool for nutrition specialists to effectively evaluate nutritional status and monitor progression during dietary interventions. As humans age, there is a natural increase in fat mass coupled with a gradual decline in lean mass, specifically in bone and muscle mass. Individuals with a high body fat percentage are at a greater risk of cardiovascular diseases, type 2 diabetes, several types of cancer, and early mortality. Significant decreases in bone mineral density signify osteopenia and osteoporosis, while reductions in skeletal muscle mass increase the risk of developing sarcopenia. Moreover, undernutrition exacerbates the effects of many medical conditions and is important to address. Though weight tracking and calculation of BMI are used commonly by clinicians and dietitians, these measures do not provide insight on the relative contributions of fat mass and fat-free mass or the changes in these compartments that may reflect disease risk. Therefore, it is important that healthcare professionals have a critical understanding of body composition assessment and the strengths and limitations of the methods available.
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24
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Bagley L, Al-Shanti N, Bradburn S, Baig O, Slevin M, McPhee JS. Sex Comparison of Knee Extensor Size, Strength, and Fatigue Adaptation to Sprint Interval Training. J Strength Cond Res 2021. [PMID: 29533360 DOI: 10.1519/jsc.0000000000002496] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
ABSTRACT Bagley, L, Al-Shanti, N, Bradburn, S, Baig, O, Slevin, M, and McPhee, JS. Sex comparison of knee extensor size, strength, and fatigue adaptation to sprint interval training. J Strength Cond Res 35(1): 64-71, 2021-Regular sprint interval training (SIT) improves whole-body aerobic capacity and muscle oxidative potential, but very little is known about knee extensor anabolic or fatigue resistance adaptations, or whether effects are similar for men and women. The purpose of this study was to compare sex-related differences in knee extensor size, torque-velocity relationship, and fatigability adaptations to 12-week SIT. Sixteen men and 15 women (mean [SEM] age: 41 [±2.5] years) completed measurements of total body composition assessed by dual energy X-ray absorptiometry, quadriceps muscle cross-sectional area (CSAQ) assessed by magnetic resonance imaging, the knee extensor torque-velocity relationship (covering 0-240°·s-1) and fatigue resistance, which was measured as the decline in torque from the first to the last of 60 repeated concentric knee extensions performed at 180°·s-1. Sprint interval training consisted of 4 × 20-second sprints on a cycle ergometer set at an initial power output of 175% of power at V̇o2max, 3 times per week for 12 weeks. Quadriceps muscle cross-sectional area increased by 5% (p = 0.023) and fatigue resistance improved 4.8% (p = 0.048), with no sex differences in these adaptations (sex comparisons: p = 0.140 and p = 0.282, respectively). Knee extensor isometric and concentric torque was unaffected by SIT in both men and women (p > 0.05 for all velocities). Twelve-week SIT, totaling 4 minutes of very intense cycling per week, significantly increased fatigue resistance and CSAQ similarly in men and women, but did not significantly increase torque in men or women. These results suggest that SIT is a time-effective training modality for men and women to increase leg muscle size and fatigue resistance.
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Affiliation(s)
- Liam Bagley
- School of Healthcare Science, John Dalton Building, Manchester Metropolitan University, Manchester, United Kingdom
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25
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Findlay M, White K, Lai M, Luo D, Bauer JD. The Association Between Computed Tomography-Defined Sarcopenia and Outcomes in Adult Patients Undergoing Radiotherapy of Curative Intent for Head and Neck Cancer: A Systematic Review. J Acad Nutr Diet 2021; 120:1330-1347.e8. [PMID: 32711854 DOI: 10.1016/j.jand.2020.03.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 03/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Computed tomography (CT)-defined sarcopenia is a demonstrated poor prognostic factor in patients with cancer; however, its influence on outcomes for patients with head and neck cancer (HNC) has not been established. OBJECTIVE This review synthesizes current knowledge regarding the association between CT-defined sarcopenia and outcomes for adult patients undergoing radiotherapy with or without other treatment modalities of curative intent for HNC. METHODS A systematic review of the literature published between January 2004 and June 2019 was conducted in Medline, Embase, Cumulative Index of Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and PubMed. Empirical studies of CT-defined sarcopenia in adult patients (≥18 years) with HNC who had completed radiotherapy of curative intent with or without other treatment modalities were included. Outcomes reported included survival, prolonged radiotherapy breaks, and chemotherapy toxicity. Study quality was assessed using the American Academy of Nutrition and Dietetics Quality Criteria Checklist. Synthesis of outcomes and clinical relevance was performed using the Grading of Recommendations Assessment, Development, and Evaluation system. RESULTS Of 11 studies (n = 3,461) identified, 3 were positive and 8 were neutral quality. Studies were heterogeneous in HNC diagnosis, ethnicity, definition of sarcopenia, CT level of evaluation, and skeletal muscle index threshold value. Eight definitions for sarcopenia were identified with pretreatment prevalence of 6.6% to 70.9% and posttreatment prevalence of 12.4% to 65.8%. Pretreatment sarcopenia was independently associated with reduced: overall survival (OS), 3-year OS, disease-free survival, prolonged radiotherapy breaks, and chemotherapy-related toxicities. Posttreatment sarcopenia was independently associated with reduced OS and 5-year OS. The overall certainty of evidence according to Grading of Recommendations Assessment, Development and Evaluation criteria was low for OS; 3-year, 5-year, and 10-year OS; locoregional control; locoregional failure; progression-free survival; metastasis-free survival, disease-specific survival; and disease-free survival and very low for distant metastasis, prolonged radiotherapy breaks, and chemotherapy toxicity-related outcomes. CONCLUSIONS CT-defined sarcopenia is independently associated with reduced OS and treatment completion in patients with HNC and holds a clinically meaningful prognostic value. The certainty of the evidence requires strengthening with further research. Understanding the impact sarcopenia has on outcomes for these patients has implications for informing potential nutrition interventions and facilitating individualized care.
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26
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The association between sarcopenia and quality of life in patients undergoing colorectal cancer surgery: an exploratory study. Support Care Cancer 2021; 29:3411-3420. [PMID: 33547963 DOI: 10.1007/s00520-021-06025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe changes in health-related quality of life (QoL) from before colorectal cancer (CRC) surgery to 1 and 3-month post-surgery in patients diagnosed pre-operatively as sarcopenic or non-sarcopenic by computed tomography (CT) analysis. METHODS Secondary analysis of a prospective observational cohort study with one pre-operative and two post-operative assessments. Patient-reported outcome measures (PROMs) were collected at each timepoint using Functional Assessment of Cancer Therapy-Colorectal and the EuroQol-5D (EQ-5D) questionnaires. Pre-operative staging CT scans of the third lumbar vertebra (axial slice) were analysed using Slice-O-Matic Software to determine if patients had CT defined sarcopenia by employing sex-specific threshold values for skeletal muscle index. Patient-reported outcome measure scores were compared with minimal clinical important difference estimates to determine if changes were clinically significant. RESULTS Twenty-five of 40 patients were found to be sarcopenic. The difference between sarcopenic groups on the EQ-5D was medium-sized and clinically significant, with the sarcopenic group reporting lower health status. The non-sarcopenic group displayed a clinically significant reduction in physical wellbeing post-operatively. The sarcopenic group did not demonstrate a clinically important reduction in physical wellbeing. For functional wellbeing, the sarcopenic group recorded a clinically significant reduction at the 1-month timepoint, trending back towards baseline by the 3-month timepoint. The non-sarcopenic group recorded almost no change in functional scores. CONCLUSION This study explored the novel concept of the effect of sarcopenia on QoL in the CRC surgical setting. Clinically significant changes were identified at both post-operative timepoints. This highlights an important proof of concept that PROMs can detect meaningful clinical change in CRC patients in the context of sarcopenia and should be further explored.
