Preoperative muscle strength as a predictor of complications after esophagectomy.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 454-454
Author(s):  
Madison Colcord ◽  
Michael D Watson ◽  
Nicole Lee Gower ◽  
Jennifer H Benbow ◽  
Sally Jeanne Trufan ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Adipose Tissue ◽  
Muscle Mass ◽  
Clinical Care ◽  
Cost Effective ◽  
Skeletal Muscle Index ◽  
Intramuscular Adipose Tissue ◽  
Operative Outcomes ◽  
Increased Risk ◽  
One Year

454 Background: Sarcopenia has been associated with post-operative complications and length of stay (LOS) in patients undergoing esophagectomy. A variety of methods exist to measure muscle mass and strength, with few comparisons between methods. We compared hand-grip strength (HGS), muscle mass and intramuscular adipose tissue as predictors of post-operative outcomes. Methods: Patients with esophageal cancer undergoing esophagectomy were identified between January 2015 – June 2019 at Levine Cancer Institute. Skeletal muscle index (SMI) and skeletal muscle density (SMD), a measure of intramuscular adipose tissue, were derived from CT. HGS was measured using a dynamometer. Uni- and multivariable GLM analyses were performed. Results: 115 patients (100 male, 15 female) underwent esophagectomy with an average age of 64.3 +/- 9.8. The analysis was stratified by sex due to significant differences in HGS, SMI, and SMD. Among men, univariable analysis revealed a significant association between pre-operative HGS <25 kg and increased risk of post-operative pneumonia ( p=0.02), ventilation >48hrs ( p=0.02), LOS ( p=0.002), discharge to home ( p=0.001), and one-year mortality ( p=0.005). All associations except discharge home remained significant in multivariable analyses (Table). Among women, no factors analyzed were significantly associated with postoperative outcomes. Conclusions: HGS is a more powerful predictor of postoperative complications and LOS than either muscle mass or intramuscular adipose tissue among men undergoing esophagectomy. HGS is cost-effective and easily incorporated into routine clinical care, allowing for preoperative intervention to optimize patients for esophagectomy. To better understand the implications in women, additional research with a larger cohort is needed. [Table: see text]

scholarly journals CT-Determined Sarcopenia in GLIM-Defined Malnutrition and Prediction of 6-Month Mortality in Cancer Inpatients

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2647
Author(s):  
Francisco José Sánchez-Torralvo ◽  
Ignacio Ruiz-García ◽  
Victoria Contreras-Bolívar ◽  
Inmaculada González-Almendros ◽  
María Ruiz-Vico ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Muscle Mass ◽  
Nutritional Assessment ◽  
Lumbar Vertebra ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Skeletal Muscle Index ◽  
Increased Risk ◽  
Muscle Cross Sectional Area

Our objective was to evaluate the clinical application of third lumbar vertebra (L3)-computer tomography (CT)-determined sarcopenia as a marker of muscle mass in cancer inpatients diagnosed with malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and to establish its association with 6-month mortality. Methods: This was an observational, prospective study in patients from an inpatient oncology unit. We performed a nutritional assessment according to GLIM criteria, including muscle cross-sectional area at L3 by CT and skeletal muscle index (SMI). Six-month mortality was evaluated. Results: A total of 208 patients were included. The skeletal muscle cross-sectional area at L3 was 136.2 ± 32.5 cm2 in men and 98.1 ± 21.2 cm2 in women. The SMI was 47.4 ± 12.3 cm2/m2 in men and 38.7 ± 8.3 cm2/m2 in women. Sarcopenia (low SMI) was detected in 59.6% of the subjects. Using SMI as a marker of low muscle mass in application of GLIM criteria, we found 183 (87.9%) malnourished patients. There were 104 deaths (50%) at 6 months. The deceased patients had a lower skeletal muscle cross-sectional area (112.9 ± 27.9 vs. 126.1 ± 37.8 cm2; p = 0.003) and a lower SMI (41.3 ± 9.5 vs. 45.7 ± 12.9 cm2/m2; p = 0.006). An increased risk of 6-month mortality was found in malnourished patients according to GLIM criteria using SMI (HR 2.47; 95% confidence interval 1.07–5.68; p = 0.033). Conclusions: Low muscle mass, assessed by L3-CT, was observed to affect more than half of cancer inpatients. The deceased patients at 6 months had a lower skeletal muscle cross-sectional area and SMI. Malnutrition according to GLIM criteria using CT-determined sarcopenia was shown to adequately predict 6-month mortality.

