Association of Sarcopenia and Expression of Interleukin-16 in Gastric Cancer Survival

We designed the present work to explore the connection between sarcopenia and interleukin-16 (IL-16) expression and their integrated relation with gastric cancer (GC) survival. We deemed the sex-specific third lumbar vertebra skeletal muscle index cutoffs for sarcopenia to be ≤40.8 and ≤34.9 cm²/m² in male and female patients, respectively. Immunohistochemistry was carried out to detect IL-16 levels among GC tissues of the patients. We determined overall survival (OS) and relapse-free survival (RFS) by univariate and multivariate analyses. This study included 225 GC cases, with an average age of 62.7 years. There were 41 (18.2%) female patients, and 107 (47.5%) patients had sarcopenia. Sarcopenia and high IL-16 expression were identified as independent factors to predict OS (hazard ratios [HR] = 1.64 and 1.79, 95% confidence interval [CI] = 1.25–2.23 and 1.16–2.78, respectively) and RFS (HR = 1.43 and 1.60, 95% CI = 1.15–2.95 and 1.10–2.37, respectively). There were more cases showing high IL-16 expression detected in the sarcopenia group (55.7% vs. 37.3%, p = 0.003). Later, we grouped the patients with sarcopenia and IL-16 expression and discovered that the patients with sarcopenia and IL-16 upregulation displayed the poorest OS (HR = 3.02; 95% CI = 1.64–5.91) and RFS (HR = 2.34; 95% CI = 1.47–4.69). In conclusion, more IL-16 upregulation was noted in GC patients with sarcopenia. Sarcopenia accompanied by high IL-16 expression remarkably indicates a dismal prognosis in GC patients. This suggests that these biomarkers may be able to identify patients with GC with poor prognosis and enhance prognostication.     

Impact of Sarcopenia on Acute Kidney Injury after Infrarenal Abdominal Aortic Aneurysm Surgery: A Propensity Matching Analysis

Background: Sarcopenia contributes to increased morbidity and mortality in patients undergoing surgery for abdominal aortic aneurysms (AAA). However, few reports have demonstrated whether sarcopenia would affect the development of postoperative acute kidney injury (AKI) in these patients. This study aimed to examine whether sarcopenia is associated with AKI and morbidity and mortality after infrarenal AAA operation. Methods: We retrospectively analysed 379 patients who underwent infrarenal AAA surgery. The diagnosis of sarcopenia was performed using the skeletal muscle index, which was calculated from axial computed tomography at the level of L3. The patients were separated into those with sarcopenia (n = 104) and those without sarcopenia (n = 275). We applied multivariable and Cox regression analyses to evaluate the risk factors for AKI and overall mortality. A propensity score matching (PSM) evaluation was done to assess the postoperative results. Results: The incidence of AKI was greater in sarcopenia than non-sarcopenia group before (34.6% vs. 15.3%; p < 0.001) and after the PSM analysis (34.6% vs. 15.4%; p = 0.002). Multivariable analysis revealed sarcopenia to be associated with AKI before (p = 0.010) and after PSM (p = 0.016). Sarcopenia was also associated with overall mortality before (p = 0.048) and after PSM (p = 0.032). A Kaplan–Meier analysis revealed that overall mortality was elevated patients with sarcopenia before and after PSM than in those without (log-rank test, p < 0.001, p = 0.022). Conclusions: Sarcopenia was associated with increased postoperative AKI incidence and overall mortality among individuals who underwent infrarenal AAA operation.     

Clinical Impact of Nutritional Status and Sarcopenia in Pediatric Patients with Bone and Soft Tissue Sarcomas: A Pilot Retrospective Study (SarcoPed)