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27
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Balstad TR, Brunelli C, Pettersen CH, Schønberg SA, Skorpen F, Fallon M, Kaasa S, Bye A, Laird BJA, Stene GB, Solheim TS. Power Comparisons and Clinical Meaning of Outcome Measures in Assessing Treatment Effect in Cancer Cachexia: Secondary Analysis From a Randomized Pilot Multimodal Intervention Trial. Front Nutr 2021; 7:602775. [PMID: 33585533 PMCID: PMC7874039 DOI: 10.3389/fnut.2020.602775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/01/2020] [Indexed: 12/15/2022] Open
Abstract
Background: New clinical trials in cancer cachexia are essential, and outcome measures with high responsiveness to detect meaningful changes are crucial. This secondary analysis from a multimodal intervention trial estimates sensitivity to change and between treatment effect sizes (ESs) of outcome measures associated with body composition, physical function, metabolism, and trial intervention. Methods: The study was a multicenter, open-label, randomized pilot study investigating the feasibility of a 6-week multimodal intervention [exercise, non-steroidal anti-inflammatory drugs, and oral nutritional supplements containing polyunsaturated fatty acids (n−3 PUFAs)] vs. standard cancer care in non-operable non-small-cell lung cancer and advanced pancreatic cancer. Body composition measures from computerized tomography scans and circulating biomarkers were analyzed. Results: Forty-six patients were randomized, and the analysis included 22 and 18 patients in the treatment and control groups, respectively. The between-group ESs were high for body weight (ES = 1.2, p < 0.001), small for body composition and physical function [handgrip strength (HGS)] measures (ES < 0.25), moderate to high for n-3 PUFAs and 25-hydroxyvitamin D (25-OH vitamin D) (ES range 0.64–1.37, p < 0.05 for all), and moderate for serum C-reactive protein (ES = 0.53, p = 0.12). Analysis within the multimodal treatment group showed high sensitivity to change for adiponectin (ES = 0.86, p = 0.001) and n-3 PUFAs (ES > 0.8, p < 0.05 for all) and moderate for 25-OH vitamin D (ES = 0.49, p = 0.03). In the control group, a moderate sensitivity to change for body weight (ES = −0.84, p = 0.002) and muscle mass (ES = −0.67, p = 0.016) and a high sensitivity to change for plasma levels of 25-OH vitamin D (ES = −0.88, p = 0.002) were found. Conclusion: Demonstrating high sensitivity to change and between treatment ES and body composition measures, body weight still stands out as a clinical and relevant outcome measure in cancer cachexia. Body composition and physical function measures clearly are important to address but demand large sample sizes to detect treatment group differences. Trial registration:ClinicalTrials.gov identifier: NCT01419145.
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Affiliation(s)
- Trude R Balstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Caroline H Pettersen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Svanhild A Schønberg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Frank Skorpen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Marie Fallon
- Edinburgh Cancer Research Centre (IGMM), University of Edinburgh, Edinburgh, United Kingdom
| | - Stein Kaasa
- Department of Oncology, European Palliative Care Research Centre (PRC), Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Asta Bye
- Department of Oncology, European Palliative Care Research Centre (PRC), Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Barry J A Laird
- St. Columba's Hospice, Edinburgh, United Kingdom.,Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Guro B Stene
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tora S Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Magudia K, Bridge CP, Bay CP, Babic A, Fintelmann FJ, Troschel FM, Miskin N, Wrobel WC, Brais LK, Andriole KP, Wolpin BM, Rosenthal MH. Population-Scale CT-based Body Composition Analysis of a Large Outpatient Population Using Deep Learning to Derive Age-, Sex-, and Race-specific Reference Curves. Radiology 2020; 298:319-329. [PMID: 33231527 DOI: 10.1148/radiol.2020201640] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Although CT-based body composition (BC) metrics may inform disease risk and outcomes, obtaining these metrics has been too resource intensive for large-scale use. Thus, population-wide distributions of BC remain uncertain. Purpose To demonstrate the validity of fully automated, deep learning BC analysis from abdominal CT examinations, to define demographically adjusted BC reference curves, and to illustrate the advantage of use of these curves compared with standard methods, along with their biologic significance in predicting survival. Materials and Methods After external validation and equivalency testing with manual segmentation, a fully automated deep learning BC analysis pipeline was applied to a cross-sectional population cohort that included any outpatient without a cardiovascular disease or cancer who underwent abdominal CT examination at one of three hospitals in 2012. Demographically adjusted population reference curves were generated for each BC area. The z scores derived from these curves were compared with sex-specific thresholds for sarcopenia by using χ2 tests and used to predict 2-year survival in multivariable Cox proportional hazards models that included weight and body mass index (BMI). Results External validation showed excellent correlation (R = 0.99) and equivalency (P < .001) of the fully automated deep learning BC analysis method with manual segmentation. With use of the fully automated BC data from 12 128 outpatients (mean age, 52 years; 6936 [57%] women), age-, race-, and sex-normalized BC reference curves were generated. All BC areas varied significantly with these variables (P < .001 except for subcutaneous fat area vs age [P = .003]). Sex-specific thresholds for sarcopenia demonstrated that age and race bias were not present if z scores derived from the reference curves were used (P < .001). Skeletal muscle area z scores were significantly predictive of 2-year survival (P = .04) in combined models that included BMI. Conclusion Fully automated body composition (BC) metrics vary significantly by age, race, and sex. The z scores derived from reference curves for BC parameters better capture the demographic distribution of BC compared with standard methods and can help predict survival. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Summers in this issue.
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Affiliation(s)
- Kirti Magudia
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Christopher P Bridge
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Camden P Bay
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Ana Babic
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Florian J Fintelmann
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Fabian M Troschel
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Nityanand Miskin
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - William C Wrobel
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Lauren K Brais
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Katherine P Andriole
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Brian M Wolpin
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
| | - Michael H Rosenthal
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (K.M., C.P. Bay, N.M., W.C.W., M.H.R.); MGH & BWH Center for Clinical Data Science, Boston, Mass (C.P. Bridge, K.P.A.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass (A.B., L.K.B., B.M.W.); and Department of Radiology, Massachusetts General Hospital, Boston, Mass (F.J.F., F.M.T.)
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Associations between body composition and prognosis of patients admitted because of acute pancreatitis: a retrospective study. Eur J Clin Nutr 2020; 75:817-822. [PMID: 33116236 DOI: 10.1038/s41430-020-00789-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/31/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To investigate the possible associations of muscle and visceral fat mass with the prognosis of patients hospitalized with acute pancreatitis. METHODS Body composition analysis (Sliceomatic, TomoVision, Montreal, Canada) was performed on CT images at the L3 level in patients admitted with acute pancreatitis during 2008-2014. Regression analysis was used to examine associations of body composition with 1-year mortality and 1-year readmission rates. RESULTS A total of 158 patients were included (mean age 63.7 ± 17.4 years, 91 (57.6%) were male). Fat was the most abundant tissue (408 ± 180 cm2 surface area). None of the prognostic factors examined were associated with 1-year mortality. Values below compared to above the medians for muscle mass and visceral fat were associated with higher mean 1-year readmissions: 1.7 versus 1.0, p = 0.02 and 1.6 versus 1.1, p = 0.09, respectively. Logistic regression analysis showed an association of high visceral fat with reduced 1-year readmission (OR 0.995, 95% CI 0.991-1.000, p = 0.03). Linear regression analysis showed an inverse correlation of visceral fat mass with the number of 1-year readmissions (HR -0.004, 95% CI -0.008-000, p = 0.070). CONCLUSIONS Higher amounts of visceral fat and muscle mass were positively associated with lower recurrent hospitalizations in patients admitted with acute pancreatitis. These results support the importance of nutritional rehabilitation in patients after admission due to acute pancreatitis.
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Is sarcopenia a predictor of prognosis for patients undergoing radiotherapy for head and neck cancer? A meta-analysis. Clin Nutr 2020; 40:1711-1718. [PMID: 32994071 DOI: 10.1016/j.clnu.2020.09.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/24/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Computed tomography (CT)-defined sarcopenia is a demonstrated poor prognostic factor for survival in patients with cancer, however, its impact in patients with head and neck cancer (HNC) has only recently been explored. This study aimed to determine the prognostic impact of CT-defined sarcopenia at the level of the third lumbar vertebra (L3) on overall survival in patients with HNC undergoing radiotherapy ± other treatment modality of curative intent. METHODS A systematic review of the literature published between January 2004 and May 2020 was conducted in Medline, Embase, CINAHL, AMED and PubMed. Empirical studies in adults (≥18 years) who had completed radiotherapy of curative intent ± other treatment modalities that evaluated sarcopenia using the gold standard method at L3 and applied sex-specific cut-offs were included. Outcome of interest was overall survival. Study quality was assessed using the Quality In Prognosis Studies (QUIPS) tool. Hazard ratios with 95% confidence intervals derived from multivariate analysis were extracted directly from studies. Random-effects meta-analysis was used to determine the pooled hazard ratio for overall survival in patients with sarcopenia versus those without using RevMan (Version 5.3). The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. RESULTS A total of 6211 studies were identified and screened from which seven studies met the inclusion criteria with 1059 pooled patients. All studies defined sarcopenia as low muscle mass but varied in skeletal muscle index (SMI) threshold values applied and ethnicity. Sarcopenia prevalence ranged from 6.6 to 64.6% pre-treatment and 12.4 to 65.8% post-treatment. Pre-treatment sarcopenia was associated with reduced overall survival (HR 2.07; 95%CI, 1.47-2.92, p < 0.0001, I2 = 49%) with similar findings for post-treatment sarcopenia (HR 2.93; 95%CI, 2.00-4.29, p < 0.00001, I2 = 0%) with moderate to low heterogeneity exhibited amongst studies respectively. The certainty of evidence for overall survival according to GRADE was low for pre-treatment sarcopenia and moderate for post-treatment sarcopenia. CONCLUSIONS CT-defined sarcopenia is independently associated with reduced overall survival in patients with HNC and holds a clinically meaningful prognostic value. Consensus regarding sarcopenia assessment and definitions is warranted in order to substantiate these findings and support implementation of body composition assessment as a clinically meaningful prognostic tool into practice.
