Sarcopenia in Breast Cancer Patients: A Systematic Review and Meta-Analysis

(1) Background: We estimated the prevalence and clinical outcomes of sarcopenia among breast cancer patients. (2) Methods: A systematic literature search was carried out for the period between July 2023 and October 2023. Studies with breast cancer patients evaluated for sarcopenia in relation to overall survival (OS), progression-free survival (PFS), relapse of disease (DFS), pathological complete response (pCR), or toxicity to chemotherapy were included. (3) Results: Out of 359 screened studies, 16 were eligible for meta-analysis, including 6130 patients, of whom 5284 with non-MBC. Sarcopenia was evaluated with the computed tomography (CT) scan skeletal muscle index and, in two studies, with the dual-energy x-ray absorptiometry (DEXA) appendicular lean mass index. Using different classifications and cut-off points, overall, there were 2007 sarcopenic patients (33%), of whom 1901 (95%) presented with non-MBC. Sarcopenia was associated with a 33% and 29% higher risk of mortality and progression/relapse of disease, respectively. Sarcopenic patients were more likely to develop grade 3-4 toxicity (OR 3.58, 95% CI 2.11-6.06, p < 0.0001). In the neoadjuvant setting, a higher rate of pCR was observed among sarcopenic patients (49%) (OR 2.74, 95% CI 0.92-8.22). (4) Conclusions: Our meta-analysis confirms the correlation between sarcopenia and negative outcomes, especially in terms of higher toxicity.

Does Conventional Open TLIF cause more Muscle Injury when Compared to Minimally Invasive TLIF?-A Prospective Single Center Analysis

STUDY DESIGN

Prospective, observational.

OBJECTIVES

The aim of our study was to assess the amount of reduction in lean muscle mass (LMM) of multifidus muscle (MFM) between conventional open Transforaminal lumbar interbody fusion (CO-TLIF) as compared to Minimally invasive spine Transforaminal lumbar interbody fusion (MIS-TLIF).

METHODS

This study was conducted between 2017 and 2020. It included 100 patients divided into two groups, 50 patients treated with CO-TLIF, 50 treated with MIS-TLIF. Only patients undergoing single level, primary lumbar fusion at L4-5 or L5-S1 level for degenerative pathologies were included. All patients were assessed by magnetic resonance imaging (MRI) scans 1-year post surgery. Measurements were performed using ImageJ image processing program.

RESULTS

Mean percentage reduction in LMM in CO-TLIF group was 45.52 ± 12.36% and MIS-TLIF group was 25.83 ± 9.64% [statistically significant (t = 8.78, P < .001)]. Mean percentage reduction in LMM on side of cage insertion was 39.63 ± 15.96% and opposite side was 31.40 ± 15.01% [statistically significant (t = 9.06, P < .001)]. Mean reduction of LMM among males was 29.38 ± 15.23% and females was 40.42 ± 12.67% [statistically significant (t = -3.95, P < .001)].We observed significant but weak degree of correlation between age and percentage reduction of LMM (r = .22, P = .028).

CONCLUSION

Mean reduction in LMM was greater in CO-TLIF group as compared to MIS-TLIF. There was greater reduction in LMM in females and on side of cage insertion. We also found greater reduction in LMM with increasing age in both groups.

Association between lean muscle mass and treatment-resistant late-life depression in the IRL-GRey randomized controlled trial

OBJECTIVE

To investigate the relationship between lean muscle mass and treatment response in treatment-resistant late-life depression (TR-LLD). We hypothesized that lower lean muscle mass would be associated with older age, higher physical comorbidities, higher depressive symptom severity, and poorer treatment response.

DESIGN

Secondary analysis of a randomized, placebo-controlled trial.

SETTING

Three academic hospitals in the United States and Canada.

PARTICIPANTS

Adults aged 60+ years with major depressive disorder who did not remit following open treatment with venlafaxine extended-release (XR) (n = 178).

MEASUREMENTS

We estimated lean muscle mass using dual-energy X-ray absorptiometry (DEXA) scans prior to and following randomized treatment with aripiprazole or placebo added to venlafaxine XR. Multivariate regressions estimated influence of demographic and clinical factors on baseline lean muscle mass, and whether baseline lean muscle mass was associated with treatment response, adjusted for treatment arm.

