Sarcopenia in ovarian cancer patients, oncologic outcomes revealing the importance of clinical nutrition: review of literature. Sarcopenia in Advanced Serous Ovarian Cancer Texture‐modified diets are associated with decreased muscle mass in older adults admitted to a rehabilitation ward Body composition in patients with non-small cell lung cancer: a contemporary view of cancer cachexia with the use of computed tomography image analysis. Sarcopenia during neoadjuvant therapy for oesophageal cancer: characterising the impact on muscle strength and physical performance Association of skeletal muscle wasting with treatment with sorafenib in patients with advanced renal cell carcinoma: results from a placebo-controlled study. Comparative associations of muscle mass and muscle strength with mortality in dialysis patients. Sarcopenia is associated with the neutrophil/lymphocyte and platelet/lymphocyte ratios in operable gastric cancer patients: a prospective study Do muscle mass, muscle density, strength, and physical function similarly influence risk of hospitalization in older adults? Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam. Sarcopenia: Prevalence, and Impact on Operative and Oncologic Outcomes in the Multimodal Management of Locally Advanced Esophageal Cancer Fish oil-derived n-3 PUFA therapy increases muscle mass and function in healthy older adults. Sarcopenia predicts 1-year mortality in elderly patients undergoing curative gastrectomy for gastric cancer: a prospective study Impact of preoperative hand grip strength on morbidity following gastric cancer surgery Sarcopenia in overweight and obese patients is a predictive factor for postoperative complication in gastric cancer: A prospective study. The influence of sarcopenia on survival and surgical complications in ovarian cancer patients undergoing primary debulking surgery. Associations between dietary nutrient intake and muscle mass and strength in community-dwelling older adults: the Tasmanian Older Adult Cohort Study. Androgen deprivation causes selective deficits in the biomechanical leg muscle function of men during walking: a prospective case–control study Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. Lower Pectoralis Muscle Area Is Associated with a Worse Overall Survival in Non–Small Cell Lung Cancer Sarcopenia as a predictor of survival and chemotoxicity in patients with epithelial ovarian cancer receiving platinum and taxane-based chemotherapy. Fat mass rather than muscle strength is the major determinant of physical function and disability in postmenopausal women younger than 75 years of age Similar effects of leucine rich and regular dairy products on muscle mass and functions of older polymyalgia rheumatica patients: A randomized crossover trial
INTRODUCTION Ovarian cancer is the leading cause of death among gynecological malignancies . Its usual clinical manifestation is at advanced stages , with nutritional impairment , weight loss , and a consequent decline in skeletal muscle mass and strength ( defined as sarcopenia ) . The relationship between sarcopenia and decreased survival was demonstrated not only in ovarian cancer but also in other cancer types , such as hepatocellular , pancreatic , lung , colon , cervical , metastatic breast , and renal cancer . The aim of this study is to review the current evidence regarding the relationship between sarcopenia and the surgical and oncological outcomes in ovarian cancer patients . METHODS The systematic search was performed according to the Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRSIMA ) statement . The terms " SARCOPENIA " AND " OVARIAN CANCER " were systematic ally used to search PubMed and Scopus data bases . Original reports in English language were identified , with the purpose to include all relevant papers regarding the role of sarcopenia and indicators of skeletal muscle quality assessment in gynecological ovarian cancer . RESULTS A total of 9 studies were considered eligible for the present review . The strength of recommendation was moderate and the level of evidence was low in all selected articles . No prospect i ve studies were conducted and most of the papers were case-control series comparing ovarian cancer sarcopenic population vs. non sarcopenic population . CONCLUSIONS Sarcopenia appears to have an important role in oncological outcomes of ovarian cancer patients . However , sarcopenia occurrence during disease history and mechanisms underlying the possible impairment in prognosis should be better investigated . Prospect i ve trials are awaited in order to obtain a better