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31
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Derksen JWG, Kurk SA, Peeters PHM, Dorresteijn B, Jourdan M, van der Velden AMT, Nieboer P, de Jong RS, Honkoop AH, Punt CJA, Koopman M, May AM. The association between changes in muscle mass and quality of life in patients with metastatic colorectal cancer. J Cachexia Sarcopenia Muscle 2020; 11:919-928. [PMID: 32107889 PMCID: PMC7432557 DOI: 10.1002/jcsm.12562] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/16/2019] [Accepted: 02/09/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Skeletal muscle mass (SMM) loss is common in metastatic colorectal cancer (mCRC) patients and associated with poor clinical outcomes, including increased treatment-related toxicities and reduced survival. Muscle loss may contribute to reduced health-related quality of life (HRQoL), including fatigue. Our aim was to study associations between changes in SMM and concomitant changes in patient-reported HRQoL. METHODS This was a secondary analysis of mCRC patients in the CAIRO3 randomized clinical trial who were-after initial treatment-randomized between maintenance treatment with capecitabine plus bevacizumab (CAP-B) and observation until first disease progression (PD1). Included patients had computed tomography images for SMM quantification, together with HRQoL assessments available at randomization and PD1. Changes in SMM (categorized as >2% loss, stable, and >2% gain) and HRQoL were computed between randomization and PD1. Changes in HRQoL score >10 points were considered clinically relevant. Associations between SMM and HRQoL changes were studied by multiple linear regression models. We also investigated whether associations differed by treatment arm for global health and the 13 other HRQoL subscales. RESULTS Of 221 patients included (mean age 63.5 ± 8.4 years), 24% lost, 27% remained stable, and 49% gained SMM. At randomization, mean global health status was 73.5 ± 15.9 in the CAP-B arm and 75.1 ± 17.5 in the observation arm (P = 0.48). A stable or gain in SMM was significantly associated with a clinically relevant improvement in global health status (9.9 and 14.7 points, respectively), compared with patients who lost SMM. From the subscales that did not show significant differences between the two treatment arms, we found significant and clinically relevant associations for stable or gain in SMM with improved role functioning (12.0 and 17.9, respectively) and with less fatigue (-10.0 and -15.0, respectively) and pain (-16.3 for SMM gain). From the subscales that did show significantly different associations with SMM between the two treatment arms, we only found significant results in the observation arm. Here, associations were found for stable or gain in SMM with clinically relevant improved physical (12.4 for SMM gain), cognitive (10.7 and 9.7, respectively), and social functioning (15.5 and 15.6, respectively) as well as reduced appetite loss (-28.5 and -30.7, respectively). CONCLUSIONS In mCRC, SMM preservation during CAP-B and observation treatment is associated with significant and clinically relevant improvements in global health status and multiple functional and symptom scales. Studies are warranted to investigate whether interventions targeting SMM lead to improved HRQoL, fewer symptoms, and better functioning.
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Affiliation(s)
- Jeroen W G Derksen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, GA, Utrecht, The Netherlands
| | - Sophie A Kurk
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, GA, Utrecht, The Netherlands
| | - Petra H M Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, GA, Utrecht, The Netherlands
| | - Bram Dorresteijn
- Danone Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands
| | - Marion Jourdan
- Danone Nutricia Research, Nutricia Advanced Medical Nutrition, Utrecht, The Netherlands
| | | | - Peter Nieboer
- Department of Medical Oncology, Wilhemina Hospital, Assen, The Netherlands
| | - Robert S de Jong
- Department of Medical Oncology, Martini Hospital, Groningen, The Netherlands
| | - Aafke H Honkoop
- Department of Medical Oncology, Isala Hospital, Zwolle, The Netherlands
| | - Cornelis J A Punt
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne M May
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, GA, Utrecht, The Netherlands
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32
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Findlay M, Brown C, De Abreu Lourenço R, White K, Bauer J. Sarcopenia and myosteatosis in patients undergoing curative radiotherapy for head and neck cancer: Impact on survival, treatment completion, hospital admission and cost. J Hum Nutr Diet 2020; 33:811-821. [PMID: 32609428 DOI: 10.1111/jhn.12788] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Computed tomography (CT) is the gold standard of body composition analysis at the tissue-organ level. The present study aimed to determine the impact of CT-defined sarcopenia and myosteatosis on outcomes, including overall survival, unplanned hospital admissions and related costs, in patients who had completed treatment of curative intent for head and neck cancer (HNC). METHODS Retrospective observational study of patients undergoing radiotherapy of curative intent ± other treatment modalities for HNC. Tissue density data derived at the third lumbar vertebra (L3) were evaluated with sarcopenia defined per sex-specific published threshold values for skeletal muscle index, stratified by body mass index and mean skeletal muscle attenuation in HU (Hounsfield units). RESULTS Pre- or post-treatment images were available for 79/98 patients (80.6%) and 61/98 patients (62.2%), respectively. Sarcopenia was present in 42/79 patients pre-treatment and 36/61 patients post-treatment, whereas myosteatosis was present in 63/79 patients pre-treatment and 48/61 patients post-treatment. In patients with pre- and post-treatment images (n = 60), the median (range) percentage weight change was -8.5% (-29.9 to +11.7). On multivariable analysis, a post-treatment sarcopenia hazard ratio of 3.87 (95% confidence interval = 1.22-12.24, P = 0.021) and a pre-treatment myosteatosis hazard ratio of 8.86 (95% confidence interval = 1.12-69.88, P = 0.038) were independent predictors of reduced overall survival. There was no difference in radiotherapy or chemotherapy treatment completion based on pre-treatment sarcopenia status. The mean (SD) difference unplanned hospital admission cost was $15 846 ($17 707) for patients without sarcopenia versus $47 945 ($82 688) for patients with sarcopenia at any time point (P = 0.077). CONCLUSIONS As CT-defined sarcopenia and myosteatosis hold clinically meaningful prognostic value, muscle status evaluation is recommended in routine clinical practice.
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Affiliation(s)
- M Findlay
- Cancer Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Chris O'Brien Lifehouse, Sydney, NSW, Australia.,Cancer Nursing Research Unit, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, NSW, Australia
| | - C Brown
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - R De Abreu Lourenço
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - K White
- Cancer Nursing Research Unit, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, NSW, Australia
| | - J Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
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Early high protein intake and mortality in critically ill ICU patients with low skeletal muscle area and -density. Clin Nutr 2020; 39:2192-2201. [DOI: 10.1016/j.clnu.2019.09.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/30/2019] [Accepted: 09/13/2019] [Indexed: 12/20/2022]
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34
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Poltronieri TS, de Paula NS, Chaves GV. Assessing skeletal muscle radiodensity by computed tomography: An integrative review of the applied methodologies. Clin Physiol Funct Imaging 2020; 40:207-223. [PMID: 32196914 DOI: 10.1111/cpf.12629] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/04/2020] [Accepted: 03/12/2020] [Indexed: 12/15/2022]
Abstract
Low-radiodensity skeletal muscle has been related to the degree of muscle fat infiltration and seems to be associated with worse outcomes. The aim of this study was to summarize the methodologies used to appraise skeletal muscle radiodensity by computed tomography, to describe the terms used in the literature to define muscle radiodensity and to give recommendations for its measurement standardization. An integrative bibliographic review in four databases included studies published until August 2019 in Portuguese, English or Spanish and performed in humans, adults and/or the elderly, of both sex, which investigated skeletal muscle radiodensity through computed tomography (CT) of the region between the third and fifth lumbar vertebrae and evaluated at least two muscular groups. One hundred and seventeen studies were selected. We observed a trend towards selecting all abdominal region muscle. A significant methodological variation in terms of contrast use, selection of skeletal muscle areas, radiodensity ranges delimitation and their cut-off points, as well as the terminologies used, was also found. The methodological differences detected are probably due to the lack of more precise information about the correlation between skeletal muscle radiodensity by CT and its molecular composition, among others. Therefore, until the gaps are addressed in future studies, authors should avoid arbitrary approaches when reporting skeletal muscle radiodensity, especially when it comes to prognosis inference. Studies using both CT and direct methods of muscle composition evaluation are encouraged, to enable the definition and validation of the best approach to classify fat-infiltrated muscle tissue, which will favour the nomenclature uniformization.