Body composition and association with treatment toxicity in patients with advanced renal cell carcinoma receiving targeted agents.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15608-e15608
Author(s):  
Kelly McCabe ◽  
Vicky Goh ◽  
Anup Vinayan ◽  
Ann Petruckevitch ◽  
Paul D. Nathan
Keyword(s):  
Skeletal Muscle ◽  
Body Composition ◽  
Adipose Tissue ◽  
Weight Change ◽  
Mtor Inhibitors ◽  
Targeted Agents ◽  
Muscle Area ◽  
Skeletal Muscle Index ◽  
Treatment Toxicity ◽  
Increased Risk

e15608 Background: Treatment toxicity may be influenced by heterogeneity in body composition. Muscle wasting in mRCC patients treated with sorafenib is associated with increased risk of toxicity (Antoun et al, 2010). We used CT analysis to investigate changes in adipose tissue and skeletal muscle in a large cohort of mRCC patients treated with a number of targeted agents and determined whether body composition was associated with treatment toxicity. Methods: A retrospective analysis of between 2-7 sequential CT scans of 112 mRCC patients was conducted. Each patient received between 1-4 courses of therapy. In total 191 treatment episodes within this population were included; 113 courses of VEGF TKIs, 22 courses of mTOR inhibitors, 36 courses of immunotherapy and 20 episodes where no treatment was given. A validated method, using L3 as a lumbar vertebral landmark, was used to measure lumbar skeletal muscle area (cm3) and adipose tissue volume (cm3). Appendicular Skeletal Muscle Index (ASMI) was calculated to determine prevalence of sarcopenia within the cohort; sarcopenia was defined as ASMI <7.26kg/m2 for males and <5.45kg/m2for females. Toxicity was assessed by Common Toxicity Criteria (CTC) scores documented in medical records. The cohort was divided into body mass index (BMI) quartiles. Results: Of the 112 participants, 74.1% of the group had a BMI >25 at their first scan. Mean weight change between first and last scan was -3.89kg (SD: ±9.09). 20.5% of the cohort were sarcopenic at baseline, increasing to 38.4% at final scan. Sarcopenia was independent of weight change and was associated with increased frequency of severe (CTC grade > 2) treatment toxicity (Pearson Chi Square Value: 12.82; p= 0.001). This effect persisted after adjusting for BMI quartile (odds ratio = 5.04; p=0.004). Changes in bone composition and correlation of body composition with clinical outcome will also be reported. Conclusions: Sarcopenia is common in mRCC patients and is associated with a significantly increased risk of severe treatment toxicity when receiving targeted agents. Sarcopenia was seen across all BMI quartiles and was not associated with weight change.

Clinical impact of sarcopenia on prognosis in pancreatic ductal adenocarcinoma.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 259-259
Author(s):  
Go Ninomiya ◽  
Tsutomu Fujii ◽  
Suguru Yamada ◽  
Tomonari Asano ◽  
Nao Takano ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Skeletal Muscle ◽  
Adipose Tissue ◽  
Prognostic Factors ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
The Body ◽  
Pancreatic Ductal Carcinoma ◽  
Skeletal Muscle Index ◽  
Significant Difference