Background: We evaluated nutritional and sarcopenia status and their clinical impact in pediatric patients affected by bone and soft tissue sarcomas. Methods: Body mass index (BMI), prognostic nutritional index (PNI), and total psoas muscle area (tPMA) at diagnosis and after 12 months were analyzed. tPMA was measured from single cross-sectional computed tomography (CT) images at L4–L5. Age-specific and sex-specific tPMA Z-scores were retrieved from an online calculator. Results: A total of 21 patients were identified between February 2013 and December 2018. Twelve patients (57.1%) experienced sarcopenia at diagnosis, although not statistically associated with overall survival (OS) (p = 0.09). BMI Z-score, PNI, and tPMA Z-score significantly decreased between diagnosis and after 12 months of treatment (p < 0.05). Univariate analysis showed significant associations between poor OS and the presence of metastasis (p = 0.008), the absence of surgery (p = 0.005), PNI decrease (p = 0.027), and the reduction in tPMA > 25% (p = 0.042) over the 12 months. Conclusions: Sarcopenia affects more than half of the patients at diagnosis. Decreased PNI during 12 months of treatment has significant predictive value for OS. The role of tPMA derived from CT scan among pediatric patients with sarcoma should be investigated in further prospective and larger studies.     

Factors Associated with Sarcopenia in Patients with Colorectal Cancer

Introduction; Sarcopenia are frequently observed in cancer patients and was associated with poor prognosis. Objectives; to determine the association of nutritional status, body composition, and clinic parameters with sarcopenia in patients with colorectal cancer (CRC). Methods; We conducted a cross-sectional study of 197 patients with CRC. The sarcopenia elements, including lumbar skeletal muscle index (SMI), handgrip strength, and gait speed were measured. The SMI was assessed by computed tomography at third lumbar vertebra. Phase angle (PA), serum albumin (SAlb), muscle attenuation (MA), and the scored patient-generated subjective global assessment (PG-SGA) were also evaluated. Univariate and multivariate analysis of factors associated with sarcopenia were performed. Results; Sarcopenia was present in 29 of 195 patients (15%) and was significantly correlated with advance age, lower body mass index (BMI), SAlb, PA, MA, higher PG-SGA score, and malnutrition (PG-SGA B). In univariate analysis, age, BMI, SAlb, PA, MA, PG-SGA score, and malnutrition (PG-SGA B) were associated with sarcopenia. Multivariable analysis revealed that BMI, SAlb, PA, MA, and PG-SGA score were independent predictors of sarcopenia. Conclusion; BMI, SAlb, PA, MA, and PG-SGA score were independent predictors of sarcopenia in patients with CRC.     

Prevalence and Factors Associated with Sarcopenia in Patients on Maintenance Dialysis in Australia—A Single Centre,Cross-Sectional Study

Background: Sarcopenia is associated with significant morbidity and mortality in patients with chronic kidney disease. The prevalence of sarcopenia in the dialysis population varies from 4% to 63%. However, the prevalence and risk factors of sarcopenia in the Australian dialysis population remain uncertain. Aim: To study the prevalence of sarcopenia in patients on maintenance dialysis by using the European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic criteria of sarcopenia and to identify associated risk factors. Methods: We evaluated adult patients on maintenance haemodialysis and peritoneal dialysis in this single-centre cross-sectional study in Australia. Patient’s clinical (age, gender, dialysis modality and diabetic status) and laboratory parameters (serum albumin, calcium, phosphate, 25-hydroxy-vitamin D and parathyroid hormone levels) were investigated. We employed bioimpedance spectroscopy, hand grip dynamometer and the timed up and go test (TUG) to evaluate muscle mass, strength and function, respectively. Results: We evaluated 39 dialysis patients with a median age of 69 years old. The prevalence of sarcopenia was 18%. Sarcopenia was associated with low serum albumin (p = 0.02) and low serum phosphate level (p = 0.04). Increasing age and female sex were potential risk factors for sarcopenia (p = 0.05 and 0.08, respectively). Low lean muscle mass, reduced hand grip strength and prolonged TUG were present in 23.1%, 41% and 40.5%, respectively, of the cohort. The hand grip test had good correlation with lean muscle evaluation and the TUG. Conclusions: Sarcopenia was prevalent in 18% of maintenance haemodialysis patients from an Australian single-centre cohort, with low serum albumin and phosphate as significant risk factors.     