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Affiliation(s)
- Taiara Scopel Poltronieri
- Department of Nutrition, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Nathália Silva de Paula
- Department of Nutrition, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
| | - Gabriela Villaça Chaves
- Department of Nutrition, National Cancer Institute José Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
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Wong A, Zhu D, Kraus D, Tham T. Radiologically Defined Sarcopenia Affects Survival in Head and Neck Cancer: A Meta-Analysis. Laryngoscope 2020; 131:333-341. [PMID: 32220072 DOI: 10.1002/lary.28616] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/12/2020] [Accepted: 02/20/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine whether radiologically defined sarcopenia at the C3 or L3 level as measured by computed tomography or magnetic resonance imaging is prognostic of overall survival (OS) in head and neck cancers (HNCs). METHODS Literature searches of PubMed, Embase, and Scopus were conducted on July 12, 2019, to include articles written in the English language with no constraints on publication date. To be included in the analysis, articles had to report the prognostic impact of skeletal muscle mass measured radiologically at the C3 or L3 vertebral level in HNC patients; hazard ratios (HRs) for OS; 95% confidence intervals (CIs); be from a clinical trial, cohort, or case-control study; and have English full-text availability. Articles were reviewed in consensus by two reviewers, with disagreements reviewed by a third reviewer. Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis Of Observational Studies in Epidemiology Checklist guidelines were used for reporting. Study quality assessment was performed using Quality In Prognosis Studies tool. The random-effects DerSimonian and Laird method was used for meta-analysis. RESULTS Ten articles, nine retrospective and one prospective, were included in this meta-analysis (n = 2,181 patients). Significant differences were found in OS for HNC patients with sarcopenia (HR = 1.98; 95% CI: 1.64-2.39; P < .00001). No heterogeneity was detected in either the overall or subgroup analyses. CONCLUSIONS Radiologically defined sarcopenia is a negative predictor of OS in patients with HNC. Early detection of sarcopenia in cancer patients may help guide nutritional and adjuvant support to improve treatment outcomes. LEVEL OF EVIDENCE NA Laryngoscope, 131:333-341, 2021.
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Affiliation(s)
- Amanda Wong
- Department of Otolaryngology - Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Daniel Zhu
- Department of Otolaryngology - Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Dennis Kraus
- Department of Otolaryngology - Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Tristan Tham
- Department of Otolaryngology - Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
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Walowski CO, Braun W, Maisch MJ, Jensen B, Peine S, Norman K, Müller MJ, Bosy-Westphal A. Reference Values for Skeletal Muscle Mass - Current Concepts and Methodological Considerations. Nutrients 2020; 12:nu12030755. [PMID: 32178373 PMCID: PMC7146130 DOI: 10.3390/nu12030755] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/12/2022] Open
Abstract
Assessment of a low skeletal muscle mass (SM) is important for diagnosis of ageing and disease-associated sarcopenia and is hindered by heterogeneous methods and terminologies that lead to differences in diagnostic criteria among studies and even among consensus definitions. The aim of this review was to analyze and summarize previously published cut-offs for SM applied in clinical and research settings and to facilitate comparison of results between studies. Multiple published reference values for discrepant parameters of SM were identified from 64 studies and the underlying methodological assumptions and limitations are compared including different concepts for normalization of SM for body size and fat mass (FM). Single computed tomography or magnetic resonance imaging images and appendicular lean soft tissue by dual X-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA) are taken as a valid substitute of total SM because they show a high correlation with results from whole body imaging in cross-sectional and longitudinal analyses. However, the random error of these methods limits the applicability of these substitutes in the assessment of individual cases and together with the systematic error limits the accurate detection of changes in SM. Adverse effects of obesity on muscle quality and function may lead to an underestimation of sarcopenia in obesity and may justify normalization of SM for FM. In conclusion, results for SM can only be compared with reference values using the same method, BIA- or DXA-device and an appropriate reference population. Limitations of proxies for total SM as well as normalization of SM for FM are important content-related issues that need to be considered in longitudinal studies, populations with obesity or older subjects.
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Affiliation(s)
- Carina O. Walowski
- Institute for Human Nutrition and Food Science, Christian-Albrechts-University Kiel, 24105 Kiel, Germany; (C.O.W.); (W.B.); (M.J.M.)
| | - Wiebke Braun
- Institute for Human Nutrition and Food Science, Christian-Albrechts-University Kiel, 24105 Kiel, Germany; (C.O.W.); (W.B.); (M.J.M.)
| | - Michael J. Maisch
- seca gmbh & co. kg., Hammer Steindamm 3-25, 22089 Hamburg, Germany; (M.J.M.); (B.J.)
| | - Björn Jensen
- seca gmbh & co. kg., Hammer Steindamm 3-25, 22089 Hamburg, Germany; (M.J.M.); (B.J.)
| | - Sven Peine
- Institute for Transfusion Medicine, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Kristina Norman
- Department of Nutrition and Gerontology, German Institute of Human Nutrition, Potsdam-Rehbruecke, 14558 Berlin, Germany;
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 13347 Berlin, Germany
| | - Manfred J. Müller
- Institute for Human Nutrition and Food Science, Christian-Albrechts-University Kiel, 24105 Kiel, Germany; (C.O.W.); (W.B.); (M.J.M.)
| | - Anja Bosy-Westphal
- Institute for Human Nutrition and Food Science, Christian-Albrechts-University Kiel, 24105 Kiel, Germany; (C.O.W.); (W.B.); (M.J.M.)
- Correspondence: ; Tel.: +49-(0)431-880-5674
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Dolly A, Lecomte T, Bouché O, Borg C, Terrebonne E, Douillard JY, Chautard R, Raoul W, Ternant D, Leger J, Bleuzen A, Dumas JF, Servais S, Baracos VE. Concurrent losses of skeletal muscle mass, adipose tissue and bone mineral density during bevacizumab / cytotoxic chemotherapy treatment for metastatic colorectal cancer. Clin Nutr 2020; 39:3319-3330. [PMID: 32164981 DOI: 10.1016/j.clnu.2020.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 01/12/2020] [Accepted: 02/13/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Changes in skeletal muscle mass (SMM), total adipose tissue mass (TAT) or bone mineral density (BMD) have been described in patients with cancer undergoing various treatments; simultaneous variations of all 3 tissues has not been reported. METHODS Data were prospectively collected in a clinical study (NCT00489697) including patients with liver metastases of colorectal cancer who received 4 cycles of bevacizumab in combination with cytotoxic chemotherapy. Computerized tomography (CT) at baseline and after chemotherapy was used to quantify skeletal muscle and adipose tissue cross-sectional areas, and mean lumbar spine BMD using validated approaches. RESULTS After exclusion of patients lacking adequate CT images or missing data, 72 subjects were included. Patients were 63% male, aged 63.2 ± 10.3 years, 100% had liver metastases and 54%, 24% and 22% respectively has 0, 1 and ≥2 extrahepatic metastases. 100% tolerated 4 cycles of treatment and none showed progressive disease at the end of treatment. The scan interval was 70 days (95% CI, 62.3 to 80.5). Thresholds for loss of tissue were defined as loss ≥ measurement error. 10% of patients showed no loss of any tissue and a further 43% lost one tissue (SMM, TAT or BMD); 47% of patients lost 2 tissues (16.5% lost SMM + TAT, 8% lost SMM + BMD, 10% lost TAT + BMD) or all 3 tissues (12.5%). Catabolic behavior (2 or 3 tissue loss vs 0 or 1 tissue loss) associated with disease burden, including unresectable primary tumor (p = 0.010), presence of extrahepatic (EH) metastases (p = 0.039) and number of EH metastases (p = 0.004). No association was found between the number of tissues lost and treatment response, which was uniformly high, or treatment toxicity, which was uniformly low. CONCLUSION Multiple tissues can be measured in routine CT images and these show considerable inter-individual variation. Substantial losses in some individuals appear to associate with disease burden.