259 Background: In the past, various prognostic factors in pancreatic ductal carcinoma (PDAC) have been identified, and there found to be not only tumor-specific clinicopathological factors but also individual patient characteristics. In particular, weight loss, muscle wasting and cachexia are hallmarks of PDAC that may be associated with depletion of both skeletal muscle and adipose tissue. Most notably, sarcopenia is defined to be degenerative loss of skeletal muscle mass that is quantifiable using cross sectional imaging computed tomography (CT) by measurement of psoas area and the muscle’s density. Furthermore, visceral adipose tissue loss also has been reported to associate with a poor survival among patients with PDAC. Methods: A total of 265 patients who underwent curative surgery for PDAC were examined in this study. The total skeletal muscle and fat tissue areas were evaluated in a single image obtained at the third lumber vertebra during a preoperative computed tomography (CT) scan. The patients were assigned to either the sarcopenia or non-sarcopenia group based on their skeletal muscle index (SMI) and classified into high visceral fat area (H-VFA) or low VFA (L-VFA) groups. The association of clinicopathological features and prognosis with the body composition were statistically analyzed. Results: There were 170 patients (64.2%) with sarcopenia. The median survival time (MST) was 23.7 months for sarcopenia patients and 25.8 months for patients without sarcopenia. The MST was 24.4 months for H-VFA patients and 25.8 months for L-VFA patients. However, sarcopenia patients with BMI ≥ 22 exhibited significantly poorer survival than patients without sarcopenia (MST: 19.2 vs. 35.4 months, P = 0.025). There was a significant difference between patients with and without sarcopenia who did not receive chemotherapy (5-year survival rate: 0% vs. 68.3%, P = 0.003). The multivariate analysis revealed that tumor size, positive dissected peripancreatic tissue margin, and sarcopenia were independent prognostic factors. Conclusions: Sarcopenia is an independent prognostic factor in PDAC patients with a BMI ≥ 22. Therefore, evaluating skeletal muscle mass may be a simple and useful approach for predicting patient prognosis.

scholarly journals Augmentation Index Is Inversely Associated with Skeletal Muscle Mass, Muscle Strength, and Anaerobic Power in Young Male Adults: A Preliminary Study

2021 ◽  
Vol 11 (7) ◽  
pp. 3146
Author(s):  
Dongmin Lee ◽  
Kyengho Byun ◽  
Moon-Hyon Hwang ◽  
Sewon Lee
Keyword(s):  
Skeletal Muscle ◽  
Muscle Strength ◽  
Arterial Stiffness ◽  
Muscle Mass ◽  
Muscular Strength ◽  
Skeletal Muscle Mass ◽  
Augmentation Index ◽  
Anaerobic Power ◽  
Negatively Associated ◽  
Increased Risk

Arterial stiffness is associated with an increased risk of cardiovascular disease. Previous studies have shown that there is a negative correlation between arterial stiffness and variables such as skeletal muscle mass, muscular strength, and anaerobic power in older individuals. However, little research has been undertaken on relationships in healthy young adults. This study presents a preliminary research that investigates the association between arterial stiffness and muscular factors in healthy male college students. Twenty-three healthy young males (23.9 ± 0.5 years) participated in the study. The participants visited the laboratory, and variables including body composition, blood pressure, arterial stiffness, blood parameters, grip strength, and anaerobic power were measured. Measurements of augmentation index (AIx) and brachial-ankle pulse wave velocity (baPWV) were performed to determine arterial stiffness. There were significant positive correlations among skeletal muscle mass, muscle strength, and anaerobic power in healthy young adult males. AIx was negatively associated with a skeletal muscle mass (r = −0.785, p < 0.01), muscular strength (r = −0.500, p < 0.05), and anaerobic power (r = −0.469, p < 0.05), respectively. Likewise, AIx@75 corrected with a heart rate of 75 was negatively associated with skeletal muscle mass (r = −0.738, p < 0.01), muscular strength (r = −0.461, p < 0.05), and anaerobic power (r = −0.420, p < 0.05) respectively. However, the baPWV showed no correlation with all muscular factors. Our findings suggest that maintaining high levels of skeletal muscle mass, muscular strength, and anaerobic power from relatively young age may lower AIx.