Sarcopenia and Mortality in Older Hemodialysis Patients

(1) Sarcopenia is a progressive loss of skeletal muscle mass and strength. The aim of this study was to determine the association of sarcopenia, defined according to the Working Group on Sarcopenia in Older People (EWGSOP2) diagnostic criteria, with mortality at 24 months in very elderly hemodialysis patients. (2) A prospective study was conducted in 60 patients on chronic hemodialysis who were older than 75 years. Sarcopenia was diagnosed according to EWGSOP2 criteria. Additionally, clinical, anthropometric and analytical variables and body composition by bioimpedance were assessed. The date and cause of death were recorded during 2 years of follow-up. (3) Among study participants, 41 (68%) were men, the mean age 81.85 ± 5.58 years and the dialysis vintage was 49.88 ± 40.29 months. The prevalence of probable sarcopenia was 75% to 97%, depending on the criteria employed: confirmed sarcopenia ranged from 37 to 40%, and severe sarcopenia ranged from 18 to 37%. A total of 30 (50%) patients died over 24 months. Sarcopenia probability variables were not related to mortality. In contrast, sarcopenia confirmation (appendicular skeletal muscle mass, ASM) and severity (gait speed, GS) variables were associated with mortality. In multivariate analysis, the hazard ratio (95% confidence interval) for all-cause death was 3.03 (1.14–8.08, p = 0.028) for patients fulfilling ASM sarcopenia criteria and 3.29 (1.04–10.39, p = 0.042) for patients fulfilling GS sarcopenia criteria. (4) The diagnosis of sarcopenia by EWGSOP2 criteria is associated with an increased risk of all-cause death in elderly dialysis patients. Specifically, ASM and GS criteria could be used as mortality risk markers in elderly hemodialysis patients. Future studies should address whether the early diagnosis and treatment of sarcopenia improve outcomes.     

Association between Dietary Inflammatory Index and Sarcopenia in Crohn’s Disease Patients

Background: Chronic inflammation is a pathophysiological cause of sarcopenia in Crohn’s disease (CD) patients. However, the potential impact of diet-related inflammation on sarcopenia has not yet been adequately investigated. We examined the associations between Dietary Inflammatory Index (DII) and sarcopenia in CD patients. Methods: A total of 140 CD patients from Ruijin Hospital in Shanghai were included in this cross-sectional study. DII scores were calculated from the dietary data collected using a validated food frequency questionnaire (FFQ). Sarcopenia was determined according to the Asian Working Group for Sarcopenia. Multivariable logistic regression analyses were performed to determine the association between DII and sarcopenia. Results: The mean DII score was 0.81 ± 2.13, ranging from −3.24 to 4.89. The overall prevalence of sarcopenia was 26.4%. The higher DII score significantly increased the risk of sarcopenia in CD patients (OR_Quartile4vs1: 9.59, 95% CI: 1.69, 54.42, p_trend = 0.031) in the multivariable model after adjusting for more potential confounders. Moreover, CD patients with a lower DII had a significantly higher appendicular skeletal muscle mass index (ASMI, OR_Quartile4vs1: 5.48, 95% CI: 1.51, 19.87, p_trend = 0.018) after adjusting for age, gender, BMI, smoking status and drinking status model. Yet, there were no significant differences between DII and ASMI after adjusting for more potential confounders. Additionally, no significant association was observed between DII and handgrip strength in the multivariable-adjusted models. Conclusions: Pro-inflammatory diet was associated with increased risk of sarcopenia in CD patients. CD patients should have a proper intake of energy and protein. These patients could also benefit from supplementation with enteral nutrition due to its anti-inflammatory potential.     

Relationship between Sarcopenia and mTOR Pathway in Patients with Colorectal Cancer: Preliminary Report

Sarcopenia is a syndrome characterized by loss of muscle mass and strength that impacts clinical outcomes and mortality in cancer patients. Although the molecular pathways involved in sarcopenia are not fully elucidated, the decrease in protein synthesis rate appears to be one of the most important events. The objective of this study was to investigate the relationship between sarcopenia and mTOR signaling pathway in patients undergoing colorectal resection surgery. Three groups of patients were assessed: 1) the control group (no cancer, no sarcopenia), 2) the cancer non-sarcopenic group and 3) the cancer sarcopenic group. All individuals were evaluated in relation to presence of sarcopenia and mTOR signaling pathway. Sarcopenia was evaluated by the combination of low muscle mass and low muscle strength, measured using computerized tomography images, and hand grip strength, respectively. Rectus abdominis muscle biopsy was performed at the time of surgery. mTOR pathway was analyzed by MILLIPLEX Map Kit Phospho/total mTOR 2-Plex Magnetic Bead Panel. Results were presented by phosphor/total mTOR ratio. Independent T test, Kruskal-Wallis test, and Dunn-Bonferroni post hoc were performed for statistical analysis and P?<?0.05 was considered. Thirty-six patients and five controls were evaluated. A total of 13 cancer patients (36.1%) had sarcopenia. The phospho/total mTOR ratio was different between the control group (0.167 MFI) and the cancer non-sarcopenic group (0.055 MFI) (P?=?0.026) as well as between the control group (0.167 MFI) and the cancer sarcopenic group (0.0049 MFI) (P?=?0.041). No difference was observed on the median phospho/total mTOR ratio between the cancer groups (P?>?0.05). More research is needed to extrapolate these results.     