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Affiliation(s)
- Adeline Dolly
- INSERM UMR1069, "Nutrition, Croissance et Cancer", University of Tours, France
| | - Thierry Lecomte
- Department of Hepatogastroenterology and Digestive Oncology, Hôpital Trousseau, CHRU de Tours, 37044, Tours, Cedex 09, France; EA GICC 7501, University of Tours, 10 Boulevard Tonnellé, 37000, Tours, France
| | - Olivier Bouché
- Department of Hepatogastroenterology, Hôpital Robert Debré, CHU de Reims, Avenue Général Koenig, 51092, Reims, Cedex, France
| | - Christophe Borg
- Department of Medical Oncology, Hôpital Jean Minjoz, CHRU de Besançon, 3 Boulevard Alexandre Fleming, 25000, Besançon, France
| | - Eric Terrebonne
- Department of Hepatogastroenterology and Digestive Oncology, Hôpital du Haut Lêvèque, CHU de Bordeaux, Avenue Magellan, 33604, Pessac Cedex, France
| | - Jean-Yves Douillard
- Department of Medical Oncology, ICO René Gauducheau, 44805, Saint-Herblain, France
| | - Romain Chautard
- Department of Hepatogastroenterology and Digestive Oncology, Hôpital Trousseau, CHRU de Tours, 37044, Tours, Cedex 09, France; EA GICC 7501, University of Tours, 10 Boulevard Tonnellé, 37000, Tours, France
| | - William Raoul
- EA GICC 7501, University of Tours, 10 Boulevard Tonnellé, 37000, Tours, France
| | - David Ternant
- EA GICC 7501, University of Tours, 10 Boulevard Tonnellé, 37000, Tours, France; Department of Pharmacology & Toxicology, Hôpital Bretonneau, CHRU de Tours, 37044, Tours, Cedex 09, France
| | - Julie Leger
- INSERM CIC 1415, CHRU de Tours, CHRU de Tours, 37044, Tours, Cedex 09, France
| | - Aurore Bleuzen
- Department of Radiology, Hôpital Bretonneau, CHRU de Tours, CHRU de Tours, 37044, Tours, Cedex 09, France
| | - Jean-François Dumas
- INSERM UMR1069, "Nutrition, Croissance et Cancer", University of Tours, France
| | - Stéphane Servais
- INSERM UMR1069, "Nutrition, Croissance et Cancer", University of Tours, France.
| | - Vickie E Baracos
- Department of Oncology, Division of Palliative Care Medicine, University of Alberta, Edmonton, Canada.
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van der Werf A, Langius JAE, Beeker A, Ten Tije AJ, Vulink AJ, Haringhuizen A, Berkhof J, van der Vliet HJ, Verheul HMW, de van der Schueren MAE. The effect of nutritional counseling on muscle mass and treatment outcome in patients with metastatic colorectal cancer undergoing chemotherapy: A randomized controlled trial. Clin Nutr 2020; 39:3005-3013. [PMID: 32037284 DOI: 10.1016/j.clnu.2020.01.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS A low muscle mass before start of treatment and loss of muscle mass during chemotherapy is related to adverse outcomes in patients with cancer. In this randomized controlled trial, the effect of nutritional counseling on change in muscle mass and treatment outcome in patients with metastatic colorectal cancer during first-line chemotherapy was studied. METHODS Patients scheduled for first-line chemotherapy (n = 107) were randomly assigned to individualized nutritional counseling by a dietitian (NC) or usual care (UC). NC was aimed at sufficient protein- and energy intake, supported by oral supplements or enteral feeding if indicated. Furthermore, physical activity was encouraged. Outcomes were assessed at baseline (T0) and the time of the first (T1) and second (T2) regular follow-up computed tomography scans. The proportion of patients with a clinically relevant decrease in skeletal muscle area of ≥6.0 cm2, measured by computed tomography, was the primary outcome. Secondary outcomes included body weight, quality of life, treatment toxicity and progression free and overall survival. RESULTS A total of 107 patients were enrolled (mean age, 65 years (SD, 11 years), 63% male). Mean change in skeletal muscle area from T0 till T1 was -2.5 (SD, 9.5) cm2, with no difference between NC versus UC (p = 0.891). The proportion of patients with a clinically relevant decrease in skeletal muscle area of ≥6.0 cm2 did not differ (NC 30% versus UC 31%, p = 0.467). NC compared with UC had a significant positive effect on body weight (B coefficient 1.7, p = 0.045), progression free survival (p = 0.039) and overall survival (p = 0.046). CONCLUSIONS NC of patients undergoing chemotherapy for metastatic colorectal cancer had no effect on muscle mass. However, we found that NC may increase body weight and improve progression free survival and overall survival compared to UC in this group of patients. These findings need further evaluation in future clinical trials. CLINICAL TRIAL INFORMATION ClinicalTrials.gov NCT01998152; Netherlands Trial Register NTR4223.
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Affiliation(s)
- A van der Werf
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, P.O. Box 7057, 1081 HV, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Internal Medicine, Amsterdam UMC, Vrije Universiteit, P.O. Box 7057, 1081 HV, Amsterdam, the Netherlands.
| | - J A E Langius
- Department of Nutrition and Dietetics, Internal Medicine, Amsterdam UMC, Vrije Universiteit, P.O. Box 7057, 1081 HV, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Faculty of Health, Nutrition and Sport, The Hague University of Applied Sciences, P.O. Box 13336, 2501 EH, The Hague, the Netherlands
| | - A Beeker
- Department of Medical Oncology, Spaarne Gasthuis, P.O. Box 417, 2000 AK, Haarlem, the Netherlands
| | - A J Ten Tije
- Department of Medical Oncology, Amphia Ziekenhuis, P.O. Box 90157, 4800 RL, Breda, the Netherlands
| | - A J Vulink
- Department of Medical Oncology, Reinier de Graaf Gasthuis, P.O. Box 5011, 2600 GA, Delft, the Netherlands
| | - A Haringhuizen
- Department of Medical Oncology, Ziekenhuis Gelderse Vallei, P.O. Box 9025, 6710 HN, Ede, the Netherlands
| | - J Berkhof
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit, P.O. Box 7057, 1081 HV, Amsterdam, the Netherlands
| | - H J van der Vliet
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, P.O. Box 7057, 1081 HV, Amsterdam, the Netherlands
| | - H M W Verheul
- Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit, Cancer Center Amsterdam, P.O. Box 7057, 1081 HV, Amsterdam, the Netherlands
| | - M A E de van der Schueren
- Department of Nutrition and Dietetics, Internal Medicine, Amsterdam UMC, Vrije Universiteit, P.O. Box 7057, 1081 HV, Amsterdam, the Netherlands; Department of Nutrition and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, P.O. Box 6960, 6503 GL, Nijmegen, the Netherlands
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Kjønigsen LJ, Harneshaug M, Fløtten AM, Karterud LK, Petterson K, Skjolde G, Eggesbø HB, Weedon-Fekjær H, Henriksen HB, Lauritzen PM. Reproducibility of semiautomated body composition segmentation of abdominal computed tomography: a multiobserver study. Eur Radiol Exp 2019; 3:42. [PMID: 31664547 PMCID: PMC6820626 DOI: 10.1186/s41747-019-0122-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/28/2019] [Indexed: 12/21/2022] Open
Abstract
Background Segmentation of computed tomography (CT) images provides quantitative data on body tissue composition, which may greatly impact the development and progression of diseases such as type 2 diabetes mellitus and cancer. We aimed to evaluate the inter- and intraobserver variation of semiautomated segmentation, to assess whether multiple observers may interchangeably perform this task. Methods Anonymised, unenhanced, single mid-abdominal CT images were acquired from 132 subjects from two previous studies. Semiautomated segmentation was performed using a proprietary software package. Abdominal muscle compartment (AMC), inter- and intramuscular adipose tissue (IMAT), visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were identified according to pre-established attenuation ranges. The segmentation was performed by four observers: an oncology resident with extensive training and three radiographers with a 2-week training programme. To assess interobserver variation, segmentation of each CT image was performed individually by two or more observers. To assess intraobserver variation, three of the observers did repeated segmentations of the images. The distribution of variation between subjects, observers and random noise was estimated by a mixed effects model. Inter- and intraobserver correlation was assessed by intraclass correlation coefficient (ICC). Results For all four tissue compartments, the observer variations were far lower than random noise by factors ranging from 1.6 to 3.6 and those between subjects by factors ranging from 7.3 to 186.1. All interobserver ICC was ≥ 0.938, and all intraobserver ICC was ≥ 0.996. Conclusions Body composition segmentation showed a very low level of operator dependability. Multiple observers may interchangeably perform this task with highly reproducible results. Electronic supplementary material The online version of this article (10.1186/s41747-019-0122-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Magnus Harneshaug
- The Centre for Old Age Psychiatry Research, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ann-Monica Fløtten
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Lena Korsmo Karterud
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Kent Petterson
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Grethe Skjolde
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Heidi B Eggesbø
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Harald Weedon-Fekjær
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Hege Berg Henriksen
- Division of Clinical Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Peter M Lauritzen
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
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The effects of testosterone administration on muscle areas of the trunk and pelvic floor in hysterectomized women with low testosterone levels: proof-of-concept study. ACTA ACUST UNITED AC 2019; 26:1405-1414. [PMID: 31479032 DOI: 10.1097/gme.0000000000001410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this study was to determine the effect of testosterone administration on trunk and pelvic floor muscle area in women with low testosterone levels. METHODS Participants were hysterectomized women with total testosterone<31 ng/dL and/or free testosterone<3.5 pg/mL; participating in the Testosterone Dose Response in Surgically Menopausal Women (TDSM) trial. All participants received a standardized transdermal estradiol regimen during the 12-week run-in period, and were then randomized to receive weekly intramuscular injections of placebo, or 3, 6.25, 12.5, or 25 mg testosterone enanthate for 24 weeks. Muscle areas of the trunk and pelvis were measured at baseline and end of treatment using 1.5 Tesla magnetic resonance imaging. Total and free testosterone levels were measured by liquid chromatography-tandem mass spectrometry and equilibrium dialysis, respectively. Testosterone effect on muscle areas was analyzed using linear regression models. RESULTS A total of 24 women who had available baseline and posttreatment magnetic resonance imaging were included in the analysis. Increased cross-sectional areas of the paraspinal, psoas, and abdominal wall muscles were seen after testosterone administration. The estimated mean change (95% CI; P value) between treatment groups was 4.07 cm (1.26-6.88; P = 0.007) for paraspinal, 1.60 cm (0.10-3.09; P = 0.038) for psoas major, and 7.49 cm (1.96-13.02; P = 0.011) for abdominal wall muscles. Increases in psoas muscle area were significantly associated with changes in free testosterone concentrations. No significant changes in obturator internus and pelvic floor muscle areas were observed. CONCLUSION Short-term testosterone administration in women with low testosterone levels was associated with increased trunk muscle area.