insight in this topic Objective Cancer cachexia is a paraneoplastic syndrome comprising involuntary weight loss and muscle depletion ( sarcopenia ) . Although weight loss has been associated with poor clinical outcome , there is only limited information on the prevalence and prognostic impact of sarcopenia in ovarian cancer so far . Methods Total skeletal muscle mass was determined by computed tomography image analysis of the third lumbar skeletal muscle cross-sectional area in 128 patients with advanced serous ovarian cancer . Longitudinal change of muscle mass was studied in  209 consecutive computed tomography scans  from 43 patients . Association with survival was determined using Cox proportional hazards model . Results The prevalence of sarcopenia at first diagnosis was 11 % ( 12/105 ; 95 % confidence interval [ CI ] , 6%–20 % ) . Sarcopenic patients had a significantly reduced progression-free ( hazard ratio , 2.64 ; 95 % CI , 1.24–5.64 ; P = 0.012 ) and overall survival ( hazard ratio , 3.17 ; 95 % CI , 1.29–7.80 ; P = 0.012 ) . On multivariable analysis , these prognostic effects remained significant after adjustment for age , International Federation of Gynecology and Obstetrics stage , and postsurgical residual disease . Longitudinal analyses identified both patients with loss and gain of muscle mass . However , change in muscle mass over time was not associated with survival . Conclusions Baseline sarcopenia is a prognostic factor in advanced serous ovarian cancer . Identification of sarcopenic patients and early enrollment in physical or nutritional education programs might thus be a feasible way to improve outcome and should be further evaluated in prospect i ve clinical trials AIM Texture-modified diets ( TMD ) have significantly lower energy and protein content than normal diets . Therefore , TMD can cause malnutrition and loss of muscle mass . However , few studies have reported the relationship between TMD and decreased skeletal muscle mass . The aim of the present study was to clarify the association between TMD and decreased skeletal muscle mass . METHODS We review ed data of 188 older adult patients who were admitted to a rehabilitation hospital . TMD were defined based on the Japanese Dysphagia Diet Criteria 2013 proposed by the Japanese Society of Dysphagia Rehabilitation . The Mini Nutritional Assessment -Short Form was used to assess nutritional status ;  dual-energy X-ray absorptiometry was used to measure the skeletal muscle mass index , and the cut-off values for decreased skeletal muscle mass index were based on the Asian Working Group for Sarcopenia ; the Functional Independence Measure was used to evaluate activities of daily living . RESULTS The patients ' mean age was 80.6 ± 7.5 years , and 62 % were women . A total of 22 patients ( 11.7 % ) consumed TMD . A total of 104 patients ( 55.3 % ) had decreased skeletal muscle mass , and approximately 90 % of them consumed TMD . Decreased skeletal muscle mass index ( odds ratio 7.199 , 95 % confidence interval 1.489 - 34.805 , P ≤ 0.01 ) and Functional Independence Measure scores ( odds ratio 0.972 , 95 % confidence interval 0.952 - 0.992 , P ≤ 0.01 ) were independently related to TMD in the multivariate analysis . CONCLUSIONS The TMD group was associated with decreased skeletal muscle mass . Future , prospect i ve studies are necessary to investigate causality . Geriatr Gerontol Int 2018 ; 18 : 698 - 704 BACKGROUND The prominent clinical feature of cachexia has traditionally been understood to be weight loss ; however , in recognition of the potential for divergent behavior of muscle and adipose tissue , cachexia was recently defined as loss of muscle with or without loss of fat mass . Detailed assessment s are required to verify body composition in patients with cancer cachexia . DESIGN We adopted a population -based approach to study body composition in patients with cancer , with the use of diagnostic computed tomography images acquired for cancer diagnosis and follow-up . A prospect i ve cohort of 441 patients with non-small cell lung cancer , who were referred consecutively to a regional medical oncology service in Alberta , Canada , was evaluated . RESULTS At referral ( median time to death : 265 d ) , mean body mass index ( BMI ; in kg/m(2 ) ) was 24.9 , with 47.4 % of patients being overweight or obese . Only 7.5 % overall were underweight as conventionally understood ( BMI < 18.5 ) . Analysis of computed tomography images showed extremely high heterogeneity of muscle mass within all strata of BMI . The overall prevalence of severe muscle depletion ( sarcopenia ) was 46.8 % and was present in patients in all BMI categories . A much higher proportion of men ( 61 % ) than women ( 31 % ) met the criteria for sarcopenia . CONCLUSIONS Wasting of skeletal muscle is a prominent feature of patients with lung cancer , despite normal or heavy body weights . The significance of muscle wasting in normal-weight , overweight , and obese patients as a nutritional risk factor , as a prognostic factor , and as a predictor of cancer treatment toxicity is discussed in this article Purpose Preoperative chemo(radio)therapy for oesophageal cancer ( OC ) may have an attritional impact on body composition and functional status , impacting postoperative outcome . Physical decline with skeletal muscle loss has not been previously characterised in OC and may be amenable to physical rehabilitation . This study characterises skeletal muscle mass and physical performance from diagnosis to post-neoadjuvant therapy in patients undergoing preoperative chemo(radio)therapy for OC . Methods Measures of body composition ( axial computerised tomography ) , muscle strength ( h and grip ) , functional capacity ( walking distance ) , anthropometry ( weight , height and waist circumference ) , physical activity , quality -of-life and nutritional status were captured prospect ively . Sarcopenia status was defined as pre-sarcopenic ( low muscle mass only ) , sarcopenic ( low muscle mass and low muscle strength or function ) or severely sarcopenic ( low muscle mass and low muscle strength and low muscle function ) . Results Twenty-eight participants were studied at both time points ( mean age 62.86 ± 8.18 years , n = 23 male ) . Lean body mass reduced by 4.9 ( 95 % confidence interval 3.2 to 6.7 ) kg and mean grip strength reduced by 4.3 ( 2.5 to 6.1 ) kg from pre- to post-neoadjuvant therapy . Quality -of-life scores capturing gastrointestinal symptoms improved . Measures of anthropometry , walking distance , physical activity and nutritional status did not change . There was an increase in sarcopenic status from diagnosis ( pre-sarcopenic n = 2 ) to post-treatment ( pre-sarcopenic n = 5 , severely sarcopenic n = 1 ) . Conclusions Despite maintenance of body weight , functional capacity and activity habits , participants experience declines in muscle mass and strength . Interventions involving exercise and /or nutritional support to build muscle mass and strength during preoperative therapy , even in patients who are functioning normally , are warranted PURPOSE Effects of specific antineoplastic therapies on progression of cancer-associated wasting remain uncharacterized . We selected a targeted therapy , sorafenib , because of its reported association with weight loss . PATIENTS AND METHODS Patients with metastatic renal cell cancer ( RCC ) who were resistant to st and ard therapy ( N = 80 ) received sorafenib 400 mg twice daily or placebo in a r and omized , double-blinded clinical trial . Computed tomography image analysis , which has high precision and specificity for evaluation of specific muscles and adipose tissues , was used to define change in total skeletal muscle and adipose tissue . Results At inclusion , 51 % of patients were overweight or obese ( ie , body mass index [ BMI ] > 25 kg/m(2 ) ) . Only 5 % were underweight .  Advanced muscle wasting ( ie , sarcopenia ) was present in 72 % of patients with BMI less than 25 and in 34 % of those with a BMI greater than 25 . Patients received placebo for an average of 6 months and received sorafenib for 1 year . Patients in the placebo group had stable body weight during 6 months ( 0.8 kg + /- 0.7 kg ) , with no significant alteration of muscle or fat . Patients who received sorafenib  lost 2.1 kg + /- 0.6 kg ( P < .01 ) in 6 months and lost 4.2 kg + /- 0.7 kg ( P < .01 ) by 1 year . Sorafenib-treated patients lost skeletal muscle progressively at 6 months ( decrease of 4.9 % ; P < .01 ) and 12 months ( decrease of 8.0 % ; P < .01 ) . CONCLUSION Sarcopenia is prevalent in patients with metastatic RCC and is an occult condition in patients with normal or high BMI . Muscle loss is specifically exacerbated by sorafenib , consistent with the evidence for a role of kinases in regulating muscle mass . Muscle loss is a sorafenib adverse effect that may relate to asthenia , fatigue , and physical disability BACKGROUND AND OBJECTIVES Reduced muscle mass and strength are prevalent conditions in dialysis patients . However , muscle strength and muscle mass are not congruent ; muscle strength can diminish even though muscle mass is maintained or increased . This study addresses phenotype and mortality associations of these muscle dysfunction entities alone or in combination ( i.e. , concurrent loss of muscle mass and strength/mobility , here defined as sarcopenia ) . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS This study included 330 incident dialysis patients ( 203 men , mean age 53±13 years , and mean GFR 7±2 ml/min per 1.73 m(2 ) ) recruited between 1994 and 2010 and followed prospect ively for up to 5 years . Low muscle mass ( by dual-energy x-ray absorptiometry appendicular mass index ) and low muscle strength ( by h and grip ) were defined against young reference population s according to the European Working Group on Sarcopenia in Older People . RESULTS Whereas 20 % of patients had sarcopenia , low muscle mass and low muscle strength alone were observed in a further 24 % and 15 % of patients , respectively . Old age , comorbidities , protein-energy wasting , physical inactivity , low albumin , and inflammation associated with low muscle strength , but not with low muscle mass ( multivariate ANOVA interactions ) . During follow-up , 95 patients ( 29 % ) died and both conditions associated with mortality as separate entities . When combined , individuals with low muscle mass alone were not at increased risk of mortality ( adjusted hazard ratio [ HR ] , 1.23 ; 95 % confidence interval [ 95 % CI ] , 0.56 to 2.67 ) . Individuals with low muscle strength were at increased risk , irrespective of their muscle stores being appropriate ( HR , 1.98 ; 95 % CI , 1.01 to 3.87 ) or low ( HR , 1.93 ; 95 % CI , 1.01 to 3.71 ) . CONCLUSIONS Low muscle strength was more strongly associated with aging , protein-energy wasting , physical inactivity , inflammation , and mortality than low muscle mass . Assessment of muscle functionality may provide additional diagnostic and prognostic information to muscle-mass evaluation Purpose Sarcopenia is distinguished by decreased skeletal muscle plus low muscle strength and /or physical performance . This study was design ed to demonstrate the relationship between sarcopenia and systemic inflammatory response ( neutrophil/lymphocyte ratio [ NLR ] , platelet/lymphocyte ratio [ PLR ] , and large platelet/lymphocyte ratio [ LPLR ] ) prior to radical gastrectomy for gastric cancer . Patients and methods We conducted a prospect i ve study of gastric cancer patients who underwent radical gastrectomy .  The clinical utility of the NLR , PLR , and LPLR was evaluated by receiver operating characteristic curves . Sarcopenia components including skeletal muscle index , h and grip strength , and 6 m usual gait speed were measured . Logistic analysis was used to identify the independent indices associated with sarcopenia . Results A total of 670 patients were included , representing 504 men and 166 women . Of these , 104 patients ( 15.5 % ) were diagnosed with sarcopenia and 567 ( 84.5 % ) were non-sarcopenia . PLR has a diagnostic sensitivity of 91.3 % for sarcopenia . In addition to the indicators of preoperative age , nutritional risk screening , body mass index , preoperative albumin , and diabetes , the NLR and PLR were independent predictors for sarcopenia ( P<0.05 ) . Conclusion The present study showed that at-diagnosis sarcopenia was associated with inflammation in patients with operable gastric cancer . Due to the complex assessment of muscle condition , PLR may be used as a primary screening test for sarcopenia . How systemic inflammatory response influences changes in sarcopenia may provide new therapeutic perception toward improving outcomes OBJECTIVES To examine the association between strength , function , lean mass , muscle density , and risk of hospitalization . DESIGN Prospect i ve cohort study . SETTING Two U.S. clinical centers . PARTICIPANTS Adults aged 70 to 80 ( N=3,011 ) from the Health , Aging and Body Composition Study . MEASUREMENTS Measurements were of  grip strength , knee extension strength , lean mass , walking speed , and chair st and pace . Thigh computed tomography scans assessed muscle area and density ( a proxy for muscle fat infiltration ) . Hospitalizations were confirmed by local review of medical records . Negative binomial regression models estimated incident rate ratios ( IRRs ) of hospitalization for race- and sex-specific quartiles of each muscle and function parameter separately . Multivariate models adjusted for age , body mass index , health status , and coexisting medical conditions . RESULTS During an average 4.7 years of follow-up , 1,678 ( 55.7 % ) participants experienced one or more hospitalizations . Participants in the lowest quartile