Protein , malnutrition and wasting disorders Body composition and nutritional status in malignant pleural mesothelioma : implications for activity levels and quality of life

Background/Objectives Malignant pleural mesothelioma (MPM) is an incurable cancer and optimizing daily physical activity and quality of life are key goals of patient management. Little is known about the prevalence of pre-sarcopenia and malnutrition in MPM or their associations with patient outcomes. This study aimed to determine the prevalence of presarcopenia and malnutrition in MPM and investigate if activity levels and quality of life differed according to body composition and nutritional status. Subjects/Methods Patients with a diagnosis of MPM were recruited. Pre-sarcopenia was defined as low appendicular skeletal muscle mass (≤ 7.26 kg/m for men and ≤ 5.45 kg/m for women), measured by dual energy X-ray absorptiometry. Malnutrition was defined as a rating of B or C on the Patient-Generated Subjective Global Assessment. Outcome measures included objective activity levels (Actigraph GT3X) and health-related quality of life (HRQoL; Functional Assessment of Cancer Therapy General). Results Sixty-one people participated (79% male, median age 69 [IQR 62–74] years and median BMI 25.8 [IQR 24.3–28.4] kg/m). Fifty-four percent were pre-sarcopenic and 38% were malnourished. Percent of time spent in light activity/day was lower in participants with pre-sarcopenia compared with non-sarcopenic participants (median 25.4 [IQR 19.8–32.1]% vs. 32.3 [27.1–35.6]%; p= 0.008). Participants with malnutrition had poorer HRQoL than well-nourished participants (mean 69.0 (16.3) vs. 84.4 (13.3); p < 0.001). Conclusion Participants with MPM had high rates of pre-sarcopenia and malnutrition. Pre-sarcopenia was associated with poorer activity levels, whilst malnutrition was associated with poorer quality of life. Interventions that aim to address reduced muscle mass and weight loss, should be tested in MPM to assess their impact on patient outcomes. * Carolyn J. Peddle-McIntyre c.mcintyre@ecu.edu. au 1 Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia 2 School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia 3 Respiratory Department, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia 4 Institute for Respiratory Health, Nedlands, WA 6009, Australia 5 Medical School, University of Western Australia, Crawley, WA, Australia 6 School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD, Australia 7 School of Occupational Therapy, Speech Therapy and Social Work, Curtin University, Perth, WA, Australia 8 Movement Physiology Laboratory, School of Physiology, University of Witwatersrand, Johannesburg 2000, South Africa 9 Medical Oncology Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia 10 National Centre for Asbestos Related Diseases, University of Western Australia, Crawley, WA, Australia 11 School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia Supplementary information The online version of this article (https:// doi.org/10.1038/s41430-019-0418-9) contains supplementary material, which is available to authorized users. 12 34 56 78 90 () ;,: 12 34 56 78 90 (); ,: