Longitudinal Changes in CT Body Composition in Patients Undergoing Surgery for Colorectal Cancer and Associations With Peri-Operative Clinicopathological Characteristics

There is evidence for the direct association between body composition, the magnitude of the systemic inflammatory response, and outcomes in patients with colorectal cancer. Patients with a primary operable disease with and without follow-up CT scans were examined in this study. CT scans were used to define the presence and changes in subcutaneous fat, visceral fat, skeletal muscle mass, and skeletal muscle density (SMD). In total, 804 patients had follow-up scans and 83 patients did not. Furthermore, 783 (97%) patients with follow-up scans and 60 (72%) patients without follow-up scans were alive at 1 year. Patients with follow-up scans were younger (p < 0.001), had a lower American Society of Anaesthesiology Grade (p < 0.01), underwent a laparoscopic surgery (p < 0.05), had a higher BMI (p < 0.05), a higher skeletal muscle index (SMI) (p < 0.01), a higher SMD (p < 0.01), and a better 1-year survival (p < 0.001). Overall only 20% of the patients showed changes in their SMI (n = 161) and an even lower percentage of patients showed relative changes of 10% (n = 82) or more. In conclusion, over the period of ~12 months, a low–skeletal muscle mass was associated with a systemic inflammatory response and was largely maintained following surgical resection.

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The Relationship between Imaging-Based Body Composition Analysis and the Systemic Inflammatory Response in Patients with Cancer: A Systematic Review

Cancers ◽

10.3390/cancers11091304 ◽

2019 ◽

Vol 11 (9) ◽

pp. 1304 ◽

Cited By ~ 7

Author(s):

Abbass ◽

Dolan ◽

Laird ◽

McMillan

Keyword(s):

Colorectal Cancer ◽

Skeletal Muscle ◽

Body Composition ◽

Inflammatory Response ◽

Systemic Inflammation ◽

Systemic Inflammatory Response ◽

Cochrane Library ◽

Composition Analysis ◽

Patients With Cancer ◽

The Relationship

Background and aim: Cancer is the second leading cause of death globally. Nutritional status (cachexia) and systemic inflammation play a significant role in predicting cancer outcome. The aim of the present review was to examine the relationship between imaging-based body composition and systemic inflammation in patients with cancer. Methods: MEDLINE, EMBASE, Cochrane Library and Google Scholar were searched up to 31 March 2019 for published articles using MESH terms cancer, body composition, systemic inflammation, Dual energy X-ray absorptiometry (DEXA), magnetic resonance imaging (MRI), ultrasound sonography (USS) and computed tomography (CT). Studies performed in adult patients with cancer describing the relationship between imaging-based body composition and measures of the systemic inflammatory response were included in this review. Results: The literature search retrieved 807 studies and 23 met the final eligibility criteria and consisted of prospective and retrospective cohort studies comprising 11,474 patients. CT was the most common imaging modality used (20 studies) and primary operable (16 studies) and colorectal cancer (10 studies) were the most commonly studied cancers. Low skeletal muscle index (SMI) and systemic inflammation were consistently associated; both had a prognostic value and this relationship between low SMI and systemic inflammation was confirmed in four longitudinal studies. There was also evidence that skeletal muscle density (SMD) and systemic inflammation were associated (9 studies). Discussion: The majority of studies examining the relationship between CT based body composition and systemic inflammation were in primary operable diseases and in patients with colorectal cancer. These studies showed that there was a consistent association between low skeletal muscle mass and the presence of a systemic inflammatory response. These findings have important implications for the definition of cancer cachexia and its treatment.