of muscle density were more likely to be subsequently hospitalized ( multivariate IRR=1.47 , 95 % confidence interval (CI)=1.24 - 1.73 ) than those in the highest quartile . Similarly , participants with the weakest grip strength were at greater risk of hospitalization ( multivariate IRR=1.52 , 95 % CI=1.30 - 1.78 , Q1 vs. Q4 ) . Comparable results were seen for knee strength , walking pace , and chair st and s pace . Lean mass and muscle area were not associated with risk of hospitalization . CONCLUSION Weak strength , poor function , and low muscle density , but not muscle size or lean mass , were associated with greater risk of hospitalization . Interventions to reduce the disease burden associated with sarcopenia should focus on increasing muscle strength and improving physical function rather than simply increasing lean mass The age-related change in hormone concentrations has been hypothesized to play a role in the loss of muscle mass and muscle strength with aging , also called sarcopenia . The aim of this prospect i ve study was to investigate whether low serum 25-hydroxyvitamin D ( 25-OHD ) and high serum PTH concentration were associated with sarcopenia . In men and women aged 65 yr and older , participants of the Longitudinal Aging Study Amsterdam , grip strength ( n = 1008 ) and appendicular skeletal muscle mass ( n = 331 , using dual-energy x-ray absorptiometry ) were measured in 1995 - 1996 and after a 3-yr follow-up . Sarcopenia was defined as the lowest sex-specific 15th percentile of the cohort , translating into a loss of grip strength greater than 40 % or a loss of muscle mass greater than 3 % . After adjustment for physical activity level , season of data collection , serum creatinine concentration , chronic disease , smoking , and body mass index , persons with low ( < 25 nmol/liter ) baseline 25-OHD levels were 2.57 ( 95 % confidence interval 1.40 - 4.70 , based on grip strength ) and 2.14 ( 0.73 - 6.33 , based on muscle mass ) times more likely to experience sarcopenia , compared with those with high ( > 50 nmol/liter ) levels . High PTH levels ( > or=4.0 pmol/liter ) were associated with an increased risk of sarcopenia , compared with low PTH ( < 3.0 pmol/liter ) : odds ratio = 1.71 ( 1.07 - 2.73 ) based on grip strength , odds ratio = 2.35 ( 1.05 - 5.28 ) based on muscle mass . The associations were similar in men and women . The results of this prospect i ve , population -based study show that lower  25-OHD  and higher  PTH levels increase the risk of sarcopenia in older men and women Objective : The aim of this article was to study the prevalence and significance of sarcopenia in the multimodal management of locally advanced esophageal cancer ( LAEC ) , and to assess its independent impact on operative and oncologic outcomes . Summary of Background Data : Sarcopenia in cancer may confer negative outcomes , but its prevalence and impact on modern multimodal regimens for LAEC have not been systematic ally studied . Methods : Two hundred fifty-two consecutive patients were studied .  Lean body mass ( LBM ) , skeletal muscle index ( SMI ) , and fat mass ( FM ) were determined pre-treatment , preoperatively , and 1 year postoperatively . Sarcopenia was defined by computed tomography ( CT ) at L3 as SMI < 52.4 cm2/m2 for males and SMI < 38.5 cm2/m2 for females . All complications were recorded prospect ively , including comprehensive complications index ( CCI ) , Clavien-Dindo complication ( CDC ) , and pulmonary complications ( PPCs ) . Multivariable linear , logistic , and Cox regression analysis was performed . Results : In-hospital mortality was 1 % , and CCI was 21 ± 19 . Sarcopenia increased ( P = 0.02 ) from 16 % at diagnosis to 31 % post-neoadjuvant therapy , with loss of LBM ( -3.0 ± 5.4 kg , P < 0.0001 ) , but not FM ( -0.3 ± 2.7 kg , P= 0.31 ) during treatment . On multivariable analysis , preoperative sarcopenia was associated with CCI ( P = 0.043 ) , and CDC ≥IIIb ( P = 0.003 ) . PPCs occurred in 36 % nonsarcopenic versus 55 % sarcopenic patients ( P = 0.01 ) . Sarcopenia did not impact disease-specific ( P = 0.14 ) or overall survival ( P = 0.11 ) after resection . At 1 year , 35 % had sarcopenia , significantly associated with pre-treatment BMI ( P = 0.013 ) but not complications ( P = 0.20 ) . Conclusions : Sarcopenia increases through multimodal therapy , is associated with an increased risk of major postoperative complications , and is prevalent in survivorship . These data highlight a potentially modifiable marker of risk that should be assessed and targeted in modern multimodal care pathways