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Looijaard WGPM, Stapel SN, Dekker IM, Rusticus H, Remmelzwaal S, Girbes ARJ, Weijs PJM, Oudemans-van Straaten HM. Identifying critically ill patients with low muscle mass: Agreement between bioelectrical impedance analysis and computed tomography. Clin Nutr 2019; 39:1809-1817. [PMID: 31492456 DOI: 10.1016/j.clnu.2019.07.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/18/2019] [Accepted: 07/20/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Low muscle mass and -quality on ICU admission, as assessed by muscle area and -density on CT-scanning at lumbar level 3 (L3), are associated with increased mortality. However, CT-scan analysis is not feasible for standard care. Bioelectrical impedance analysis (BIA) assesses body composition by incorporating the raw measurements resistance, reactance, and phase angle in equations. Our purpose was to compare BIA- and CT-derived muscle mass, to determine whether BIA identified the patients with low skeletal muscle area on CT-scan, and to determine the relation between raw BIA and raw CT measurements. METHODS This prospective observational study included adult intensive care patients with an abdominal CT-scan. CT-scans were analysed at L3 level for skeletal muscle area (cm2) and skeletal muscle density (Hounsfield Units). Muscle area was converted to muscle mass (kg) using the Shen equation (MMCT). BIA was performed within 72 h of the CT-scan. BIA-derived muscle mass was calculated by three equations: Talluri (MMTalluri), Janssen (MMJanssen), and Kyle (MMKyle). To compare BIA- and CT-derived muscle mass correlations, bias, and limits of agreement were calculated. To test whether BIA identifies low skeletal muscle area on CT-scan, ROC-curves were constructed. Furthermore, raw BIA and CT measurements, were correlated and raw CT-measurements were compared between groups with normal and low phase angle. RESULTS 110 patients were included. Mean age 59 ± 17 years, mean APACHE II score 17 (11-25); 68% male. MMTalluri and MMJanssen were significantly higher (36.0 ± 9.9 kg and 31.5 ± 7.8 kg, respectively) and MMKyle significantly lower (25.2 ± 5.6 kg) than MMCT (29.2 ± 6.7 kg). For all BIA-derived muscle mass equations, a proportional bias was apparent with increasing disagreement at higher muscle mass. MMTalluri correlated strongest with CT-derived muscle mass (r = 0.834, p < 0.001) and had good discriminative capacity to identify patients with low skeletal muscle area on CT-scan (AUC: 0.919 for males; 0.912 for females). Of the raw measurements, phase angle and skeletal muscle density correlated best (r = 0.701, p < 0.001). CT-derived skeletal muscle area and -density were significantly lower in patients with low compared to normal phase angle. CONCLUSIONS Although correlated, absolute values of BIA- and CT-derived muscle mass disagree, especially in the high muscle mass range. However, BIA and CT identified the same critically ill population with low skeletal muscle area on CT-scan. Furthermore, low phase angle corresponded to low skeletal muscle area and -density. TRIAL REGISTRATION ClinicalTrials.gov (NCT02555670).
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Affiliation(s)
- Willem G P M Looijaard
- Department of Adult Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute for Cardiovascular Research (ICaR), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Sandra N Stapel
- Department of Adult Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute for Cardiovascular Research (ICaR), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Ingeborg M Dekker
- Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Hanna Rusticus
- Department of Adult Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute for Cardiovascular Research (ICaR), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Sharon Remmelzwaal
- Department of Adult Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute for Cardiovascular Research (ICaR), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Armand R J Girbes
- Department of Adult Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute for Cardiovascular Research (ICaR), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Peter J M Weijs
- Department of Adult Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Heleen M Oudemans-van Straaten
- Department of Adult Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute for Cardiovascular Research (ICaR), Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
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Reber E, Gomes F, Vasiloglou MF, Schuetz P, Stanga Z. Nutritional Risk Screening and Assessment. J Clin Med 2019; 8:jcm8071065. [PMID: 31330781 PMCID: PMC6679209 DOI: 10.3390/jcm8071065] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 01/04/2023] Open
Abstract
Malnutrition is an independent risk factor that negatively influences patients’ clinical outcomes, quality of life, body function, and autonomy. Early identification of patients at risk of malnutrition or who are malnourished is crucial in order to start a timely and adequate nutritional support. Nutritional risk screening, a simple and rapid first-line tool to detect patients at risk of malnutrition, should be performed systematically in patients at hospital admission. Patients with nutritional risk should subsequently undergo a more detailed nutritional assessment to identify and quantify specific nutritional problems. Such an assessment includes subjective and objective parameters such as medical history, current and past dietary intake (including energy and protein balance), physical examination and anthropometric measurements, functional and mental assessment, quality of life, medications, and laboratory values. Nutritional care plans should be developed in a multidisciplinary approach, and implemented to maintain and improve patients’ nutritional condition. Standardized nutritional management including systematic risk screening and assessment may also contribute to reduced healthcare costs. Adequate and timely implementation of nutritional support has been linked with favorable outcomes such as a decrease in length of hospital stay, reduced mortality, and reductions in the rate of severe complications, as well as improvements in quality of life and functional status. The aim of this review article is to provide a comprehensive overview of nutritional screening and assessment methods that can contribute to an effective and well-structured nutritional management (process cascade) of hospitalized patients.
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Affiliation(s)
- Emilie Reber
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland.
| | - Filomena Gomes
- The New York Academy of Sciences, 250 Greenwich Sweet, 40th floor, New York, NY 10007, USA
| | - Maria F Vasiloglou
- Diabetes Technology Research Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008 Bern, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Tellstrasse 25, 5000 Aarau, Switzerland
- Department for Clinical Research, Medical Faculty, University of Basel, 4001 Basel, Switzerland
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital, and University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
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Ng CC, Lee ZY, Chan WY, Jamaluddin MF, Tan LJ, Sitaram PN, Ruslan SR, Hasan MS. Low Muscularity as Assessed by Abdominal Computed Tomography on Intensive Care Unit Admission Is Associated With Mortality in a Critically Ill Asian Population. JPEN J Parenter Enteral Nutr 2019; 44:425-433. [PMID: 31173666 DOI: 10.1002/jpen.1666] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/22/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Low muscularity (LM) is associated with high mortality in the Caucasian critically ill population. Muscularity can be accurately measured by the skeletal muscle index (SMI; cm2 /m2 ) generated by computed tomography (CT). This study aimed to establish the overall and sex-specific cutoff values that predict hospital mortality in an Asian critically ill population. METHODS This single-center, retrospective, observational study included patients aged ≥18 years with an abdominal CT conducted within 72 hours of admission to the intensive care unit. SMI generated from CT images at the level of the mid-third lumbar vertebra were extracted from the medical records. Area under the receiver operating characteristic curves (AUC) was generated to determine the SMI cutoff values for hospital mortality. Association between LM (defined by SMI cutoff value) and hospital mortality was further evaluated by multivariable logistic regression. RESULTS In a sample of 228 patients, the overall SMI cutoff value (cm2 /m2 ) for hospital mortality was 42.0 (AUC: 0.637; sensitivity: 66.7%, specificity: 56.8%), whereas it was 46.5 in males and 35.3 in females. More males than females had LM (51.4% vs 37.5%), and >40% of overweight/obese patients had LM. Patients with LM were older and had a longer duration of mechanical ventilation and hospitalization. After adjusting for known confounders, LM independently predicted hospital mortality in the overall sample (adjusted odds ratio: 2.42; 95% CI 1.16-5.03; P = 0.003) and in both sexes. CONCLUSION This study established a set of SMI cutoff values that predict hospital mortality. LM is independently associated with hospital mortality.