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Clinical implications of low skeletal muscle mass in early-stage breast and colorectal cancer

Proceedings of The Nutrition Society ◽

10.1017/s0029665118000423 ◽

2018 ◽

Vol 77 (4) ◽

pp. 382-387 ◽

Cited By ~ 9

Author(s):

Elizabeth Cespedes Feliciano ◽

Wendy Y. Chen

Keyword(s):

Colorectal Cancer ◽

Skeletal Muscle ◽

Body Composition ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Early Stage ◽

Metastatic Cancer ◽

Disease Free Survival ◽

Metastatic Breast ◽

Metastatic Setting

Although obesity has now been widely accepted to be an important risk factor for cancer survival, the associations between BMI and cancer mortality have not been consistently linear. Although morbid obesity has clearly been associated with worse survival, some studies have suggested a U-shaped association with no adverse association with overweight or lower levels of obesity. This ‘obesity paradox’ may be due to the fact that BMI likely incompletely captures key measures of body composition, including distribution of skeletal muscle and adipose tissue. Fat and lean body mass can be measured using clinically acquired computed tomography scans. Many of the earlier studies focused on patients with metastatic cancer. However, skeletal muscle loss in the metastatic setting may reflect end-stage disease processes. Therefore, this article focuses on the clinical implication of low skeletal muscle mass in early-stage non-metastatic breast and colorectal cancer where measures of body composition have been shown to be strong predictors of disease-free survival and overall survival and also chemotherapy toxicity and operative risk.

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Hypoalbuminemia Reflects Nutritional Risk, Body Composition and Systemic Inflammation and Is Independently Associated with Survival in Patients with Colorectal Cancer

Cancers ◽

10.3390/cancers12071986 ◽

2020 ◽

Vol 12 (7) ◽

pp. 1986 ◽

Cited By ~ 1

Author(s):

Arwa S. Almasaudi ◽

Ross D. Dolan ◽

Christine A. Edwards ◽

Donald C. McMillan

Keyword(s):

Colorectal Cancer ◽

Skeletal Muscle ◽

Body Composition ◽

Inflammatory Response ◽

Systemic Inflammation ◽

Systemic Inflammatory Response ◽

Nutritional Risk ◽

Skeletal Muscle Index ◽

Muscle Density ◽

Subcutaneous Adiposity

It has long been recognized that albumin has prognostic value in patients with cancer. However, although the Global Leadership Initiative on Malnutrition GLIM criteria (based on five diagnostic criteria, three phenotypic criteria and two etiologic criteria) recognize inflammation as an important etiologic factor in malnutrition, there are limited data regarding the association between albumin, nutritional risk, body composition and systemic inflammation, and whether albumin is associated with mortality independent of these parameters. The aim of this study was to examine the relationship between albumin, nutritional risk, body composition, systemic inflammation, and outcomes in patients with colorectal cancer (CRC). A retrospective cohort study (n = 795) was carried out in which patients were divided into normal and hypoalbuminaemic groups (albumin < 35 g/L) in the presence and absence of a systemic inflammatory response C-reactive protein (CRP > 10 and <10 mg/L, respectively). Post-operative complications, severity of complications and mortality were considered as outcome measures. Categorical variables were analyzed using Chi-square test χ2 or linear-by-linear association. Survival data were analyzed using univariate and multivariate Cox regression. In the presence of a systemic inflammatory response, hypoalbuminemia was directly associated with Malnutrition Universal Screening Tool MUST (p < 0.001) and inversely associated with Body Mass Index BMI (p < 0.001), subcutaneous adiposity (p < 0.01), visceral obesity (p < 0.01), skeletal muscle index (p < 0.001) and skeletal muscle density (p < 0.001). There was no significant association between hypoalbuminemia and either the presence of complications or their severity. In the absence of a systemic inflammatory response (n = 589), hypoalbuminemia was directly associated with MUST (p < 0.05) and inversely associated with BMI (p < 0.01), subcutaneous adiposity (p < 0.05), visceral adiposity (p < 0.05), skeletal muscle index (p < 0.01) and skeletal muscle density (p < 0.001). Hypoalbuminemia was, independently of inflammatory markers, associated with poorer cancer-specific and overall survival (both p < 0.001). The results suggest that hypoalbuminemia in patients with CRC reflects both increased nutritional risk and greater systemic inflammatory response and was independently associated with poorer survival in patients with CRC.

