Lymphocyte-C-Reactive Protein Ratio with Calf Circumference Could Better Predict Survival of Patients with Non-Metastatic Cancer

Background Systemic inflammatory responses caused by tumor cells play an important role in the occurrence and development of tumors. Most of these responses are accompanied by a decrease in muscle mass. The aim of this study was to identify biomarkers that most accurately predict prognoses in patients with non-metastatic cancer and to evaluate their clinical significance when combined with muscle markers. Methods This study retrospectively evaluated 2,797 cancer patients diagnosed with cancer at TNM stages I, II, and III. Lymphocyte-C-reactive protein ratio (LCR) in conjunction with calf circumference (CC) were used (or chosed) after evaluating the predictive value of 13 inflammatory marker combinations and five anthropometric indicators for patient outcomes using the C-index. The Kaplan-Meier method and Cox’s proportional hazards regression modeling were used to analyze the individual and combined effects of these two potential biomarkers on overall survival. Results This study enrolled 1,604 men (57.3%) and 1,193 women (42.7%) with a mean age of 58.75 years. Among the 13 inflammatory nutritional indicators, the LCR was the most accurate predictor of prognoses in patients with non-metastatic cancer. The optimal threshold for the LCR was 2,500. After multifactorial adjustment, we found that low LCR had an adverse effect on overall survival (hazard ratio [HR]: 2.50; 95% confidence interval [CI]: 2.17, 2.88; P<0.001). Low LCR combined with low CC was also shown to be an independent risk factor for poor overall survival (HR: 2.26; 95% CI: 1.80, 2.83; P<0.001). In non-metastatic cancer patients of different ages, stages, surgery history, and tumor types (for example, upper gastrointestinal cancer, colorectal cancer, lung cancer), patients with a low LCR combined with a low CC had statistically significantly reduced overall survival. Compared with LCR or CC alone, the combination of the two had greater prognostic value for patients with non-metastatic cancer. Conclusions The LCR can be implemented as a useful biomarker to predict prognoses in patients with non-metastatic cancer, its predictive value is superior to the other evaluated indicators of inflammation. CC is the best anthropometric indicator of muscle loss in patients with non-metastatic cancer. The combination of LCR and CC can better predict the prognosis of patients with non-metastatic cancer, and can provide important information for clinicians to formulate diagnosis and treatment plans.

Association Between Serum Follicle-Stimulating Hormone and Sarcopenia and Physical Disability Among Older Chinese Men: Evidence From a Cross-Sectional Study

Background: Sarcopenia is a geriatric syndrome characterized by progressive loss of muscle mass, function and quality and associated with a range of adverse health outcomes including disability. Despite a negative correlation between muscle mass and follicle-stimulating hormone (FSH) levels in postmenopausal women, it is unclear if FSH is associated with sarcopenia and its poor outcomes, especially in older men.Methods: We used cross-sectional data from 360 men aged over 80 who participated in health check-ups to investigate correlations between serum FSH and sarcopenia, individual sarcopenia components, low physical performance (gait speed ≤ 0.8 m/s) and instrumental activities of daily living (IADL) disability. Sarcopenia and severe sarcopenia were diagnosed according to the revised definition of the European Working Group on Sarcopenia in Old People (EWGSOP2).Results: The prevalence of sarcopenia was 17.8% in this population. In binary logistic regression analysis, compared with higher FSH group, lower FSH group showed a significant reduction in the risk of low calf circumference (a surrogate for muscle mass; OR 0.308, 95% CI 0.109–0.868, P = 0.026) after adjusting potential confounders including age, waist circumference, education, exercise, associated biochemical parameters, other sex hormones and high-sensitivity C-reactive protein. The correlation between FSH and low handgrip strength was marginally significant (OR 0.390, 95% CI 0.151–1.005, P = 0.051). No associations were observed between FSH and sarcopenia, severe sarcopenia, and disability in adjusted models.Conclusion: In older men, circulating FSH was not associated with sarcopenia, sarcopenia severity, the majority of its components and adverse health outcome (IADL disability), with the exception of low calf circumference. Further work is needed to better elucidate the association of FSH and low muscle quantity by adopting more accurate measurement method of appendicular skeletal muscle mass such as DXA, CT or MRI.