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Affiliation(s)
- Ching Choe Ng
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zheng-Yii Lee
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wai Yee Chan
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Lin Jun Tan
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Premela Naidu Sitaram
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shairil Rahayu Ruslan
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - M Shahnaz Hasan
- Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Moreau J, Ordan MA, Barbe C, Mazza C, Perrier M, Botsen D, Brasseur M, Portefaix C, Renard Y, Tallière B, Bertin E, Hoeffel C, Bouché O. Correlation between muscle mass and handgrip strength in digestive cancer patients undergoing chemotherapy. Cancer Med 2019; 8:3677-3684. [PMID: 31115188 PMCID: PMC6639177 DOI: 10.1002/cam4.2238] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background FIGHTDIGO study has shown the feasibility of handgrip strength (HGS) measurements in 201 consecutive digestive cancer patients undergoing chemotherapy. Objective This study focuses on a secondary aim of FIGHTDIGO study: the relationship between muscle mass and HGS. Design Two consecutive bilateral measures of HGS were performed using a Jamar dynamometer before the start of each chemotherapy. The highest value was chosen for final evaluation. Dynapenia (loss of muscle strength) was defined as HGS < 30 kg (men) and < 20 kg (women). Muscle mass was measured at lumbar level (L3) on Computed Tomography (CT) scans performed less than 3 weeks before or after the measurement of HGS. Muscle mass loss was defined by skeletal muscle index (SMI) < 53 cm2/m2 (in men with a body mass index (BMI)> 25 kg/m2), < 43 cm2/m2 (in men with a BMI < 25 kg/m2), and < 41 cm2/m2 (in women regardless of BMI). Sarcopenia was defined by the association of a dynapenia and a loss of muscle mass. Results A total of 150 patients were included in this analysis (mean age: 65.6 ± 10.9 years, 87 males (58%), colorectal cancer (47.3%), metastatic stage (76.7%)). A total of 348 CT scans were evaluated. For the 348 measurements, mean SMI and HGS were 41.8 ± 8.7 cm2/m2 and 32.1 ± 11.0 kg, respectively. Muscle mass loss, dynapenia, or sarcopenia were reported at least once, in 120 (80%), 45 (30%), and 30 (20%) patients, respectively. SMI was significantly correlated with HGS (Pearson coefficient = 0.53, P < 0.0001). At concordance analysis, 188 dyad SMI/HGS (54%) were in agreement (Kappa = 0.14 [95% CI, 0.07‐0.21]). Conclusion Correlation between the measurements of HGS and SMI is strong but the concordance between dynapenia and muscle mass loss is poor. Further studies should be performed to confirm the diagnostic thresholds, and to study the chronology of dynapenia and loss of muscle mass.
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Affiliation(s)
- Johanna Moreau
- Ambulatory Care Unit, Reims University Hospital, Reims, France.,Departement of Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
| | | | - Coralie Barbe
- Department of Biostatistics, Reims University Hospital, Reims, France
| | - Camille Mazza
- Ambulatory Care Unit, Reims University Hospital, Reims, France
| | - Marine Perrier
- Ambulatory Care Unit, Reims University Hospital, Reims, France.,Departement of Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
| | - Damien Botsen
- Ambulatory Care Unit, Reims University Hospital, Reims, France
| | - Mathilde Brasseur
- Ambulatory Care Unit, Reims University Hospital, Reims, France.,Departement of Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
| | - Christophe Portefaix
- Department of Radiology, Reims University Hospital, Reims, France.,CReSTIC, Reims University, Reims, France
| | - Yohann Renard
- Department of General and Digestive Surgey, Reims University Hospital, Reims, France
| | - Barbara Tallière
- Artificial Nutrition Unit, Reims University Hospital, Reims, France
| | - Eric Bertin
- Department of Nutrition, Endocrinology, and Diabétology, Reims University Hospital, Reims, France
| | - Christine Hoeffel
- Department of Radiology, Reims University Hospital, Reims, France.,CReSTIC, Reims University, Reims, France
| | - Olivier Bouché
- Ambulatory Care Unit, Reims University Hospital, Reims, France.,Departement of Gastroenterology and Digestive Oncology, Reims University Hospital, Reims, France
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Nichols JA, Bo Foreman K, Barg A, Saltzman CL, Anderson AE. Ankle strength, muscle size, and adipose content following unilateral tibiotalar arthrodesis. J Orthop Res 2019; 37:1143-1152. [PMID: 30908742 PMCID: PMC6557278 DOI: 10.1002/jor.24282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/25/2019] [Indexed: 02/04/2023]
Abstract
Tibiotalar arthrodesis is commonly used to treat end-stage ankle osteoarthritis. Post-operative impairments are often attributed to limited ankle motion. However, whether muscular deficits also exist, thereby potentially contributing to impairments, is unknown. This study aimed to identify post-operative deficits in ankle musculature by examining range of motion, strength (maximum isometric ankle joint torque), and leg composition (cross-sectional area of individual tissue types: bone, subcutaneous adipose, intramuscular adipose, muscle). Ten individuals with unilateral tibiotalar arthrodesis participated. Paired t-tests (p < 0.05) identified differences between the fused and contralateral, control limb. The results indicate that individuals with tibiotalar arthrodesis have profound losses of range of motion and strength. Across participants, range of motion in the fused limb was 53.5 ± 11.7%, 66.8 ± 6.3%, 38.2 ± 18.7%, 37.8 ± 13.6% less than the control for dorsiflexion, plantarflexion, inversion, and eversion, respectively. The largest strength deficit was in dorsiflexion, with the fused limb producing 47.2 ± 9.4% less torque than the control. The quantity and quality of muscle tissue was also negatively affected in individuals following tibiotalar arthrodesis. The total cross-sectional area of the fused limb was 11.4 ± 5.4% smaller than the control limb. This change was primarily due to the 16.1 ± 6.7% decrease in muscle cross-sectional area. However, intramuscular adipose was significantly increased. Although the posterior compartment demonstrated a significant decrease in cross-sectional area, when accounting for differences in total cross-sectional area, the relative sizes of the four muscle compartments were consistent between limbs. This cross-sectional study motivates longitudinal research examining muscular deficits and whether these deficits are reversible with exercise and rehabilitation. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Jennifer A. Nichols
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108
| | - K. Bo Foreman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108,Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108
| | - Charles L. Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108
| | - Andrew E. Anderson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108,Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108,Department of Bioengineering, University of Utah, 36 S Wasatch Drive, Salt Lake City, UT 84112,Scientific Computing & Imaging Institute, University of Utah, 72 S Central Campus Drive, Salt Lake City, UT 84112
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46
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Tapper J, Arver S, Pencina KM, Martling A, Blomqvist L, Buchli C, Li Z, Gagliano-Jucá T, Travison TG, Huang G, Storer TW, Bhasin S, Basaria S. Muscles of the trunk and pelvis are responsive to testosterone administration: data from testosterone dose-response study in young healthy men. Andrology 2018; 6:64-73. [PMID: 29280355 DOI: 10.1111/andr.12454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 12/26/2022]
Abstract
Testosterone dose-dependently increases appendicular muscle mass. However, the effects of testosterone administration on the core muscles of the trunk and the pelvis have not been evaluated. The present study evaluated the effects of testosterone administration on truncal and pelvic muscles in a dose-response trial. Participants were young healthy men aged 18-50 years participating in the 5α-Reductase (5aR) Trial. All participants received monthly injections of 7.5 mg leuprolide acetate to suppress endogenous testosterone production and weekly injections of 50, 125, 300, or 600 mg of testosterone enanthate and were randomized to receive either 2.5 mg dutasteride (5aR inhibitor) or placebo daily for 20 weeks. Muscles of the trunk and the pelvis were measured at baseline and the end of treatment using 1.5-Tesla magnetic resonance imaging. The dose effect of testosterone on changes in the psoas major muscle area was the primary outcome; secondary outcomes included changes in paraspinal, abdominal, pelvic floor, ischiocavernosus, and obturator internus muscles. The association between changes in testosterone levels and muscle area was also assessed. Testosterone dose-dependently increased areas of all truncal and pelvic muscles. The estimated change (95% confidence interval) of muscle area increase per 100 mg of testosterone enanthate dosage increase was 0.622 cm2 (0.394, 0.850) for psoas; 1.789 cm2 (1.317, 2.261) for paraspinal muscles, 2.530 cm2 (1.627, 3.434) for total abdominal muscles, 0.455 cm2 (0.233, 0.678) for obturator internus, and 0.082 cm2 (0.003, 0.045) for ischiocavernosus; the increase in these volumes was significantly associated with the changes in on-treatment total and free serum testosterone concentrations. In conclusion, core muscles of the trunk and pelvis are responsive to testosterone administration. Future trials should evaluate the potential role of testosterone administration in frail men who are predisposed to falls and men with pelvic floor dysfunction.