RESULTS

Low lean muscle mass was present in 22 (12.4%) participants. Older age and female sex, but not depressive symptom severity, were independently associated with lower lean muscle mass at baseline. Marital status, baseline depressive symptom severity, and treatment group were associated with improvement of depressive symptoms in the randomized treatment phase. Baseline lean muscle mass was not associated with improvement, regardless of treatment group.

CONCLUSION

As expected, older age and female sex were associated with lower lean muscle mass in TR-LLD. However, contrary to prior results in LLD, lean muscle mass was not associated with depression severity or outcome. This suggests that aripiprazole augmentation may be useful for TR-LLD, even in the presence of anomalous body composition.clinicaltrials.gov Identifier: NCT00892047.

Investigation of the Relationship between Lean Muscle Mass and Erythropoietin Resistance in Maintenance Haemodialysis Patients: A Cross-Sectional Study

Each patient undergoing maintenance haemodialysis (MHD) has a different response to erythropoiesis-stimulating agents (ESAs). Haemodilution due to fluid overload has been shown to contribute to anaemia. Body mass index (BMI) has been shown to influence ESA response in dialysis patients; however, BMI calculation does not distinguish between fat and lean tissue. The association between lean muscle mass and erythropoietin hyporesponsiveness is still not well-known among MHD patients. We designed a cross-sectional study and used bioimpedance spectroscopy (BIS) to analyse the relationship between body composition, haemoglobin level, and erythropoietin resistance index (ERI) in MHD patients. Seventy-seven patients were enrolled in the study group. Compared with patients with haemoglobin ≥ 10 g/dL, those with haemoglobin < 10 g/dL had higher serum ferritin levels, malnutrition−inflammation scores (MIS), relative overhydration, ESA doses, and ERIs. In multivariate logistic regression, higher ferritin levels and MIS were the only predictors of lower haemoglobin levels. The ERI was significantly positively correlated with age, Kt/V, ferritin levels, and MIS and negatively correlated with albumin levels, BMI, and lean tissue index (LTI). Multivariate linear regression analysis revealed that ferritin levels, BMI, and LTI were the most important predictors of ERI. In MHD patients, using BIS to measure body composition can facilitate the development of early interventions that aim to prevent sarcopenia, support ESA responsiveness, and, consequently, improve anaemia management.

Sex differences and shifts in body composition, physical activity, and total energy expenditure across a 3-month expedition

OBJECTIVES

An energetically demanding environment like a wilderness expedition can lead to potent stressors on human physiology and homeostatic balance causing shifts in energy expenditure and body composition. These shifts likely have consequences on overall health and performance and may potentially differ by sex. It is therefore critical to understand the potential differential body composition and energy expenditure changes in response to a novel and challenging environment in both males and female bodies.

METHODS

Data were collected from 75 healthy individuals (female = 41; ages 18-53) throughout a 3-month long expedition in the American Rockies. Body mass, body fat, and lean muscle mass were measured before, during, and after the course. Physical activity intensity and energy expenditure were also measured in a subset of participants using the wGT3X-BT Actigraph wrist monitor and an accompanying Bluetooth heart rate monitor.

RESULTS

Over the 3-month period, individuals initially experienced declines in body mass, body fat percentage, and lean muscle mass. Participants partially rebounded from these deficits to maintain overall body mass with a slight recomposition of body fat and lean muscle mass. Our data also demonstrated that sex moderated total energy expenditure, where females experienced a modest decline whereas males experienced an increase in energy expenditure from the beginning to the end of the course.

CONCLUSIONS

Understanding changes in energy storage in the body and variation in energy expenditure between sexes during a 3-month expedition has critical implications for maintaining health and performance in an energetically demanding environment where resources may be scarce.

