Cancer Cachexia in the Age of Obesity: Skeletal Muscle Depletion Is a Powerful Prognostic Factor, Independent of Body Mass Index

Purpose Emerging evidence suggests muscle depletion predicts survival of patients with cancer. Patients and Methods At a cancer center in Alberta, Canada, consecutive patients with cancer (lung or GI; N = 1,473) were assessed at presentation for weight loss history, lumbar skeletal muscle index, and mean muscle attenuation (Hounsfield units) by computed tomography (CT). Univariate and multivariate analyses were conducted. Concordance (c) statistics were used to test predictive accuracy of survival models. Results Body mass index (BMI) distribution was 17% obese, 35% overweight, 36% normal weight, and 12% underweight. Patients in all BMI categories varied widely in weight loss, muscle index, and muscle attenuation. Thresholds defining associations between these three variables and survival were determined using optimal stratification. High weight loss, low muscle index, and low muscle attenuation were independently prognostic of survival. A survival model containing conventional covariates (cancer diagnosis, stage, age, performance status) gave a c statistic of 0.73 (95% CI, 0.67 to 0.79), whereas a model ignoring conventional variables and including only BMI, weight loss, muscle index, and muscle attenuation gave a c statistic of 0.92 (95% CI, 0.88 to 0.95; P < .001). Patients who possessed all three of these poor prognostic variables survived 8.4 months (95% CI, 6.5 to 10.3), regardless of whether they presented as obese, overweight, normal weight, or underweight, in contrast to patients who had none of these features, who survived 28.4 months (95% CI, 24.2 to 32.6; P < .001). Conclusion CT images reveal otherwise occult muscle depletion. Patients with cancer who are cachexic by the conventional criterion (involuntary weight loss) and by two additional criteria (muscle depletion and low muscle attenuation) share a poor prognosis, regardless of overall body weight.

Download Full-text

Effect of weight loss on early left atrial myopathy in obese patients without known cardiovascular disease

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab090.053 ◽

2021 ◽

Vol 22 (Supplement_2) ◽

Author(s):

O Deal ◽

J Rayner ◽

A Stracquadanio ◽

R Wijesurendra ◽

S Neubauer ◽

...

Keyword(s):

Cardiovascular Disease ◽

Body Mass Index ◽

Weight Loss ◽

Body Mass ◽

Left Atrial ◽

Normal Weight ◽

Obese Patients ◽

Weight Loss Intervention ◽

Reservoir Function ◽

Lv Mass

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): BHF & NIHR BRC Introduction Obesity is strongly associated with increased risk of heart failure and ischaemic stroke independently of associated co-morbidities. Left atrial (LA) reservoir dysfunction, a marker of atrial distensibility and compliance, is an early pathophysiological change which precedes the onset of cardiovascular disease in patients with obesity. It is unclear whether a weight loss intervention may be sufficient to reverse LA reservoir dysfunction. Purpose To longitudinally assess whether a weight loss intervention normalizes LA reservoir function by cardiac magnetic resonance (CMR) feature-tracking in patients with obesity and only subclinical cardiovascular disease and compared this age and sex matched non-obese normal weight controls. Methods A total of 45 patients with severe obese (age = 45 ± 11 years, body mass index = 39.1 ± 6.7 kg/m2, 51 ± 18 kg of excess body weight [EBW], 67% female) underwent CMR for quantification of LA and left ventricular (LV) size and function before and a median of 373 days following weight loss intervention. Weight loss was achieved by means of a very-low calorie diet (N = 28; 800 kcal/day) or by bariatric surgery (N = 17). A total of N = 27 non-obese healthy controls (age = 41 ± 12 years, body mass index = 22.3 ± 2.4 kg/m2, 75% female) underwent the same CMR protocol once. Results At baseline, patients with obesity displayed signs of atrial myopathy with increased LA volume and reduced LA reservoir function as compared to normal-weight controls (both P < 0.05, Figure 1) alongside increased LV mass and hyper-normal LV ejection fraction [LVEF] (both p < 0.01). As expected, weight loss led to a significant reduction of LA volume and LV mass with normalization of LVEF regardless of the degree of weight loss achieved (all P < 0.05, Figure 2). By contrast, only a large weight loss (>46.6% EBW, in red in Figure 2) was sufficient to improve and normalize the LA reservoir function (P < 0.05, Figure 2). On the other hand, moderate or milder weight loss (in orange and red) had no significant effect on LA reservoir function (both P > 0.05). Conclusion Successful weight loss can completely revert early LA myopathic phenotype in obese patients without known cardiovascular disease although this can be achieved only with larger weight loss targets.