Change in skeletal muscle index and its prognostic significance in conversion therapy for initially unresectable colorectal cancer.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 56-56
Author(s):  
Hiroaki Nozawa ◽  
Shigenobu Emoto ◽  
Koji Murono ◽  
Yasutaka Shuno ◽  
Soichiro Ishihara
Keyword(s):  
Colorectal Cancer ◽  
Skeletal Muscle ◽  
Muscle Mass ◽  
Skeletal Muscles ◽  
Systemic Chemotherapy ◽  
Stage Iv ◽  
The Body ◽  
Pharmacological Intervention ◽  
Conversion Therapy ◽  
Skeletal Muscle Index

56 Background: Systemic chemotherapy can cause loss of skeletal muscle mass in colorectal cancer (CRC) patients in the neoadjuvant and palliative settings. However, it is largely unknown how the body composition is changed by chemotherapy rendering unresectable CRC to resectable disease or how it affects the prognosis. This study aimed at elucidating the effects of systemic chemotherapy on skeletal muscles and survival in stage IV CRC patients who underwent conversion therapy. Methods: We reviewed 98 stage IV CRC patients who received systemic chemotherapy in our hospital. According to the treatment setting, patients were divided into the ‘Conversion’, ‘Neoadjuvant chemotherapy (NAC)’, and ‘Palliation’ groups. The cross-sectional area of skeletal muscles at the third lumbar level and changes in the skeletal muscle index (SMI), defined as the area divided by height squared, during chemotherapy were compared among patient groups. The effects of these parameters on prognosis were analyzed in the Conversion group. Results: The mean SMI increased by 8.0% during chemotherapy in the Conversion group (n = 38), whereas it decreased by 6.2% in the NAC group (n = 18) and 3.7% in the Palliation group (n = 42, p < 0.0001). Moreover, patients with increased SMI during chemotherapy had a better overall survival (OS) than those whose SMI decreased in the Conversion group (p = 0.021). The increase in SMI was an independent predictor of favorable OS on multivariate analysis (hazard ratio: 0.26). Conclusions: Stage IV CRC patients who underwent conversion to resection often had an increased SMI. As such an increase in SMI further conveys a survival benefit in conversion therapy, it may be important to make efforts to preserve muscle mass by meticulous approaches, such as nutritional support, muscle exercise programs, and pharmacological intervention even during chemotherapy in patients with metastatic CRC.

scholarly journals Skeletal muscle index and its association with mobility among community‐dwelling older women

2021 ◽  
Vol 13 (1) ◽  
pp. 37-44
Author(s):  
ZBIGNIEW M. OSSOWSKI
Keyword(s):  
Skeletal Muscle ◽  
Older People ◽  
Older Women ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Lower Extremities ◽  
Community Dwelling ◽  
Functional Mobility ◽  
Skeletal Muscle Index ◽  
Chair Stand

Background: The loss of muscle function and reduced mobility levels are the main reasons for the limitations of independence and disability in older people. The main aim of this study was to determine the relationship between the skeletal muscle index and mobility in older women. Material and methods: ‪The study involved 166 older women. Skeletal muscle mass and other body components were determined by bioimpedance using an InBody 720 device. Functional mobility was evaluated with the timed up-and-go test. 30-second chair stand was also used to measure the level of functional strength in lower extremities. Results: ‪The skeletal muscle index was positively correlated with functional mobility (r=-0.22; p=0.00) and 30-second chair stand (r=-0.47; p=0.00). However, the strength of lower extremities was a significantly better parameter in predicting mobility in older women than the skeletal muscle index and skeletal muscle mass. Conclusions: The functional strength of lower extremity muscles and the skeletal muscle index can have a positive effect on functional mobility in older people. The results may be helpful in clinical practice when diagnosing mobility limitations and in the process of programming physical activity of older women aimed at the prevention of sarcopenia.

scholarly journals Simplified morphological evaluation of skeletal muscle mass and maximum muscle strength in healthy young women: Comparison between thigh and calf