Calf Circumference,a Valuable Tool to Predict Sarcopenia in Older People Hospitalized with Hip Fracture

Sarcopenia is an important risk factor for hip fracture in older people. Nevertheless, this condition is overlooked in clinical practice. This study aimed to explore the factors associated with sarcopenia among older patients hospitalized for hip fracture, to identify a predictive model of sarcopenia based on variables related to this condition, and to evaluate the performance of screening tools in order to choose the most suitable to be adopted in routine care of older people with hip fracture. A cross-sectional study was undertaken with 90 patients (mean age 83.4 ± 7.2 years), by assessing sociodemographic and clinical characteristics, anthropometric measures, such as body mass index (BMI) and calf circumference (CC), the functional status (Barthel Index), the nutritional status (MNA-SF), and the adherence to the Mediterranean Diet (MEDAS). Diagnosis of sarcopenia was established according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). The analysis of variables associated with sarcopenia was performed using multivariate logistic regression models. Clusters of sarcopenia were explored with heatmaps and predictive risk models were estimated. Sarcopenia was confirmed in 30% of hip fracture patients. Variables with the strongest association with sarcopenia were BMI (OR = 0.79 [0.68–0.91], p < 0.05) and CC (OR = 0.64 [0.51–0.81], p < 0.01). CC showed a relatively high predictive capacity of sarcopenia (area under the curve: AUC = 0.82). Furthermore, CC could be a valuable tool to predict sarcopenia risk compared with the currently used screening tools, SARC-F and SARC-CalF (AUC, 0.819 vs. 0.734 and 0.576, respectively). More studies are needed to validate these findings in external study populations.     

Prevalence of Sarcopenia and Its Impact on Postoperative Outcome in Patients With Crohn's Disease Undergoing Bowel Resection

Background: Sarcopenia has been proposed to be a prognostic factor of outcomes for various diseases but has not been applied to Crohn's disease (CD). We aimed to assess the impact of sarcopenia on postoperative outcomes after bowel resection in patients with CD. Materials and Methods: Abdominal computed tomography images within 30 days before bowel resection in 114 patients with CD between May 2011 and March 2014 were assessed for sarcopenia as well as visceral fat areas and subcutaneous fat areas. The impact of sarcopenia on postoperative outcomes was evaluated using univariate and multivariate analyses. Results: Of 114 patients, 70 (61.4%) had sarcopenia. Patients with sarcopenia had a lower body mass index, lower preoperative levels of serum albumin, and more major complications (15.7% vs 2.3%, P = .027) compared with patients without sarcopenia. Moreover, predictors of major postoperative complications were sarcopenia (odds ratio [OR], 9.24; P = .04) and a decreased skeletal muscle index (1.11; P = .023). Preoperative enteral nutrition (OR, 0.13; P = .004) and preoperative serum albumin level >35 g/L (0.19; P = .017) were protective factors in multivariate analyses. Conclusion: The prevalence of sarcopenia is high in patients with CD requiring bowel resection. It significantly increases the risk of major postoperative complications and has clinical implications with respect to nutrition management before surgery for CD.     