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Body composition and energy intake — skeletal muscle mass is the strongest predictor of food intake in obese adolescents: The HEARTY trial

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2015-0479 ◽

2016 ◽

Vol 41 (6) ◽

pp. 611-617 ◽

Cited By ~ 37

Author(s):

Jameason D. Cameron ◽

Ronald J. Sigal ◽

Glen P. Kenny ◽

Angela S. Alberga ◽

Denis Prud’homme ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Composition ◽

Body Weight ◽

Muscle Mass ◽

Energy Intake ◽

Skeletal Muscle Mass ◽

Fat Free Mass ◽

Cross Sectional ◽

Percentage Body Fat ◽

Obese Adolescents

There has been renewed interest in examining the relationship between specific components of energy expenditure and the overall influence on energy intake (EI). The purpose of this cross-sectional analysis was to determine the strongest metabolic and anthropometric predictors of EI. It was hypothesized that resting metabolic rate (RMR) and skeletal muscle mass would be the strongest predictors of EI in a sample of overweight and obese adolescents. 304 post-pubertal adolescents (91 boys, 213 girls) aged 16.1 (±1.4) years with body mass index at or above the 95th percentile for age and sex OR at or above the 85th percentile plus an additional diabetes risk factor were measured for body weight, RMR (kcal/day) by indirect calorimetry, body composition by magnetic resonance imaging (fat free mass (FFM), skeletal muscle mass, fat mass (FM), and percentage body fat), and EI (kcal/day) using 3 day food records. Body weight, RMR, FFM, skeletal muscle mass, and FM were all significantly correlated with EI (p < 0.005). After adjusting the model for age, sex, height, and physical activity, only FFM (β = 21.9, p = 0.007) and skeletal muscle mass (β = 25.8, p = 0.02) remained as significant predictors of EI. FFM and skeletal muscle mass also predicted dietary protein and fat intake (p < 0.05), but not carbohydrate intake. In conclusion, with skeletal muscle mass being the best predictor of EI, our results support the hypothesis that the magnitude of the body’s lean tissue is related to absolute levels of EI in a sample of inactive adolescents with obesity.

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Combining Amino Acid and Vitamin D Supplementation with Exercise Training Increases Skeletal Muscle Mass and Prevent Bone Mineral Density Loss in Participants with Low Muscle Mass

Global Journal of Health Science ◽

10.5539/gjhs.v10n2p28 ◽

2017 ◽

Vol 10 (2) ◽

pp. 28

Author(s):

Ha Cao Thi Thu ◽

Satoshi Kurose ◽

Yaeko Fukushima ◽

Nana Takao ◽

Natsuko Nakamura ◽

...

Keyword(s):

Bone Mineral Density ◽

Skeletal Muscle ◽

Vitamin D ◽

Body Composition ◽

Amino Acid ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Vitamin D Supplementation ◽

Mineral Density ◽

Supplement Group

This study evaluated the impact of exercise training with amino acid and vitamin D supplementation on muscle and bone mass in participants with low muscle volume. Twenty-nine Japanese participants (56-84 years old) were enrolled and assigned into the supplement (n=15) and non-supplement (n=14) groups. All participants underwent a 6-month exercise program. Supplements and nutrition support were provided to the participants in the supplement group for 12 weeks. Body composition and whole bone mineral density (BMD) were measured using dual energy x-ray absorptiometry. The outcomes, including body composition, whole BMD, and skeletal muscle mass index (SMI), were evaluated twice: pre- and post-intervention. The SMI was 6.51(6.28; 7.14) and 5.58 (5.24; 6.05) (kg/m2) in men and women, respectively. The average SMI change was 0.13% (-0.05%; 0.31%) and 2.33% (-0.88%; 5.48%); [mean (lower; upper quartile)]. The average BMD loss in the non-supplement group was -2.78%, and the BMD increased in the supplement group by 4.34%; there was an absolute difference between the two groups (p<0.05). After the intervention, serum myostatin was changed (p=0.001, non-supplement>supplement), serum vitamin D was increased (p=0.03; supplement>non-supplement), and BMD was maintained (p=0.03, supplement>non-supplement). There was a significant difference in the serum myostatin level at baseline and at 6-month in the non-supplement group, with a mean difference of 483.78 ng/ml (p=0.01). There was no significant improvement in the total lean mass, and handgrip strength. Resistance exercise combined with an amino acid supplement affects muscle and bone mass in the short-term intervention.

