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Sarcopenia and obesity among patients with soft tissue sarcoma - Association with clinicopathologic characteristics, complications and oncologic outcome: A systematic review and meta-analysis.
Barnes, ME, Elliott, JA, McIntyre, TV, Boyle, EA, Gillis, AE, Ridgway, PF
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2021;(9):2237-2247
Abstract
BACKGROUND AND AIMS Sarcopenia and obesity may be associated with negative outcomes in many cancers, but their prevalence and impact in modern regimens for soft-tissue sarcoma (STS) have not been systematically studied. This study summarises and critically evaluates the current evidence-based literature on body mass index (BMI) and body composition among patients with STS, with respect to clinical and pathologic characteristics, treatment-associated morbidity and oncologic outcome. METHODS A systematic literature search of the PubMed, Embase and Cochrane databases was performed. Meta-analysis of the relationship between BMI, body composition and pathologic characteristics, operative morbidity and oncologic outcome was undertaken using RevMan v.5.4 using fixed or random effects methods as appropriate. RESULTS 14 studies including 3598 patients met inclusion criteria. Ten studies reported on BMI, two on CT and two on PET-CT assessment of body composition. BMI ranged from 14.6 to 63.7 kg/m2, with obesity in 18%-39% of patients. Although some studies demonstrated larger tumours among patients with obesity, this was not significant on meta-analysis (P = 0.31, I2 = 99%). There was no significant difference in tumour grade or histologic type according to BMI. Postoperatively, obesity was associated with increased risk of overall morbidity (odds ratio (OR) 2.03 [95% CI 1.41-2.92], P = 0.0001, I2 = 22%), and wound morbidity (OR 1.32 [95% CI 1.02-1.71], P = 0.03, I2 = 0%). Similar effects were observed in studies of visceral adiposity. No differences in functional outcomes were observed. There was a trend towards reduced local recurrence among patients with obesity (HR 0.64 [95% CI 0.38-1.08], P = 0.10, I2 = 0%), but no difference in distant metastasis (HR 1.00 [95% CI 0.76-1.30], P = 0.98, I2 = 0%) or overall survival (HR 0.98 [95% CI 0.43-2.22], P = 0.95, I2 = 64%). Various measures of sarcopenia were associated with poorer survival outcomes. CONCLUSION While obesity is associated with increased postoperative morbidity, it had no significant association with long-term oncologic outcomes. Sarcopenia may be associated with a poorer long-term prognosis. A greater understanding of the impact of nutritional status on disease characteristics and treatment outcomes is essential to facilitate improvements in clinical care for patients with STS.
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Associations of accelerometer-determined physical activity and sedentary behavior with sarcopenia and incident falls over 12 months in community-dwelling Swedish older adults.
Scott, D, Johansson, J, Gandham, A, Ebeling, PR, Nordstrom, P, Nordstrom, A
Journal of sport and health science. 2021;(5):577-584
Abstract
PURPOSE This study was aimed to determine associations of accelerometer-determined time and bouts of sedentary behavior, light physical activity (LPA), and moderate-to-vigorous PA (MVPA) with sarcopenia and incident falls over 12 months. METHODS A total of 3334 Swedish 70-year-olds were assessed for sarcopenia, as defined by the revised definition of the European Working Group on Sarcopenia in Older People. Assessments were based on low scores for appendicular lean mass (dual-energy X-ray absorptiometry), hand grip strength, and the Timed Up and Go test. For 7 days after baseline, total time and total number of bouts (≥10 min of continuous activity at a given intensity) of activity performed at sedentary, LPA, and MVPA intensities were assessed by accelerometer. Incident falls were self-reported 6 months and 12 months after baseline. RESULTS Only 1.8% of participants had probable or confirmed sarcopenia. After multivariable adjustment for other levels of activity, only greater MVPA time was associated with a decreased likelihood of having low appendicular lean mass, low hand grip strength, and slow Timed Up and Go time as defined by the European Working Group on Sarcopenia in Older People criteria (all p < 0.05), and only MVPA time was associated with lower likelihood of probable or confirmed sarcopenia (odds ratio = 0.80, 95% confidence interval: 0.71-0.91 h/week). Similar associations were identified for total number of bouts, with no evidence of threshold effects for longer duration of bouts of MVPA. A total of 14% of participants reported ≥1 fall, but neither total time nor bouts of activity was associated with incident falls (all p > 0.05). CONCLUSION Higher amounts of accelerometer-determined MVPA are consistently associated with a decreased likelihood of sarcopenia and its components, regardless of the length of bouts or amounts of sedentary behavior.