Impact of Sarcopenia on Clinical Outcomes in a Cohort of Caucasian Active Crohn’s Disease Patients Undergoing Multidetector CT-Enterography

(1) Background: Sarcopenia has a high incidence in Crohn’s disease (CD) with considerable heterogeneity among ethnicities and variable impact on clinical outcomes. Aim: to assess the impact of sarcopenia on clinical outcomes in a cohort of Caucasian patients with active CD undergoing CT-enterography (CTE) for clinical assessment. We further investigated the prevalence of sarcopenia and its predictors. (2) Methods: Caucasian CD patients with moderate–severe clinical activity, who underwent CTE in an emergency setting, were retrospectively recruited. The skeletal muscle index (SMI) at the third lumbar vertebra was used to detect sarcopenia in the early stages. Clinical malnutrition was defined according to global clinical nutrition criteria. Clinical outcomes included the rate of surgery and infections within one year. (3) Results: A total of 63 CD patients (34 M; aged 44 ± 17 years) were recruited, and 48 patients (68.3%) were sarcopenic. Malnutrition occurred in 28 patients (44.4%) with a significant correlation between body mass index (BMI) and sarcopenia (r = 0.5, p < 0.001). The overall rate of surgery was 33%, without a significant difference between sarcopenic and non-sarcopenic (p = 0.41). The rate of infection in patients with sarcopenia was significantly higher than in non-sarcopenic (42%vs15%, p = 0.03). BMI (OR 0.73,95%, CI 0.57–0.93) and extraintestinal manifestations (EIM) (OR 19.2 95%, CI 1.05–349.1) were predictive of sarcopenia (p < 0.05). (4) Conclusions: Sarcopenia was associated with an increased rate of infections, and it was observed in 68.3% of the Caucasian cohort with active CD.     

Muscular Ultrasonography in Morphofunctional Assessment of Patients with Oncological Pathology at Risk of Malnutrition

Background: Muscular ultrasonography is a technique that allows assessing the amount and quality of muscle in a specific body region. The aim of the study was to compare the value of muscle ultrasonography in diagnosis of malnutrition with techniques such as anthropometry, handgrip strength and impedanciometry in patients with oncological pathology. Methods: Cross-sectional study in 43 patients with oncological pathology and high nutritional risk. Classical anthropometry (body mass index (BMI), arm circumference (AC), calf circumference (CC) and estimated appendicular muscle mass index (ASMI)) was performed. Body composition was measured with impedanciometry (BIA), phase angle (PA) and fat-free mass index (FFMI) and muscle ultrasonography of quadriceps rectus femoris (muscle area (MARA) and circumference (MCR) in section transverse). Malnutrition was diagnosed using the GLIM criteria and sarcopenia was assessed using EWGSOP2 criteria. Results: The mean age was 68.26 years (±11.88 years). In total, 23/20 of the patients were men/women. The BMI was 23.51 (4.75) kg/m². The ASMI was 6.40 (1.86) kg/m². The MARA was 3.31 cm² in ultrasonography. In impedanciometry, phase angle was 4.91 (0.75)°; the FFMI was 17.01 kg/m² (±2.65 kg/m²). A positive correlation was observed between the MARA with anthropometric measurements (AC: r = 0.39, p = 0.009; CC: r = 0.44, p < 0.01; ASMI: r = 0.47, p < 0.001); and with BIA (FFMI: r = 0.48, p < 0.01 and PA: r = 0.45, p < 0.001). Differences were observed when comparing the MARA based on the diagnosis of sarcopenia (Sarcopenia: 2.47 cm² (±0.54 cm²); no sarcopenia: 3.65 cm² (±1.34 cm²); p = 0.02). Conclusions: Muscle ultrasonography correlates with body composition measurement techniques such as BIA and anthropometry in patients with cancer.     

Sarcopenia and mortality among older nursing home residents

Background and AimsSarcopenia has been indicated as a reliable marker of frailty and poor prognosis among the oldest individuals. At present, no data are available on sarcopenia in the nursing home population. The aim of the current study was to explore the relationship between sarcopenia and all-cause mortality in a population of elderly persons aged 70 years and older living in a nursing home in Italy.MethodsThis study was conducted among all subjects (n = 122) aged 70 years and older who lived in the teaching nursing home of Catholic University of Rome between August 1, 2010, and September 30, 2010. According to the European Working Group on Sarcopenia in Older People (EWGSOP), sarcopenia was diagnosed in presence of low muscle mass plus either low muscle strength or low physical performance. The primary outcome measure was survival after 6 months.ResultsForty residents (32.8%) were indentified as affected by sarcopenia. This condition was more common in men (68%) than in women (21%). During the follow-up period, 26 (21.3%) patients died. After adjusting for age, gender, cerebrovascular diseases, osteoarthritis, chronic obstructive pulmonary disease, activity of daily living impairment, and body mass index, residents with sarcopenia were more likely to die compared with those without sarcopenia (adjusted hazard ratio 2.34; 95% confidence interval 1.04–5.24).ConclusionsThe present study suggests that among subjects living in a nursing home, sarcopenia is highly prevalent and is associated with a significantly increased risk of all-cause death. The current findings support the possibility that sarcopenia has an independent effect on survival among nursing home residents.     