BACKGROUND Age-associated declines in muscle mass and function are major risk factors for an impaired ability to carry out activities of daily living , falls , prolonged recovery time after hospitalization , and mortality in older adults . New strategies that can slow the age-related loss of muscle mass and function are needed to help older adults maintain adequate performance status to reduce these risks and maintain independence . OBJECTIVE We evaluated the efficacy of fish oil-derived n-3 ( ω-3 ) PUFA therapy to slow the age-associated loss of muscle mass and function . DESIGN Sixty healthy 60 - 85-y-old men and women were r and omly assigned to receive n-3 PUFA ( n = 40 ) or corn oil ( n = 20 ) therapy for 6 mo . Thigh muscle volume , h and grip strength , one-repetition maximum ( 1-RM ) lower- and upper-body strength , and average power during isokinetic leg exercises were evaluated before and after treatment . RESULTS Forty-four subjects completed the study [ 29 subjects ( 73 % ) in the n-3 PUFA group ; 15 subjects ( 75 % ) in the control group ] . Compared with the control group , 6 mo of n-3 PUFA therapy increased thigh muscle volume ( 3.6 % ; 95 % CI : 0.2 % , 7.0 % ) , h and grip strength ( 2.3 kg ; 95 % CI : 0.8 , 3.7 kg ) , and 1-RM muscle strength ( 4.0 % ; 95 % CI : 0.8 % , 7.3 % ) ( all P < 0.05 ) and tended to increase average isokinetic power ( 5.6 % ; 95 % CI : -0.6 % , 11.7 % ; P = 0.075 ) . CONCLUSION Fish oil-derived n-3 PUFA therapy slows the normal decline in muscle mass and function in older adults and should be considered a therapeutic approach for preventing sarcopenia and maintaining physical independence in older adults . This study was registered at clinical trials.gov as NCT01308957 Purpose One-year mortality is vital for elderly oncologic patients undergoing surgery . Recent studies have demonstrated that sarcopenia can predict outcomes after major abdominal surgeries , but the association of sarcopenia and 1-year mortality has never been investigated in a prospect i ve study . Methods We conducted a prospect i ve study of elderly patients ( ≥65 years ) who underwent curative gastrectomy for gastric cancer from July 2014 to July 2015 . Sarcopenia was determined by the measurements of muscle mass , h and grip strength , and gait speed . Univariate and multivariate analyses were used to identify the risk factors associated with 1-year mortality . Results A total of 173 patients were included , in which 52 ( 30.1 % ) patients were identified as having sarcopenia . Twenty-four ( 13.9 % ) patients died within 1 year of surgery . Multivariate analysis showed that sarcopenia was an independent risk factor for 1-year mortality . Area under the receiver operating characteristic curve demonstrated an increased predictive power for 1-year mortality with the inclusion of sarcopenia , from 0.835 to 0.868 . Solely low muscle mass was not predictive of 1-year mortality in the multivariate analysis . Conclusions Sarcopenia is predictive of 1-year mortality in elderly patients undergoing gastric cancer surgery . The measurement of muscle function is important for sarcopenia as a preoperative assessment tool Background Sarcopenia is a decrease in both muscle mass and strength . It remains unclear whether sarcopenia is associated with morbidity after gastric cancer surgery . This study evaluated the impact of sarcopenia on the morbidity of gastric cancer surgery . Methods A total of 293 gastric cancer patients who underwent curative surgery between May 2011 and June 2013 were retrospectively examined . Patients with performance status 3 or 4 were excluded .  Preoperative lean body mass ( LBM ) was evaluated by bioelectrical impedance analysis and expressed as LBM index .  Preoperative muscle function was measured by h and grip strength ( HGS ) . The cutoff values were the gender-specific lowest 20 % . Grade 2 or higher morbidities , as retrospectively evaluated by the Clavien – Dindo classification , were obtained from the patient record . The risk factors for morbidity were examined by univariate and multivariate analyses . Results Morbidity was observed in 39 patients ( 13.3 % ) , including 7 with pancreatic leakage , 12 with anastomotic leakage , and 4 with intraabdominal abscesses , but no mortality was observed . The univariate analysis showed that male gender , total gastrectomy , splenectomy , and a low HGS were significant risk factors for morbidity . A low LBM was not a significant risk factor . A low HGS , male gender , and total gastrectomy remained significant in the multivariate analysis . Conclusions A low h and