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Non-Pharmacological Interventions in Osteosarcopenia: A Systematic Review.
Atlihan, R, Kirk, B, Duque, G
The journal of nutrition, health & aging. 2021;(1):25-32
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Abstract
BACKGROUND Osteosarcopenia is a geriatric syndrome defined by the concomitant presence of osteopenia/osteoporosis (loss of bone mineral density (BMD)) and sarcopenia (loss of muscle mass and/or function), which increases the risk of falls, fractures, and premature mortality. OBJECTIVE To examine the efficacy of non-pharmacological (exercise and/or nutritional) interventions on musculoskeletal measures and outcomes in osteosarcopenic adults by reviewing findings from randomized controlled trials (RCTs). METHODS This review was registered at PROSPERO (registration number: CRD42020179292) and conducted in accordance with the PRISMA guidelines. Electronic databases were searched for RCTs assessing the effect of at least one non-pharmacological intervention (any form of exercise and/or supplementation with protein, vitamin D, calcium or creatine) on any musculoskeletal measure/outcome of interest (BMD, bone strength/turnover, muscle mass and strength, physical performance, falls/fractures) in adults with osteosarcopenia as defined by any proposed criteria. RESULTS Two RCTs (of n=106 older osteosarcopenic adults (≥65 years)) assessing the effects of progressive resistance training (RT) (via resistance bands or machines; 2-3 times/week; ~60 minutes in duration) were eligible for inclusion. The two RCTs demonstrated moderate quality evidence that RT increases muscle mass, strength, and quality, with changes in strength and quality occurring before muscle mass (12 vs 28 weeks). There was low quality evidence that RT increases lumbar spine BMD and maintains total hip BMD when performed for 12 and 18 months, respectively, and moderate quality evidence that RT has no effect on markers of bone turnover or physical performance. No major adverse effects were recorded in either of the RCTs. There were no eligible RCTs examining the impact of nutritional interventions. CONCLUSION Chronic RT is safe and effective at potentiating gains in muscle mass, strength, and quality, and increasing or maintaining BMD in older osteosarcopenic adults. No RCT has examined the effects of protein, vitamin D, calcium, or creatine against a control/placebo in this high-risk population.
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Sarcopenia in Inflammatory Bowel Disease: A Narrative Overview.
Dhaliwal, A, Quinlan, JI, Overthrow, K, Greig, C, Lord, JM, Armstrong, MJ, Cooper, SC
Nutrients. 2021;(2)
Abstract
Malnutrition is a common condition encountered in patients with inflammatory bowel disease (IBD) and is often associated with sarcopenia (the reduction of muscle mass and strength) which is an ever-growing consideration in chronic diseases. Recent data suggest the prevalence of sarcopenia is 52% and 37% in Crohn's disease and ulcerative colitis, respectively, however it is challenging to fully appreciate the prevalence of sarcopenia in IBD. Sarcopenia is an important consideration in the management of IBD, including the impact on quality of life, prognostication, and treatment such as surgical interventions, biologics and immunomodulators. There is evolving research in many chronic inflammatory states, such as chronic liver disease and rheumatoid arthritis, whereby interventions have begun to be developed to counteract sarcopenia. The purpose of this review is to evaluate the current literature regarding the impact of sarcopenia in the management of IBD, from mechanistic drivers through to assessment and management.
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COVID-19-induced sarcopenia and physical deconditioning may require reassessment of surgical risk for patients with cancer.