Prevalence of Sarcopenia in Geriatric Hospitalized Patients

ObjectivesSarcopenia, a common syndrome in older individuals, is characterized by a progressive loss of muscle mass and muscle strength. Although data exist on the prevalence of sarcopenia in community-dwelling older individuals and nursing home residents, there has been no systematic research in hospitalized older patients according to newly developed criteria.DesignCross-sectional study design.SettingAcute geriatric ward of a general hospital.ParticipantsGeriatric inpatients.MeasurementsHand grip strength was measured with the Jamar dynamometer, skeletal muscle index was calculated from raw data obtained from the bioelectrical impedance analysis, and physical function was assessed with the Short Physical Performance Battery. Sarcopenia was defined according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP).ResultsThis study involved 198 patients from a geriatric acute ward. Mean age was 82.8 ± 5.9 years and 70.2% (n = 139) of the study participants were women. Thirteen patients (6.6%) were defined as sarcopenic and 37 (18.7%) were defined as severely sarcopenic. In a group comparison, patients with sarcopenia had a poorer nutritional status. In a binary logistic regression analysis, only body mass index was associated with sarcopenia, whereas gender, age, length of stay, cognitive function, and self-care capacity were not.ConclusionThe prevalence of sarcopenia in geriatric hospitalized patients is high and does not differ from those of other older individuals. Nutritional status is associated with sarcopenia. The predictive value of sarcopenia regarding outcome for older individuals still requires evaluation.     

Association of Serum Phosphate with Low Handgrip Strength in Patients with Advanced Chronic Kidney Disease

Muscle wasting and hyperphosphatemia are becoming increasingly prevalent in patients who exhibit a progressive decline in kidney function. However, the association between serum phosphate (Pi) level and sarcopenia in advanced chronic kidney disease (CKD) patients remains unclear. We compared the serum Pi levels between advanced CKD patients with (n = 51) and those without sarcopenia indicators (n = 83). Low appendicular skeletal muscle mass index (ASMI), low handgrip strength, and low gait speed were defined per the standards of the Asian Working Group for Sarcopenia. Mean serum Pi level was significantly higher in advanced CKD patients with sarcopenia indicators than those without sarcopenia indicators (3.88 ± 0.86 vs. 3.54 ± 0.73 mg/dL; p = 0.016). Univariate analysis indicated that serum Pi was negatively correlated with ASMI, handgrip strength, and gait speed. Multivariable analysis revealed that serum Pi was significantly associated with handgrip strength (standardized β = −0.168; p = 0.022) and this association persisted even after adjustments for potential confounders. The optimal serum Pi cutoff for predicting low handgrip strength was 3.65 mg/dL, with a sensitivity of 82.1% and specificity of 56.6%. In summary, low handgrip strength is common in advanced CKD patients and serum Pi level is negatively associated with handgrip strength.     