Muscle Mass and Gait Characteristics in Older Women Fallers vs. Non-Fallers

Background: Falling is a major public health concern of elderly people. We aimed to determine if lean mass and spatiotemporal gait parameters could predict the risk of falling in elderly women and also study the relationships between lean mass and gait characteristics. Methods: Twenty-four community women were prospectively recruited (mean age, 72.30 ± 5.31 years). Lean mass was measured using dual-energy fan-beam X-ray absorptiometry. Gait characteristics were assessed using spatiotemporal analysis. Fall risks were assessed using the Berg Balance Scale (BBS) and the Falls Efficacy Scale-International. Fall histories were recorded. Appropriate statistical analyses were applied to determine lean mass and gait characteristics in predicting the risk of fall and the associations between lean mass and gait characteristics. Results: There were 14 participants (58.33%) with fall histories. Patients with fall histories had a significantly narrower base of support and lower BBS score. However, only the base of support was significantly associated with fall risk (odds ratio, 0.415; p = 0.022). Lean mass was significantly negatively associated with proportion of swing phase and positively associated with proportions of stance and double-support phases. Conclusion: Fall risk among elderly women can be predicted using base of support, where a narrower base predicts a greater fall risk. Although the lean mass was not related to risk of fall, lean mass is still related to some gait characteristics.

Urine creatinine concentration and clinical outcomes in older adults: The Cardiovascular Health Study

PURPOSE

Loss of muscle mass and strength are associated with long-term adverse health outcomes in older adults. Urine creatinine concentrations (Ucr; mg/dl) are a measure of muscle tissue mass and turnover. This study assessed the associations of a spot Ucr level with muscle mass and with risk of hospitalization, mortality, and diabetes mellitus in older adults.

METHODS

We examined 3424 participants from the Cardiovascular Health Study who provided spot urine samples in 1996-1997 and who were followed through June 2015. All participants underwent baseline measurement of grip strength. In a sub-cohort, 1331 participants underwent dual energy X-ray absorptiometry (DEXA) scans, from which lean muscle mass was derived. Participants were followed for a median of 10 years for hospitalizations and mortality, and 9 years for diabetes mellitus.

RESULTS

In linear regression analysis, a one standard deviation higher Ucr concentration (64.6 mg/dl) was associated with greater grip strength (kg force) β = 0.44 [0.16, 0.72]; p = 0.002) and higher lean muscle mass (kg) (β = 0.43 [0.08, 0.78]; p = 0.02). In Cox regression analyses, each standard deviation greater Ucr concentration was associated with lower rates of hospitalizations (0.94 [95% confidence interval, 0.90, 0.98]; p < 0.001) and lower mortality risk (0.92 [0.88, 0.97]; p < 0.001), while a one standard deviation increase in muscle mass derived from DEXA had no such significant association. Ucr levels were not associated with incident diabetes mellitus risk (0.97 [0.85, 1.11]; p = 0.65).

CONCLUSION

A higher spot Ucr concentration was favorably associated with muscle mass and strength and with health outcomes in older community-living adults. The ease of obtaining a spot Ucr makes it an attractive analyte to use for gauging the health of older adults.

A Systematic Review with Meta-Analysis of the Effect of Resistance Training on Whole-Body Muscle Growth in Healthy Adult Males

We performed a systematic review and meta-analysis to study all published clinical trial interventions, determined the magnitude of whole-body hypertrophy in humans (healthy males) and observed the individual responsibility of each variable in muscle growth after resistance training (RT). Searches were conducted in PubMed, Web of Science and the Cochrane Library from database inception until 10 May 2018 for original articles assessing the effects of RT on muscle size after interventions of more than 2 weeks of duration. Specifically, we obtain the variables fat-free mass (FMM), lean muscle mass (LMM) and skeletal muscle mass (SMM). The effects on outcomes were expressed as mean differences (MD) and a random-effects meta-analysis and meta-regressions determined covariates (age, weight, height, durations in weeks…) to explore the moderate effect related to the participants and characteristics of training. One hundred and eleven studies (158 groups, 1927 participants) reported on the effects of RT for muscle mass. RT significantly increased muscle mass (FFM+LMM+SMM; Δ1.53 kg; 95% CI [1.30, 1.76], p < 0.001; I² = 0%, p = 1.00). Considering the overall effects of the meta-regression, and taking into account the participants’ characteristics, none of the studied covariates explained any effect on changes in muscle mass. Regarding the training characteristics, the only significant variable that explained the variance of the hypertrophy was the sets per workout, showing a significant negative interaction (MD; estimate: 1.85, 95% CI [1.45, 2.25], p < 0.001; moderator: -0.03 95% CI [−0.05, −0.001] p = 0.04). In conclusion, RT has a significant effect on the improvement of hypertrophy (~1.5 kg). The excessive sets per workout affects negatively the muscle mass gain.