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Affiliation(s)
- J Tapper
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - S Arver
- Centre for Andrology and Sexual Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - K M Pencina
- Section of Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - A Martling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - L Blomqvist
- Department of Diagnostic Radiology, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - C Buchli
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Z Li
- Section of Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - T Gagliano-Jucá
- Section of Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - T G Travison
- Program on Aging, Hebrew SeniorLife, Roslindale, MA, USA
| | - G Huang
- Section of Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - T W Storer
- Section of Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S Bhasin
- Section of Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S Basaria
- Section of Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Muscle morphology and performance in master athletes: A systematic review and meta-analyses. Ageing Res Rev 2018; 45:62-82. [PMID: 29715523 DOI: 10.1016/j.arr.2018.04.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/26/2018] [Accepted: 04/24/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The extent to which chronic exercise training preserves age-related decrements in physical function, muscle strength, mass and morphology is unclear. Our aim was to conduct a systematic review of the literature to determine to what extent chronically trained master athletes (strength/power and endurance) preserve levels of physical function, muscle strength, muscle mass and morphology in older age, compared with older and younger controls and young trained individuals. METHODS The systematic data search included Medline, EMBASE, SPORTDiscus, CINAHL and Web of Science databases. INCLUSION CRITERIA i) master athletes mean exercise training duration ≥20 years ii) master athletes mean age of cohort >59 years) iii) at least one measurement of muscle mass/volume/fibre-type morphology and/or strength/physical function. RESULTS Fifty-five eligible studies were identified. Meta-analyses were carried out on maximal aerobic capacity, maximal voluntary contraction and body composition. Master endurance athletes (42.0 ± 6.6 ml kg-1 min-1) exhibited VO2max values comparable with young healthy controls (43.1 ± 6.8 ml kg-1 min-1, P = .84), greater than older controls (27.1 ± 4.3 ml kg-1 min-1, P < 0.01) and master strength/power athletes (26.5 ± 2.3 mlkg-1 min-1, P < 0.01), and lower than young endurance trained individuals (60.0 ± 5.4 ml kg-1 min-1, P < 0.01). Master strength/power athletes (0.60 (0.28-0.93) P < 0.01) and young controls (0.71 (0.06-1.36) P < 0.05) were significantly stronger compared with the other groups. Body fat% was greater in master endurance athletes than young endurance trained (-4.44% (-8.44 to -0.43) P < 0.05) but lower compared with older controls (7.11% (5.70-8.52) P < 0.01). CONCLUSION Despite advancing age, this review suggests that chronic exercise training preserves physical function, muscular strength and body fat levels similar to that of young, healthy individuals in an exercise mode-specific manner.
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Baracos VE, Arribas L. Sarcopenic obesity: hidden muscle wasting and its impact for survival and complications of cancer therapy. Ann Oncol 2018; 29 Suppl 2:ii1-ii9. [PMID: 29506228 DOI: 10.1093/annonc/mdx810] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Body composition, defined as the proportions and distribution of lean and fat tissues in the human body, is an emergent theme in clinical oncology. Severe muscle depletion (sarcopenia) is most easily overlooked in obese patients; the advent of secondary analysis of oncologic images provides a precise and specific assessment of sarcopenia. Here, we review the definitions, prevalence and clinical implications of sarcopenic obesity (SO) in medical and surgical oncology. Reported prevalence of SO varies due to the heterogeneity in the definitions and the variability in the cut points used to define low muscle mass and high fat mass. Prevalence of SO in advanced solid tumor patient populations average 9% (range 2.3%-14.6%) overall, and one in four (24.7%, range 5.9%-39.2%) patients with body mass index ≥ 30 kg/m2 are sarcopenic. SO is independently associated with higher mortality and higher rate of complications in systemic and surgical cancer treatment, across multiple cancer sites and treatment plans. These associations remain unexplained, however, it has been hypothesized that patients with sarcopenia are generally unfit and unable to tolerate stress. Another proposed mechanism relates to increased exposure to antineoplastic therapy, i.e. a large fat mass would be expected to inflate drug dose in BSA-based treatments, causing an increased rate of dose-limiting toxicity. Pharmacokinetic data are needed to confirm or refute this hypothesis. Old age, deconditioning, cancer progression, acute or chronic nonmalignant disease and drug side-effects are suggested causes of muscle loss, and it is unknown the degree to which this can be reversed. Sarcopenia can be readily detected before start of cancer treatment, however, clinical management protocols for SO patients require development. Studies of cancer treatment dose-modulation are in progress.
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Affiliation(s)
- V E Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Canada
| | - L Arribas
- Clinical Nutrition Unit, Catalan Institute of Oncology (ICO), Barcelona, Spain
- IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
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Visceral adiposity but not subcutaneous fat associated with improved outcome of patients with acute cholecystitis. J Surg Res 2018; 225:15-20. [PMID: 29605026 DOI: 10.1016/j.jss.2017.11.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/28/2017] [Accepted: 11/21/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of this study to study the effect of visceral and subcutaneous fat tissue mass on short- and long-term prognosis of patients with acute calculus cholecystitis (ACC). METHODS Retrospective analysis of medical records. Included were all patients admitted because of ACC. Computed tomography images at the level of L3 were analyzed for body composition using designated software (Slice-O-matic; TomoVision, Montreal, Quebec, Canada). General linear model was used to analyze the effect of body composition on length of hospital stay, and Cox regression analysis was used to ascertain the effect of the different parameters on 1-y survival. RESULTS Included were 159 patients (mean age: 71.7 ± 15.8 y, 54.7% males). Fat was the most abundant tissue (401 ± 175 cm2 of the computed tomography slices surface area), and visceral fat was 45.8 ± 14.1% of the fat area measured. Using the general linear model, we found that American Society of Anesthesiologists score, disease severity index, and age were positively associated with higher length of stay, whereas high visceral fat was associated with lower length of stay (estimated marginal means at 7.4 ± 1.4 d compared to 12.7 ± 1.4 d among patients with lower visceral fat surface area, P = 0.010). The Cox regression model showed that 1-y survival risk was significantly reduced by age, the Charlson Comorbidity Index and high muscle mass. High visceral adiposity was associated with improved survival (odds ratio: 0.216, 95% confidence interval: 0.064-0.724, P = 0.013). Subcutaneous adiposity did not affect prognosis. CONCLUSIONS Visceral adiposity is associated with shorter length of stay and improved 1-y survival among patients hospitalized with ACC.
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50
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Percentiles for skeletal muscle index, area and radiation attenuation based on computed tomography imaging in a healthy Caucasian population. Eur J Clin Nutr 2017; 72:288-296. [PMID: 29242526 PMCID: PMC5842880 DOI: 10.1038/s41430-017-0034-5] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 07/14/2017] [Accepted: 10/04/2017] [Indexed: 12/18/2022]
Abstract
Background/objectives Muscle mass is a key determinant of nutritional status and associated with outcomes in several patient groups. Computed tomography (CT) analysis is increasingly used to assess skeletal muscle area (SMA), skeletal muscle index (SMI) and muscle radiation attenuation (MRA). However, interpretation of these muscle parameters is difficult since values in a healthy population are lacking. The aim of this study was to provide sex specific percentiles for SMA, SMA and MRA in a healthy Caucasian population and to examine the association with age and BMI in order to define age- and BMI specific percentiles. Subjects/methods In this retrospective cross-sectional study CT scans of potential kidney donors were used to assess SMA, SMI and MRA at the level of the third lumbar vertebra. Sex specific distributions were described and, based on the association between age/BMI and muscle parameters, age, and BMI specific predicted percentiles were computed. The 5th percentile was considered as cut-off. Results CT scans of 420 Individuals were included (age range 20–82 years and BMI range 17.5–40.7 kg/m2). Sex specific cut-offs of SMA, SMI and MRA were 134.0 cm2, 41.6 cm2/m2 and 29.3 HU in men and 89.2 cm2, 32.0 cm2/m2 and 22.0 HU in women, respectively. Correlations were negative between age and all three muscle parameters, positive between BMI and SMA/SMI and negative between BMI and MRA, resulting in age- and BMI specific percentiles. Conclusions This study provides sex specific percentiles for SMA, SMI, and MRA. In addition, age- and BMI specific percentiles have been established.
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