Mortality as an adverse outcome of sarcopenia

Sarcopenia has an important impact in elderly. Recently the European Working Group on Sarcopenia in Older People (EWGSOP) defined sarcopenia as the loss of muscle mass plus low muscle strength or low physical performance. Lack of clinical sounding outcomes (ie external validity), is one of the flaws of this algorithm. The aim of our study was to determine the association of sarcopenia and mortality in a group of Mexican elderly. A total of 345 elderly were recruited in Mexico City, and followed up for three years. The EWGSOP algorithm was integrated by: gait speed, grip strength and calf circumference. Other covariates were assessed in order to test the independent association of sarcopenia with mortality. Of the 345 subjects, 53.3% were women; with a mean age of 78.5 (SD 7) years. During the three year follow-up a total of 43 (12.4%) subjects died. Age, cognition, ADL, IADL, health self-perception, ischemic heart disease and sarcopenia were associated in the bivariate analysis with survival. Negative predictive value for sarcopenia regarding mortality was of 90%. Kaplan-Meier curves along with their respective log-rank test were significant for sarcopenia. The components of the final Cox-regression multivariate model were age, ischemic heart disease, ADL and sarcopenia. Adjusted HR for age was 3.24 (CI 95% 1.55–6.78 p 0.002), IHD 5.07 (CI 95% 1.89–13.59 p 0.001), health self-perception 5.07 (CI 95% 1.9–13.6 p 0.001), ADL 0.75 (CI 95% 0.56–0.99 p 0.048) and sarcopenia 2.39 (CI 95% 1.05–5.43 p 0.037).     

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

BackgroundComputed 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.ObjectiveThis 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.MethodsA 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.ResultsOf 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.ConclusionsCT-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.     

Diagnosing Sarcopenia in Male Patients With Cirrhosis by Dual‐Energy X‐Ray Absorptiometry Estimates of Appendicular Skeletal Muscle Mass

Background: Ascites in cirrhotic patients interfere with accurate assessment of skeletal muscle when diagnosing sarcopenia. We hypothesized measurement of appendicular skeletal muscle index (ASMI) with dual‐energy x‐ray absorptiometry (DXA) improves the diagnosis of sarcopenia in cirrhotic patients as ASMI does not include the fluid‐filled abdominal compartment. Objective: To evaluate if ASMI is influenced by ascites, lower limb edema (LLE) and predicts mortality alone or combined with handgrip strength (HGS) in cirrhotic patients. Design: ASMI, HGS, and 36‐month mortality were obtained in 144 men with cirrhosis. ASMI was compared before and after paracentesis in 20 men with ascites and to results from 20 matched controls. The prognostic value of ASMI alone and with HGS was tested in a survival. Survival probabilities were obtained for sarcopenia diagnosed by standard ASMI and HGS European Working Group on Sarcopenia in Older People (EWGSOP) cutoffs and a new cutoff calculated from our ASMI + HGS tertiles. Results: ASMI did not change after paracentesis, was lower in patients than in controls (P < .001), and was not influenced by LLE (D = 0.30 kg/m2, P = .068; R² = 2.40%). Mortality was influenced by ASMI and HGS (P_interaction = 0.028). Sarcopenia diagnosed by EWGSOP was also diagnosed by our new cutoff; both predicted mortality with the latter more sensitive for mortality risk prediction (P = .011). Conclusions: DXA‐measured ASMI is not influenced by ascites or LLE in cirrhotic patients; can diagnose low skeletal muscle/sarcopenia; and predicts mortality, particularly when combined with HGS.     

Inflammation in Relation to Sarcopenia and Sarcopenic Obesity among Older Adults Living with Chronic Comorbidities: Results from the National Health and Nutrition Examination Survey 1999–2006

Loss of muscle mass and waning in muscle strength are common in older adults, and inflammation may play a key role in pathogenesis. This study aimed to examine associations of C-reactive protein (CRP) and systemic immune-inflammation index (SII) with sarcopenia and sarcopenic obesity in older adults with chronic comorbidities. Cross-sectional data from the National Health and Nutrition Examination Survey (1999–2006) were obtained for participants aged ≥60 years. Sarcopenia was defined by a lean mass and body height (males < 7.26 kg/m², females < 5.45 kg/m²). Sarcopenic obesity was defined by the concurrent presence of sarcopenia and obesity (defined by relative fat mass). Logistic regression was used to assess the associations of CRP and SII with sarcopenia and sarcopenic obesity. The dose–response relationship was examined via restricted cubic splines. Of the participants (n = 2483), 23.1% (n = 574) and 7.7% (n = 190) had sarcopenia and sarcopenic obesity, respectively. The multivariable logistic regression models suggested a positive association of SII with sarcopenia and sarcopenic obesity, but a positive statistically significant association was not consistently observed for CRP. Dose–response curves suggested similar association patterns for these biomarkers. In clinical practice, measures to prevent sarcopenia and sarcopenic obesity are needed for older vulnerable people with high systemic inflammation.