2020 ◽  
Vol 16 ◽  
pp. 174550652096200
Author(s):  
Tomohiro Yasuda
Keyword(s):  
Skeletal Muscle ◽  
Regression Analysis ◽  
Muscle Mass ◽  
Young Women ◽  
Skeletal Muscle Mass ◽  
Handgrip Strength ◽  
Muscle Thickness ◽  
Skeletal Muscle Index ◽  
Stand Test ◽  
Sit To Stand

Objectives: The purpose of this study was to examine the prediction of skeletal muscle mass and maximum muscle strength using simplified morphology evaluation in young Japanese women from the thigh and calf perspective. Methods: A total of 249 Japanese young women (aged 18–25 years) were used for data analyses in this study. Thigh and calf girths were measured using a tape measure at 50% of thigh length and at 30% proximal of calf length, respectively. Muscle thickness was measured using B-mode ultrasound at the anterior and posterior thigh (at 50% of thigh length) and at the posterior lower leg (at 30% proximal of calf length), respectively. The measurements were carried out on the right side of the body while the participants stood with their elbows extended and relaxed. A stepwise multiple regression analysis (method of increasing and decreasing the variables; criterion set at p < 0.05) was performed for skeletal muscle index (defined by appendicular skeletal muscle mass/height2), handgrip strength, or sit-to-stand test and five variable factors (girth (thigh and calf) and muscle thickness (anterior and posterior thigh and posterior calf)). Results: Unlike the sit-to-stand test, skeletal muscle index or handgrip strength was correlated ( p < 0.001) with the girth or muscle thickness for both thigh and calf. Unlike the sit-to-stand test, the prediction equations for skeletal muscle index and handgrip strength estimation showed significant correlations with multiple regression analysis of data obtained from the calf girth and muscle thickness. In both skeletal muscle index and handgrip strength, calf girth was adopted as a Step 1, respectively. Conclusion: Our results indicated that skeletal muscle index and handgrip strength could be evaluated by the simplified morphology methods, especially that for the calf girth measurement, which may be a good indicator of screening/preventing for sarcopenia in healthy Japanese young women.

scholarly journals Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation

Cancers ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 709 ◽  
Author(s):  
Patrick Naumann ◽  
Jonathan Eberlein ◽  
Benjamin Farnia ◽  
Thilo Hackert ◽  
Jürgen Debus ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Pancreatic Cancer ◽  
Weight Loss ◽  
Muscle Mass ◽  
Muscle Wasting ◽  
Statistical Tests ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Skeletal Muscle Index ◽  
Poor Outcomes

Background: Surgical resection offers the best chance of survival in patients with pancreatic cancer, but those with locally advanced disease (LAPC) are usually not surgical candidates. This cohort often receives either neoadjuvant chemotherapy or chemoradiation (CRT), but unintended weight loss coupled with muscle wasting (sarcopenia) can often be observed. Here, we report on the predictive value of changes in weight and muscle mass in 147 consecutive patients with LAPC treated with neoadjuvant CRT. Methods: Clinicopathologic data were obtained via a retrospective chart review. The abdominal skeletal muscle area (SMA) at the third lumbar vertebral body was determined via computer tomographic (CT) scans as a surrogate for the muscle mass and skeletal muscle index (SMI) calculated. Uni- and multi-variable statistical tests were performed to assess for impact on survival. Results: Weight loss (14.5 vs. 20.3 months; p = 0.04) and loss of muscle mass (15.1 vs. 22.2 months; p = 0.007) were associated with poor outcomes. The highest survival was observed in patients who had neither cachectic weight loss nor sarcopenia (27 months), with improved survival seen in those who ultimately received a resection (23 vs. 10 months; p < 0.001). Cox regression revealed that either continued weight loss or continued muscle wasting (SMA reduction) was predictive of poor outcomes, whereas a sarcopenic SMI was not. Conclusions: Loss of weight and lean muscle in patients with LAPC is prognostic when persistent. Therefore, both should be assessed longitudinally and considered before surgery.

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