Download Full-text

Association of body mass index changes from childhood to adulthood with dyslipidemia in adults: Hanzhong adolescent cohort study

Journal of Public Health ◽

10.1093/pubmed/fdaa108 ◽

2020 ◽

Author(s):

Yue-Yuan Liao ◽

Chao Chu ◽

Yang Wang ◽

Wen-Ling Zheng ◽

Qiong Ma ◽

...

Keyword(s):

Body Mass Index ◽

Weight Loss ◽

Body Mass ◽

Rural Areas ◽

Normal Weight ◽

Increased Risk ◽

And Control ◽

Early Weight Loss

Abstract Background Dyslipidemia is a disorder of lipid metabolism and associated with insulin resistance. The relationship between longitudinal body mass index (BMI) changes from childhood to adulthood and long-term dyslipidemia was explored in this study. Methods We assessed the longitudinal relationship between BMI changes since childhood and dyslipidemia among 1738 participants in rural areas of Hanzhong City, Shaanxi. All participants were initially examined between the ages of 6 and 15 years in 1987 and were reexamined in 1995, 2013 and 2017; the total follow-up duration was 30 years. Anthropometric measurements and blood biochemistry indexes were measured. Results We found that gradual progression of normal weight to overweight (OR = 1.65; 95% CI = 1.27, 2.15) or persistent overweight (OR = 2.45; 95% CI = 1.52, 3.96) from childhood to adulthood was associated with an increased risk of dyslipidemia in adulthood. And these risks were largely disappeared if the overweight or obesity during childhood was resolved by adulthood. The higher the BMI in adulthood and the younger the age at which overweight begins, the higher the risk of dyslipidemia. Conclusions Early weight loss and any degree of weight loss from childhood to adulthood can help improve dyslipidemia in adulthood. We further emphasize the importance of weight management and control in public health primary prevention.

Download Full-text

Body mass index and skeletal muscle index are useful prognostic factors for overall survival after gastrectomy for gastric cancer

Medicine ◽

10.1097/md.0000000000023363 ◽

2020 ◽

Vol 99 (47) ◽

pp. e23363

Author(s):

Eun Young Kim ◽

Kyong Hwa Jun ◽

Shinn Young Kim ◽

Hyung Min Chin

Keyword(s):

Gastric Cancer ◽

Skeletal Muscle ◽

Body Mass Index ◽

Overall Survival ◽

Prognostic Factors ◽

Body Mass ◽

Skeletal Muscle Index

Download Full-text

1829P Are patient-reported symptoms and concerns affected by body mass index (BMI) and weight loss (WL) in patients with cancer cachexia?

Annals of Oncology ◽

10.1016/j.annonc.2020.08.1476 ◽

2020 ◽

Vol 31 ◽

pp. S1053

Author(s):

S. Kaasa ◽

D. Currow ◽

R.J.E. Skipworth

Keyword(s):

Body Mass Index ◽

Weight Loss ◽

Body Mass ◽

Cancer Cachexia ◽

Patients With Cancer ◽

Patient Reported

Download Full-text

Relationship between skeletal muscle index measured by abdominal CT scan L3 and body mass index in cancer and non-cancer patients

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2020.09.415 ◽

2020 ◽

Vol 40 ◽

pp. 545

Author(s):

A. Kurniawan ◽

D.A. Halim ◽

W.M. Raffaello ◽

R. Muljadi ◽

T.I. Hariyanto ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Mass Index ◽

Ct Scan ◽

Cancer Patients ◽

Body Mass ◽

Abdominal Ct ◽

Skeletal Muscle Index ◽

Abdominal Ct Scan

Download Full-text

O-B05 Does rapid or gradual weight loss following bariatric surgery affect lean body mass depreciation?

British Journal of Surgery ◽

10.1093/bjs/znab429.004 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Jonathan Sivakumar ◽

Qianyu Chen ◽

Matthew Read ◽

Tom Sutherland ◽

Salena Ward ◽

...