Neck Muscle Mass Index as a Predictor of Post-Laryngectomy Wound Complications

OBJECTIVE

We investigated the relationship between paravertebral muscle cross-sectional area (PVM CSA) at the third vertebra (C3) level using computerized tomography (CT) neck images and its relationship with complications after total laryngectomy.

DESIGN

Retrospective analysis of 60 advanced laryngeal cancer patients who underwent total laryngectomy was performed. The cross-sectional areas of paravertebral neck muscles using neck CT at C3 level images obtained preoperatively were analyzed.

RESULTS

A significant difference in PVM CSA between complication and no complication groups, F(1, 53 = 4.319, P = .043), was identified by ANCOVA. There were no significant differences in between-subject effects: T-stage ( F = 1.652, P = .204), body mass index ( F = 0.889, P = .35), albumin ( F = .359, P = .552), age ( F = 1.623 P = .208), and smoking ( F = 4.319, P = .41).

CONCLUSION

The PVM CSA measured at C3 level on pretreatment CT may help identify patients at higher risk of postoperative wound complications after total laryngectomy and who may particularly benefit from preoperative optimization of nutritional status.

Vitamin D supplementation trial in infancy: body composition effects at 3 years of age in a prospective follow-up study from Montréal

BACKGROUND

The impact of vitamin D status on body composition is not well understood.

OBJECTIVES

Evaluate how vitamin D supplementation in infancy affects body composition at 3 years of age.

METHODS

Double-blind randomized trial of 132, 1-month-old healthy, breastfed infants randomly assigned to receive oral vitamin D₃ supplements of 400, 800, 1200 or 1600 IU d^-1 for 11 months. In the present analysis, 87 (66%) returned at 3 years of age. Body composition was measured using dual-energy x-ray absorptiometry and plasma 25-hydroxyvitamin D [25(OH)D] concentrations by liquid chromatography tandem mass spectrometry.

RESULTS

Anthropometry, body composition, diet, activity and demographics were similar across dosage groups at 3 years. Mean 25(OH)D concentration from 1 month to 3 years was higher (P < 0.001) in the 1200 IU group than 800 and 400 IU groups. Children with 25(OH)D concentrations above 75 nmol L^-1 had lower fat mass (~450 g; P = 0.049). In multiple linear regression, mean 25(OH)D was associated with lean mass percent (β = 0.06; CI: 0.00, 0.12; P = 0.042), fat mass (β = -11.29; CI: -22.06, -0.52; P = 0.048) and body fat percent (β = -0.06; CI: -0.12, -0.01; P = 0.045).

CONCLUSIONS

Higher vitamin D status from infancy through to 3 years of age associates with leaner body composition.

Relationships between serum irisin levels and metabolic parameters in Japanese patients with obesity

Background/Purpose

Irisin is a skeletal muscle myokine that causes the brown coloration of white fat, promotes fat burning, inhibits weight gain and may be useful for treatment of obesity. Irisin is also related to glucose/lipid metabolism and may prevent onset of diabetes, but a consensus on irisin secretion has not been reached. The purpose of this study was to determine the relationships between serum irisin levels and physical factors in untreated Japanese men and women with obesity.

Methods

The subjects were 66 untreated patients with obesity (body mass index ≥30 kg m⁻²) who visited our obesity clinic. The subjects included 19 men and 47 women with a mean age of 45.7 ± 13.4 years, mean body weight of 93.8 ± 17.6 kg, and mean body mass index of 36.5 ± 4.7 kg m⁻². At the initial visit, blood sampling was performed, body composition was evaluated using dual energy X‐ray absorptiometry, and exercise tolerance was determined in a cardiopulmonary exercise test. Homeostasis model of assessment – insulin resistance (HOMA‐IR), an index of insulin resistance, and the serum level of irisin were measured.