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Appendicular skeletal muscle mass to truncal fat mass ratio as a new index for osteosarcopenic obesity syndrome in older adults: emphasizing the role of central obesity

10.21203/rs.2.22583/v1 ◽

2020 ◽

Author(s):

Lazuardhi Dwipa ◽

Rini Widiastuti ◽

Alif Bagus Rakhimullah ◽

Marcellinus Maharsidi ◽

Yuni Susanti Pratiwi ◽

...

Keyword(s):

Older Adults ◽

Skeletal Muscle ◽

Body Composition ◽

Muscle Mass ◽

Fat Mass ◽

Central Obesity ◽

Skeletal Muscle Mass ◽

Positive Correlation ◽

Appendicular Skeletal Muscle ◽

Appendicular Skeletal Muscle Mass

Abstract Background The relationship between obesity and low bone mineral density (BMD) in older adults is still unclear. Most of the previous study did not account the factor of sarcopenia which is the progressive loss of skeletal muscle mass due to aging, and distribution of fat in obesity. Thus, this study was aimed to explore the correlation between appendicular skeletal muscle mass (ASMM), total fat mass (FM), and truncal fat mass (TrFM) as well as indexes (ASMM/FM and ASMM/TrFM ratio) with BMD in older adults.Methods This was an analytic cross-sectional study. Dual x-ray absorptiometry (DXA) and bioelectric impedance analysis (BIA) were used to assess BMD and body composition, respectively. Appendicular Skeletal Muscle Mass (ASMM) were used in the analysis to reflect sarcopenia, Fat Mass (FM) and Trunkal Fat Mass (TrFM) were used to reflect general and central obesity, respectively. All data were obtained from medical records of Geriatric Clinic of Hasan Sadikin General Hospital Bandung Indonesia from January 2014 to December 2018. The correlation between body compositions variable with BMD were analyzed using Spearman’s test. We also conducted a comparison analysis of body composition variables between low and normal BMD using Mann-Whitney test. Results A total of 112 subjects were enrolled in the study. ASMM and TrFM were positive (rs=0.517, p<0.001) and negative (rS=-0.22, p=0.02) correlated with BMD, respectively. FM were not correlated with BMD, rS=-0.113 (p=0.234). As indexes, ASMM/FM and ASMM/TrFM had positive correlation with BMD, rS=0.277 (p<0.001), and rS=0.391 (p<0.001), respectively. The ASMM, TrFM, and ASMM/TrFM ratio between normal and low BMD also significantly different (p<0.001), meanwhile FM were not (p=0.204).Conclusion ASMM and TrFM have a positive and negative correlation with BMD, respectively. ASMM/TrFM ratio as new sarcopenia-central obesity index has a positive correlation with BMD.

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P0960HOME BASED RESISTANCE EXERCISE PROGRAM AND SARCOPENIA IN HEMODIALYSIS PATIENTS: IT IS A USEFUL INTERVENTION?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0960 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Vicent Esteve Simó ◽

Anna Junqué Jiménez ◽

Verónica Duarte Gallego ◽

Irati Tapia González ◽

Fátima Moreno Guzmán ◽

...

Keyword(s):