Keyword(s):

Bariatric Surgery ◽

Skeletal Muscle ◽

Weight Loss ◽

Body Composition ◽

Lean Body Mass ◽

Body Mass ◽

Statistical Significance ◽

Resting Energy Expenditure ◽

Skeletal Muscle Index ◽

The Difference

Abstract Background Controversy exists regarding the influence of the rate of weight loss on long-term body composition. The objective of this study was to compare body composition changes in patients with successful and unsuccessful weight loss 12 months after bariatric surgery. Methods A prospective analysis was completed on patients undergoing bariatric surgery at St Vincent’s Hospital Melbourne between 2017 and 2021. Body composition was measured with dual-energy X-ray absorptiometry immediately before surgery, and at 12 months post-operatively. Fat mass (FM), lean body mass (LBM) and skeletal muscle index (SMI) trajectories were analysed between patients, with either successful weight loss (SWL) or unsuccessful weight loss (USWL) stratified based on an excess weight loss (EWL) threshold of ≥ 50%. Results Thirty-seven patients were included in this series (SWL n = 25, USWL n = 12). Compared to those with USWL, SWL demonstrated a greater mean loss in BMI (12.3 vs 7.3 kg/m2; p < 0.001) and weight (34.4 vs 20.3 kg; p < 0.001). SWL demonstrated a significantly greater reduction in tissue fat% than USWL, with patients losing 7.3% more tissue fat on average. SWL was associated with an improved mean SMI% when compared with USWL (5.5 vs. 2.42%; p < 0.0009). However, the difference in FM:LBM loss ratio between the two groups did not demonstrate statistical significance (7.07 vs 4.62, p = 0.2519). Conclusions This data suggests that SWL is associated with a more optimal body composition outcome than USWL, which is at least partly due to a relative skeletal muscle-sparing effect in this group. Further research is warranted in understanding the implications of these changes on resting energy expenditure and the risk of weight regain.

Download Full-text

Tobacco smoking and body composition in persons living with HIV/AIDS

Ciência & Saúde Coletiva ◽

10.1590/1413-81232021265.19532019 ◽

2021 ◽

Vol 26 (5) ◽

pp. 1923-1930

Author(s):

Lúcia Helena Gonzales Real ◽

Fernanda Pedrotti Moreira ◽

Maria Cristina Gonzalez ◽

Karen Jansen

Keyword(s):

Skeletal Muscle ◽

Body Mass Index ◽

Body Composition ◽

Body Mass ◽

Tobacco Smoking ◽

Care Service ◽

Cross Sectional ◽

Skeletal Muscle Index ◽

Persons Living With Hiv ◽

Hiv Aids

Abstract This study aimed to assess the association between tobacco smoking and body composition in patients with HIV/AIDS in combination antiretroviral therapy (cART). This is a cross-sectional study with people of HIV followed in specialized care service for HIV patients located in the South of Brazil. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was used to assess smoking and other psychoactive substance use. Body mass index (BMI) was calculated as the ratio of body weight (in kilograms) to squared height (in meters). Patients also had their body composition evaluated with a multi-frequency bioelectrical impedance (Bodystat® Quadscan 4000, RU) to estimate skeletal muscle index (SMI). In total, 320 subjects were included in the study. The prevalence of smoking was 54.7%. Tobacco smoking was associated with malnutrition, lower body mass index scores, and lower skeletal muscle mass index. It is concluded that there is a high prevalence of smoking among patients with HIV/AIDS and that this behavior is associated with worse body composition. Thus, it is suggested to implement strategies to support smoking cessation among people with HIV/AIDS.

Download Full-text

Low Skeletal Muscle Index Adjusted for Body Mass Index Is an Independent Risk Factor for Inflammatory Bowel Disease Surgical Complications

Crohn's & Colitis 360 ◽

10.1093/crocol/otaa064 ◽

2020 ◽

Vol 2 (3) ◽

Author(s):

Matthew Berger ◽

Akihiro Yamada ◽

Yuga Komaki ◽

Fukiko Komaki ◽

Russell D Cohen ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Mass Index ◽

Inflammatory Bowel Disease ◽

Postoperative Complications ◽

Body Mass ◽

Bowel Disease ◽

Cross Sectional ◽

Skeletal Muscle Index ◽

Computed Tomography Images ◽

Inflammatory Bowel

Abstract Background This study aims to evaluate sarcopenia defined by skeletal muscle index (SMI) with cutoffs adjusted for sex and body mass index as a predictive marker for postoperative outcomes among individuals with inflammatory bowel disease. Methods The SMI was measured using the cross-sectional computed tomography images at the lumbar spine. Multivariate logistic regression was performed to identify independent risk factors of postoperative complications. Results Ninety-one patients were included in the study. In multivariate analysis, sarcopenia (odds ratio = 5.37; confidence interval: 1.04–27.6) was predictive of infectious postoperative complications. Conclusions Sarcopenia as defined by the SMI is a predictor for 30-day postoperative infection complications in inflammatory bowel disease surgeries.

Download Full-text