Results

In men, serum irisin was positively correlated with fasting blood glucose (r = 0.491, P < 0.05), immunoreactive insulin (r = 0.536, P < 0.05), HOMA‐IR (r = 0.635, P < 0.01), body weight (r = 0.491, P < 0.05), lean body mass of the trunk (r = 0.579, P < 0.05) and whole lean body mass (r = 0.489, P < 0.05). In women, serum irisin was positively correlated with immunoreactive insulin (r = 0.502, P < 0.01) and HOMA‐IR (r = 0.385, P < 0.01). In both sexes, HOMA‐IR was an independent variable associated with obesity (men: β = 0.635, R² = 0.369, P < 0.01; women: β = 0.385, R² = 0.129, P < 0.01).

Conclusion

The serum level of irisin was positively correlated with HOMA‐IR in Japanese patients with obesity of both sexes. This suggests that compensatory enhancement of irisin secretion may occur in response to insulin resistance.

In men with obesity, the serum irisin level was positively correlated with the fasting blood glucose level, immunoreactive insulin and homeostasis model of assessment – insulin resistance (HOMA‐IR).

In women with obesity, the serum irisin level was positively correlated with immunoreactive insulin and HOMA‐IR.

In stepwise multiple linear regression analysis, HOMA‐IR was an independent variable associated with obesity.

Compensatory enhancement of irisin secretion may occur in response to insulin resistance.

Eight weeks of pre- and postexercise whey protein supplementation increases lean body mass and improves performance in Division III collegiate female basketball players

We examined if 8 weeks of whey protein (WP) supplementation improved body composition and performance measures in NCAA Division III female basketball players. Subjects were assigned to consume 24 g WP (n = 8; age, 20 ± 2 years; height, 170 ± 6 cm; weight, 66.0 ± 3.1 kg) or 24 g of maltodextrin (MD) (n = 6; age, 21 ± 3 years; height, 169 ± 6 cm; weight, 68.2 ± 7.6 kg) immediately prior to and following training (4 days/week anaerobic and resistance training) for 8 weeks. Prior to (T1) and 8 weeks following supplementation (T2), subjects underwent dual X-ray absorptiometry body composition assessment as well as performance tests. The WP group gained lean mass from T1 to T2 (+1.4 kg, p = 0.003) whereas the MD group trended to gain lean mass (+0.4 kg, p = 0.095). The WP group also lost fat mass from T1 to T2 (-1.0 kg, p = 0.003) whereas the MD group did not (-0.5 kg, p = 0.41). The WP group presented greater gains in 1-repetition maximum (1RM) bench press (+4.9 kg) compared with the MD group (+2.3 kg) (p < 0.05). Moreover, the WP group improved agility from T1 to T2 (p = 0.001) whereas the MD group did not (p = 0.38). Both groups equally increased leg press 1RM, vertical jump, and broad jump performances. This study demonstrates that 8 weeks of WP supplementation improves body composition and select performance variables in previously trained female athletes.

Associations of physical exercise as a lifestyle habit with lean and fat body mass and handgrip strength and age in Asian men

BACKGROUND

We evaluated how the intensity of physical exercise as a lifestyle habit is associated with age, body composition and handgrip strength.

METHODS

Total body composition was analyzed using DEXA. Exercise scores were derived from an administered questionnaire and the scoring was calculated using the Metabolic Equivalent of Task (MET). Handgrip strength was measured using a dynamometer.

RESULTS

Age, independent of exercise intensity, was associated with declining lean mass, and handgrip strength and with increasing total body fat. A regular physical exercise regime of intensity greater than 1230 MET-min/week was associated with higher total lean mass and lean mass in the limbs, and handgrip strength and lower fat mass in the limbs.

DISCUSSION

We have shown that age was associated with lower lean mass especially in the limbs and handgrip strength and higher total fat mass. Regular physical exercise as a lifestyle habit of any type and of sufficient intensity could help improve muscle strength in the limbs.