Association Among Calf Circumference, Physical Performance, and Depression in the Elderly Chinese Population: A Cross-Sectional Study

Background: Depression and sarcopenia are common diseases in the elderly population. However, the association between them is controversial. Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) database, a cross-sectional study was conducted to explore the relationship between calf circumference, physical performance, and depression.Methods: From the 8th wave of CLHLS conducted in 2018, data on calf circumference, physical performance, depressive symptoms, and demographic, socioeconomic, and health-related characteristics were collected. A statistical analysis was conducted to explore the relationship between calf circumference, physical performance, and depressive symptoms. Confounding factors were adjusted for in the multiple logistic regression analysis.Results: A total of 12,227 participants, including 5689 (46.5%) men and 6538 (53.5%) women (mean age, 83.4 years), were included in this study. After adjusting for confounding factors, the association between calf circumference and depression disappeared (odds ratio [OR] = 1.04, 95% confidence interval [CI]: 0.92–1.17, p = 0.58). However, a significant inverse correlation persisted between physical performance and depressive symptoms (OR = 1.16, 95% CI: 1.13–1.20, p＜0.001). The subgroup analysis revealed a significant association of calf circumference (OR = 1.3, 95% CI: 1.04–1.62, p = 0.02) and physical performance (OR = 1.15, 95% CI: 1.08–1.22, p < 0.001) with depression in the regular exercise group.Conclusions: Physical performance was significantly associated with depression in the elderly Chinese population. Attention should be paid to assess depressive symptoms in patients with poor muscle condition.

The usage and outcomes of dextran in the treatment of acute deep venous thrombosis

Objectives In this study, we retrospectively compared the outcomes of patients with acute deep vein thrombosis treated with dextran 40 infusion and unfractionated heparin with those of patients treated with unfractionated heparin alone. Methods We evaluated 104 patients with the diagnosis of acute deep vein thrombosis. The pain complaints of the patients at the time of admission and the pain complaints in the calf with dorsiflexion of the foot were evaluated with the visual analogue pain scale, and the calf diameter of affected limbs was measured. Fifty five patients had dextran 40 infusion and unfractionated heparin treatment concomitantly (Group HD), while 49 patients had unfractionated heparin treatment (Group H). Heparin dose was adjusted to obtain 1.5- to 2.5-fold of normal activated partial thromboplastin time in both groups. Oral anticoagulant, warfarin sodium, was administered in the first day and resumed. Unfractionated heparin infusion therapy was resumed until international normalized ratio values of 2–2.5 were obtained. Dextran 40 infusion therapy was administered for 3 days. Calf diameters, current pain, and calf pain at foot dorsiflexion were recorded at 48 h and 72 h. 65 patients were distal, and 39 patients were proximal and popliteal acute DVT. None of the patients had phlegmasia. All were acute DVT. Results At 48 and 72 h of therapy, it was determined that the decrease of the calf diameter and the pain were more significant both at 48th and 72nd hours in the Group HD. The calf circumference change, especially at 72 h, was 2.58 ± 0.39 cm in the group receiving heparin + dextran, while it was 1.76 ± 0.56 cm in the group receiving only heparin. ( p = 0.000). While there were only 1.24 ± 1.02 people in the group that received dextran at 72 h, leg pain persisted in 3.35 ± 1.11 people in the other group. ( p = 0.000). Evaluation was made only with calf vein diameter measurement. When patients with Homan’s sign were evaluated for their calf pain at foot dorsiflexion; both groups had decreased pain at 48th and 72nd hours. Conclusion In this study, we observed that the use of dextran 40 infusion therapy concomitantly with unfractionated heparin accelerates recovery substantially and decreases patient complaints significantly in early stages. In particular, reduction in leg pain and calf circumference reduction were more adequate in the dextran group. The early decrease in the calf circumference will have clinical consequences such as less heparin intake, earlier return to normal life, and a decrease in the total cost of treatment. Since the antithrombotic and anticoagulant effects of dextran are well known, we think that its use in this treatment as well as venous thromboembolism prophylaxis should be discussed.

Relationship of Fat Mass Index and Fat Free Mass Index With Body Mass Index and Association With Function, Cognition and Sarcopenia in Pre-Frail Older Adults

BackgroundBody mass index (BMI) is an inadequate marker of obesity, and cannot distinguish between fat mass, fat free mass and distribution of adipose tissue. The purpose of this study was twofold. First, to assess cross-sectional relationship of BMI with fat mass index (FMI), fat free mass index (FFMI) and ratio of fat mass to fat free mass (FM/FFM). Second, to study the association of FMI, FFMI and FM/FFM with physical function including sarcopenia, and cognition in pre-frail older adults.MethodsCross-sectional study of 191 pre-frail participants ≥ 65 years, 57.1% females. Data was collected on demographics, cognition [Montreal Cognitive Assessment (MoCA)], function, frailty, calf circumference, handgrip strength (HGS), short physical performance battery (SPPB) and gait speed. Body composition was measured using InBody S10. FMI, FFMI and FM/FFM were classified into tertiles (T1, T2, T3) with T1 classified as lowest and T3 highest tertile respectively and stratified by BMI.ResultsHigher FFMI and lower FM/FFM in the high BMI group were associated with better functional outcomes. Prevalence of low muscle mass was higher in the normal BMI group. FMI and FM/FFM were significantly higher in females and FFMI in males with significant gender differences except for FFMI in ≥ 80 years old. Small calf circumference was significantly less prevalent in the highest tertile of FMI, FM/FMI and FFMI. Prevalence of sarcopenic obesity and low physical function (HGS, gait speed and SPPB scores) were significantly higher in the highest FMI and FM/FFM tertile. Highest FFMI tertile group had higher physical function, higher MoCA scores, lower prevalence of sarcopenic obesity and sarcopenia, After adjustment, highest tertile of FFMI was associated with lower odds of sarcopenia especially in the high BMI group. Highest tertile of FM/FFM was associated with higher odds of sarcopenia. Higher BMI was associated with lower odds of sarcopenia.ConclusionFFMI and FM/FFM may be a better predictor of functional outcomes in pre-frail older adults than BMI. Cut-off values for healthy BMI values and role of calf circumference as a screening tool for sarcopenia need to be validated in larger population. Health promotion intervention should focus on FFMI increment.