Skeletal Muscle ◽

Body Composition ◽

Resistance Exercise ◽

Muscle Mass ◽

Functional Capacity ◽

Muscular Strength ◽

Skeletal Muscle Mass ◽

Exercise Program ◽

Hemodialysis Patients ◽

Home Based

Abstract Background and Aims Sarcopenia is a skeletal muscle disorder associated with adverse outcomes including falls, physical disability and mortality particularly in hemodialysis (HD) patients. Currently, progressive resistance training exercise has been shown a proven method to treat and prevent sarcopenia. Nevertheless, these findings are poorly investigated in HD patients since exercise programs are not widespread. The aim of our study was to assess the effect of a home-based resistance exercise program (HBREP) on muscular strength, functional capacity and body composition in our hemodialysis patients with sarcopenia according to the European Working Group on Sarcopenia in Older People criteria (EWGSOP2). Method A 12 weeks single-center prospective study. HD patients from our institution with EWGSOP2 sarcopenia diagnosis were enrolled in a HBREP. Demographical an anthropometrical data, main biochemical and nutritional parameters, hand grip (HG) muscular strength, functional capacity tests: Sit to stand to seat 5 (STS5); Short Physical Performance Battery (SPPB), gait speed (GS), as well as body composition determined by electrical bioimpedance (BIA) and sarcopenia severity were analized. Results 18 HD patients with sarcopenia (71.4% severe) were included (4 drop out).78.6% men. Mean age 74.7 years and 53.3 months on HD. The main etiologies of ESRD were the HBP (21.4%) and DM (14.3%). Globally, a significant improvement was observed at the end of the study in relation to muscular strength (HG 19.9±6.1 vs 22.2±7.1 kg, p 0.001) and functional capacity tests (STS5 21.9±10.3 vs 17.2±9.9 sec, p 0.001; SPPB (6.9±2.3 vs 9.1±2.5 score, p 0.001 and GS 0.8±0.1 vs 0.9±0.2 m/s, p 0.015). Likewise, higher total skeletal muscle mass (SMM, 14.3±2.8 vs 14.5±2.9 kg) and SMM index (SMM/height2, 5.5±0.7 vs 5.7±0.9 Kg/m2 ) were found at the end of the study, although these differences were not significant. Finally, 2 patients (14.8%) reverse the EWGSOP2 sarcopenia criteria and 3 (21.4%) enhanced their severe sarcopenia. No relevant changes regarding anthropometrical data, main biochemical and nutritional parameters or dialysis adequacy were observed at the end of the study. Conclusion A home-based resistance exercise program improves muscular strength, functional capacity and body composition in our sarcopenic hemodialysis patients. With our results, home-based resistance exercise programs should be considered a key point in the prevention and treatment of skeletal muscle mass reduction due to sarcopenia in these patients. Further studies are mandatory to confirm our encouraging results.

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Skeletal muscle mass and sarcopenia can be determined with 1.5-T and 3-T neck MRI scans, in the event that no neck CT scan is performed

European Radiology ◽

10.1007/s00330-020-07440-1 ◽

2020 ◽

Author(s):

Aniek T. Zwart ◽

Jan-Niklas Becker ◽

Maria J. Lamers ◽

Rudi A. J. O. Dierckx ◽

Geertruida H. de Bock ◽

...

Keyword(s):

Skeletal Muscle ◽

Head And Neck Cancer ◽

Head And Neck ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Correlation Coefficients ◽

Adverse Outcomes ◽

Ct Scans ◽

Mri Scans ◽

Ct And Mri

Abstract Objectives Cross-sectional area (CSA) measurements of the neck musculature at the level of third cervical vertebra (C3) on CT scans are used to diagnose radiological sarcopenia, which is related to multiple adverse outcomes in head and neck cancer (HNC) patients. Alternatively, these assessments are performed with neck MRI, which has not been validated so far. For that, the objective was to evaluate whether skeletal muscle mass and sarcopenia can be assessed on neck MRI scans. Methods HNC patients were included between November 2014 and November 2018 from a prospective data-biobank. CSAs of the neck musculature at the C3 level were measured on CT (n = 125) and MRI neck scans (n = 92 on 1.5-T, n = 33 on 3-T). Measurements were converted into skeletal muscle index (SMI), and sarcopenia was defined (SMI < 43.2 cm2/m2). Pearson correlation coefficients, Bland–Altman plots, McNemar test, Cohen’s kappa coefficients, and interclass correlation coefficients (ICCs) were estimated. Results CT and MRI correlated highly on CSA and SMI (r = 0.958–0.998, p < 0.001). The Bland–Altman plots showed a nihil mean ΔSMI (− 0.13–0.44 cm2/m2). There was no significant difference between CT and MRI in diagnosing sarcopenia (McNemar, p = 0.5–1.0). Agreement on sarcopenia diagnosis was good with κ = 0.956–0.978 and κ = 0.870–0.933, for 1.5-T and 3-T respectively. Observer ICCs in MRI were excellent. In general, T2-weighted images had the best correlation and agreement with CT. Conclusions Skeletal muscle mass and sarcopenia can interchangeably be assessed on CT and 1.5-T and 3-T MRI neck scans. This allows future clinical outcome assessment during treatment irrespective of used modality. Key Points • Screening for low amount of skeletal muscle mass is usually measured on neck CT scans and is highly clinical relevant as it is related to multiple adverse outcomes in head and neck cancer patients. • We found that skeletal muscle mass and sarcopenia determined on CT and 1.5-T and 3-T MRI neck scans at the C3 level can be used interchangeably. • When CT imaging of the neck is missing for skeletal muscle mass analysis, patients can be assessed with 1.5-T or 3-T neck MRIs.