Casey, P, Ang, Y, Sultan, J
World journal of surgical oncology. 2021;(1):8
Abstract
BACKGROUND The long-term physiological consequences of SARS-CoV-2 (severe acute respiratory syndrome coronavirus) infection are not known. The ability of COVID-19 to cause chronic illness, sarcopenia, and physical deconditioning may be underestimated and go beyond the anticipated respiratory sequelae. Myalgia, lethargy, and anorexia are common symptoms even in mild to moderate cases and have the potential to exacerbate frailty. How this impacts on risk-stratification for patients requiring surgery for time-critical conditions, such as malignancy, requires further urgent investigation. MAIN BODY The deleterious effect of sarcopenia and poor physical capacity are well recognised in cancer surgery. This review commentary highlights current evidence which suggests skeletal muscle as an under recognised cause of COVID-19-related functional deconditioning. The mechanisms behind this are via direct (viral induced myositis, nutritional decline, cytokine-mediated myopathy) and indirect mechanisms (social isolation, inactivity, and psychological consequences). CONCLUSION Further mechanistic research is required to explore the processes behind the deconditioning effects of SARS-CoV-2 infection and how this impacts on treatment of malignant disease.
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Increased intramuscular adipose tissue of the quadriceps is more strongly related to declines in ADL than is loss of muscle mass in older inpatients.
Akazawa, N, Kishi, M, Hino, T, Tsuji, R, Tamura, K, Moriyama, H
Clinical nutrition (Edinburgh, Scotland). 2021;(3):1381-1387
Abstract
BACKGROUND & AIMS Recent studies have shown that increased intramuscular adipose tissue of the quadriceps in older people is more strongly related to decreased muscle strength, sit-up and sit-down ability, and gait ability than is loss of muscle mass. However, whether increased intramuscular adipose tissue of the quadriceps is more strongly related to declines in activities of daily living (ADL) than is loss of muscle mass in older inpatients remains unclear. This study was performed to examine the relationships of intramuscular adipose tissue and muscle mass of the quadriceps with ADL in older inpatients. METHODS This cross-sectional study included 371 inpatients aged ≥65 years. The primary outcomes were ADL and intramuscular adipose tissue of the quadriceps. ADL were assessed using the motor-Functional Independence Measure (FIM). Ultrasound images were acquired using B-mode ultrasound imaging. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed based on echo intensity and muscle thickness, respectively. A stepwise multiple regression analysis was performed to identify factors independently associated with the motor-FIM score. The independent variables were the echo intensity and muscle thickness of the quadriceps, age, sex, length of hospital stay, Food Intake Level Scale (FILS), Geriatric Nutritional Risk Index (GNRI) score, C-reactive protein (CRP) concentration, updated Charlson comorbidity index (UCCI), number of medications, and subcutaneous fat thickness of the thigh. RESULTS Quadriceps echo intensity (β = - 0.17), FILS (β = 0.38), GNRI score (β = 0.24), UCCI (β = - 0.16), subcutaneous fat thickness of the thigh (β = - 0.11), and length of hospital stay (β = 0.09) were independently and significantly associated with the motor-FIM score. Quadriceps thickness (β = 0.10), age (β = - 0.07), sex (β = - 0.04), CRP concentration (β = - 0.04), and number of medications (β = 0.03) were not associated with the motor-FIM score. CONCLUSIONS Increased intramuscular adipose tissue of the quadriceps is more strongly related to declines in ADL than is loss of muscle mass. Randomized controlled trials are needed to determine whether decreasing intramuscular adipose tissue of the quadriceps in older inpatients leads to improvement of ADL.
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Is sarcopenia a predictor of prognosis for patients undergoing radiotherapy for head and neck cancer? A meta-analysis.
Findlay, M, White, K, Stapleton, N, Bauer, J
Clinical nutrition (Edinburgh, Scotland). 2021;(4):1711-1718
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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The effect of vitamin D plus protein supplementation on sarcopenia: A systematic review and meta-analysis of randomized controlled trials.