Evaluation of Calf Circumference, Mid-upper-arm Circumference and Ishii Test for the Assessment of Sarcopenia with Schizophrenia in a Mental Health Center

ObjectiveOur objective was to understand the prevalence of sarcopenia in schizophrenic patients and to evaluate if calf circumference (CC), mid-upper-arm circumference (MUAC) and Ishii tests can be used to accurately screen for sarcopenia in schizophrenic patients.MethodWe enrolled schizophrenic patients aged 50 or older, who were regularly taking antipsychotic medications, at two mental health centres. Bioimpedance-based muscle-mass was analysed with an InBody 770 instrument, while muscle strength was measured with a digital grip-strength dynamometer. The physical performance of the patients was gauged from their gait speed over 6 m. Standard AWGS2019 diagnostic criteria were used, and the accuracies of the three screening methods were indicated by the sensitivity, specificity, receiver operating characteristic curve, positive predictive values and negative predictive values.ResultsA total of 339 stable schizophrenic patients were enrolled. The overall prevalence of sarcopenia was 53.1%, and the prevalence was, respectively, 55.6% and 47.66% for males and females. The prevalence of sarcopenia obesity in the total population was 16.22%, and that of males and females was 18.97% and 10.28%, respectively.The CC, MUAC and Ishii test sensitivity/specificity in screening for sarcopenia were 78.3%/67%, 76.74%/68.93%, 89.92%/67%, respectively, in males and 92.16 %/69.64%, 74.51%/78.57%, 96.08%/55.36%, respectively, in females. In males, the AUCs of the CC, MUAC and Ishii test were 0.8 (95%CI, 0.744-0.856), 0.78 (95%CI, 0.721-0.84) and 0.88 (95%CI, 0.837-0.922), respectively, and in females, they were 0.893 (95%CI, 0.833-0.953), 0.843 (95%CI, 0.772-0.915) and 0.855 (95%CI, 0.784-0.926), respectively.ConclusionThe incidence of sarcopenia in schizophrenia patients is high. Clinical doctors should screen for sarcopenia in patients with schizophrenia and provide timely interventions to reduce the occurrence of adverse events. The CC, MUAC and Ishii tests are simple and easy-to-use screening tools for sarcopenia in both males and females with schizophrenia.

Prevalence of low muscle mass and associated factors in community-dwelling older adults in Singapore

The population is rapidly aging worldwide, and there is an age-related decline in muscle mass. Therefore, it is important to examine the prevalence and associated factors of low appendicular skeletal muscle mass index (ASMI) in older adults. The objectives of this cross-sectional study were (i) to determine the prevalence of low ASMI (ASM/height2) and (ii) to identify factors associated with low ASMI. This study included 1211 community-dwelling adults aged ≥ 65 years. Low ASMI was defined as < 7.0 kg/m2 in males and < 5.7 kg/m2 in females (bioelectrical impedance analysis). Gender-specific cut-off values of calf circumference for low ASMI were determined. The prevalence of low ASMI in the overall cohort was 59.9%, i.e., 57.0% among males and 61.8% among females, with no significant difference between genders (P = 0.1068). The prevalence of low ASMI was 81.3% in individuals at risk of malnutrition compared to 20.6% in their counterparts with normal nutritional status (P < 0.0001). Participants with low ASMI were older, had lower physical activity scores, and greater likelihood of hospitalization in prior 6 months compared with normal ASMI (all P < 0.0001). Low ASMI was associated with risk of malnutrition (odds ratio: 3.58 for medium risk, odds ratio: 12.50 for high risk), older age, smoking, drinking, smaller calf circumference, and lower bone mass (all P ≤ 0.0328). Cut-off values of calf circumference for low ASMI for males was 33.4 cm and for females was 32.2 cm. In conclusion, we found that low ASMI was highly prevalent among community-dwelling older adults at risk of malnutrition. Other significant factors associated with low ASMI were age, smoking, drinking, calf circumference, and bone mass. Screening community-dwelling older adults for risk of malnutrition can prevent or delay onset of low ASMI.