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Impact of different palliative systemic treatments on skeletal muscle mass in metastatic colorectal cancer patients

Journal of Cachexia Sarcopenia and Muscle ◽

10.1002/jcsm.12337 ◽

2018 ◽

Vol 9 (5) ◽

pp. 909-919 ◽

Cited By ~ 21

Author(s):

Sophie A. Kurk ◽

Petra H.M. Peeters ◽

Bram Dorresteijn ◽

Pim A. de Jong ◽

Marion Jourdan ◽

...

Keyword(s):

Colorectal Cancer ◽

Skeletal Muscle ◽

Metastatic Colorectal Cancer ◽

Cancer Patients ◽

Muscle Mass ◽

Skeletal Muscle Mass ◽

Systemic Treatments ◽

Colorectal Cancer Patients

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Protein intake per day and at each daily meal and skeletal muscle mass declines among older community dwellers in Japan

Public Health Nutrition ◽

10.1017/s1368980019002921 ◽

2019 ◽

Vol 23 (6) ◽

pp. 1090-1097 ◽

Cited By ~ 8

Author(s):

Rei Otsuka ◽

Yuki Kato ◽

Chikako Tange ◽

Yukiko Nishita ◽

Makiko Tomida ◽

...

Keyword(s):

Skeletal Muscle ◽

Muscle Mass ◽

Total Protein ◽

Protein Intake ◽

Skeletal Muscle Mass ◽

Total Protein Intake ◽

Dietary Records ◽

Logistic Modelling ◽

Community Dwellers

AbstractObjective:To examine associations between protein intake per day and at different meals and skeletal muscle mass declines.Design:Two-year prospective cohort study among older community dwellers.Setting:National Institute for Longevity Sciences–Longitudinal Study of Aging (NILS-LSA) in Japan.Participants:Older men (n 292) and women (n 363) aged 60–87 years who participated in the baseline (2006–2008) and follow-up studies (2008–2010) of NILS-LSA and did not exhibit low skeletal muscle mass at baseline. Muscle mass was assessed using dual-energy X-ray absorptiometry at baseline and follow-up. Low muscle mass was defined as skeletal muscle mass index <7·0 kg/m2 for men and <5·4 kg/m2 for women at follow-up. Daily protein intake and protein intake at each meal were calculated from 3 d dietary records at baseline and sex-stratified tertiles were determined.Results:Mean (sd) protein intake at breakfast, lunch and dinner was 22·7 (7·8), 26·7 (9·3) and 37·4 (10·5) g for men and 19·3 (6·3), 23·2 (7·3) and 28·5 (7·0) g for women, respectively. After adjusting for age, baseline skeletal muscle mass and other confounders in logistic modelling, greater total protein intake was associated with lower prevalence of skeletal muscle mass decline among men at follow-up (P = 0·024). Particularly, the OR (95 % CI) for high lunchtime protein intake was low (0·11 (0·02, 0·61); P = 0·01). No significant association between total protein intake and prevalence of skeletal muscle mass decline was found among women.Conclusions:High total protein intake, particularly at lunchtime, is associated with retention of skeletal muscle mass in men.

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