Gkekas, NK, Anagnostis, P, Paraschou, V, Stamiris, D, Dellis, S, Kenanidis, E, Potoupnis, M, Tsiridis, E, Goulis, DG
Maturitas. 2021;:56-63
Abstract
PURPOSE The exact effect of vitamin D supplementation, either as monotherapy or in combination with protein, on musculoskeletal health in patients with sarcopenia is currently unknown. This study aimed to determine the effect of vitamin D alone or with protein supplementation on muscle strength, mass, and performance in this population. METHODS A comprehensive search was conducted in Medline, Cochrane Central and Scopus databases, up to March 31st, 2020. Data were expressed as standardized mean difference (SMD) with 95 % confidence intervals (CI). I2 index was employed for heterogeneity. RESULTS The initial search identified 1164 studies, eight of which met the eligibility criteria for qualitative and quantitative analysis, yielding a total of 776 patients. Vitamin D (100-1600 IU/day) plus protein (10-44 g/day) supplementation exhibited a beneficial effect on muscle strength, as demonstrated by an improvement in handgrip strength (SMD 0.38 ± 0.07, 95 % CI 0.18-0.47, p = 0.04; I2 76.2 %) and a decrease in the sit-to-stand time (SMD 0.25 ± 0.09, 95 % CI 0.06-0.43, p = 0.007; I2 0%) compared with placebo. However, the effect on muscle mass, assessed by skeletal muscle index, was marginally non-significant (SMD 0.25 ± 0.13, 95 % CI -0.006-0.51, p = 0.05; I2 0%). No effect on appendicular skeletal muscle mass or muscle performance (assessed by walking speed) was observed with vitamin D plus protein. CONCLUSIONS Vitamin D supplementation, combined with protein, improves muscle strength in patients with sarcopenia, but has no effect on muscle mass or performance.
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Sarcopenia and Appendicular Muscle Mass as Predictors of Impaired Fasting Glucose/Type 2 Diabetes in Elderly Women.
Buscemi, C, Ferro, Y, Pujia, R, Mazza, E, Boragina, G, Sciacqua, A, Piro, S, Pujia, A, Sesti, G, Buscemi, S, et al
Nutrients. 2021;(6)
Abstract
Elderly women exhibit a high risk of type 2 diabetes (T2D), but no definitive data exist about the possible role of postmenopausal increases in visceral adiposity, the loss of lean body mass, or decreases in the sum of the lean mass of arms and legs (appendicular skeletal muscle mass (ASMM)). This retrospective, longitudinal study investigated whether body composition (bioelectrical impedance analysis) predicted the development of impaired fasting glucose (IFG) or T2D in a cohort of 159 elderly women (age: 71 ± 5 years, follow-up: 94 months) from southern Italy (Clinical Nutrition and Geriatric Units of the "Mater Domini" University Hospital in Catanzaro, Calabria region, and the "P. Giaccone "University Hospital in Palermo, Sicily region). Sarcopenia was defined in a subgroup of 128 women according to the EWGSOP criteria as the presence of low muscle strength (handgrip strength <16 kg) plus low muscle mass (reported as appendicular skeletal muscle mass <15 kg). Participants with a low ASMM had a higher IFG/T2D incidence than those with a normal ASMM (17% vs. 6%, p-adjusted = 0.044); this finding was independent of BMI, fat mass, waist circumference, and habitual fat intake (OR = 3.81, p = 0.034). A higher incidence of IFG/T2D was observed in the subgroup with sarcopenia than those without sarcopenia (33% vs. 7%, p-adjusted = 0.005) independent of BMI and fat mass (OR = 6.75, p = 0.007). In conclusion, this study demonstrates that elderly women with low ASMM had a higher probability of developing IFG/T2D. Further studies are needed to confirm these results in men and in other age groups.
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Strategies to Prevent Sarcopenia in the Aging Process: Role of Protein Intake and Exercise.
Rogeri, PS, Zanella, R, Martins, GL, Garcia, MDA, Leite, G, Lugaresi, R, Gasparini, SO, Sperandio, GA, Ferreira, LHB, Souza-Junior, TP, et al
Nutrients. 2021;(1)
Abstract
Sarcopenia is one of the main issues associated with the process of aging. Characterized by muscle mass loss, it is triggered by several conditions, including sedentary habits and negative net protein balance. According to World Health Organization, it is expected a 38% increase in older individuals by 2025. Therefore, it is noteworthy to establish recommendations to prevent sarcopenia and several events and comorbidities associated with this health issue condition. In this review, we discuss the role of these factors, prevention strategies, and recommendations, with a focus on protein intake and exercise.