grip strength was a significant risk factor for morbidity after gastric cancer surgery . The importance of the h and grip strength as a risk factor should be examined in future prospect i ve studies BACKGROUND Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength . This study aims to explore the prevalence of sarcopenia in overweight and obese gastric cancer ( GC ) patients and figured out the impacts of sarcopenia on the postoperative complication of overweight and obese GC patients . METHODS According to the recommended body-mass index ( BMI ) for Asian population s by WHO , we conducted a prospect i ve study of overweight and obese gastric cancer patients ( BMI ≥ 23 kg/m2 ) under curative gastrectomy from August 2014 to December 2015 . Including  lumbar skeletal muscle index , h and grip strength and gait speed as the sarcopenic components were measured before surgery . Patients were followed up after gastrectomy to gain the actual clinical outcomes . Factors contributing to postoperative complications were analyzed by univariate and multivariate analysis . RESULTS Total of 206 overweight or obese patients were enrolled in this study , 14 patients were diagnosed sarcopenia and were demonstrated having significantly association with higher risk of postoperative complications , higher hospital costs , and higher rate of 30-days readmission compared with the non-sarcopenic ones . On the basis of univariate and multivariate analysis , sarcopenia was an independent risk factor for postoperative complication of overweight and obese patients with gastric cancer ( P = 0.002 ) . CONCLUSION Sarcopenia is an independent predictor of postoperative complications in overweight or obese patients with gastric cancer after radical gastrectomy BACKGROUND Sarcopenia , severe skeletal muscle loss , has been identified as a prognostic factor in various malignancies . This study aims to investigate whether sarcopenia is associated with overall survival ( OS ) and surgical complications in patients with advanced ovarian cancer undergoing primary debulking surgery ( PDS ) .  METHODS Ovarian cancer patients ( n = 216 ) treated with PDS were enrolled retrospectively .  Total skeletal muscle surface area was measured on axial computed tomography at the level of the third lumbar vertebra . Optimum stratification was used to find the optimal skeletal muscle index cut-off to define sarcopenia ( ≤38.73 cm2/m2 ) . Cox-regression and Kaplan-Meier analysis were used to analyse the relationship between sarcopenia and OS . The effect of sarcopenia on the development of major surgical complications was studied with logistic regression . RESULTS Kaplan-Meier analysis showed a significant survival disadvantage for patients with sarcopenia compared to patients without sarcopenia ( p = 0.010 ) . Sarcopenia univariably predicted OS ( HR 1.536 ( 95 % CI 1.105 - 2.134 ) , p = 0.011 ) but was not significant in multivariable Cox-regression analysis ( HR 1.362 ( 95 % CI 0.968 - 1.916 ) , p = 0.076 ) . Significant predictors for OS in multivariable Cox-regression analysis were complete PDS , treatment in a specialised centre and the development of major complications . Sarcopenia was not predictive of major complications . CONCLUSION Sarcopenia was not predictive of OS or major complications in ovarian cancer patients undergoing primary debulking surgery . However a strong trend towards a survival disadvantage for patients with sarcopenia was seen . Future prospect i ve studies should focus on interventions to prevent or reverse sarcopenia and possibly increase ovarian cancer survival . Complete cytoreduction remains the strongest predictor of ovarian cancer survival OBJECTIVES To describe associations between dietary nutrient intake and progression of sarcopenia , the age-related loss of muscle mass and strength . DESIGN Prospect i ve cohort study of community-dwelling older adults . SETTING Southern Tasmania , Australia . PARTICIPANTS Seven hundred forty noninstitutionalized older adults ( 50 % female ; mean age 62 ± 7 ) r and omly sample d from electoral rolls .  MEASUREMENTS Dietary nutrient intake  was examined at baseline and follow-up ( 2.6 ± 0.4 years later ) using The Cancer Council Victoria 's Food Frequency Question naire ( FFQ ) . Appendicular lean mass ( aLM ) was assessed using dual X-ray absorptiometry and muscle strength of the knee extensors using a dynamometer . RESULTS Failing to meet the recommended dietary intake for protein was associated with significantly lower aLM at baseline ( -0.81 kg , 95 % confidence interval ( CI ) = -1.54 to -0.08 ) and follow-up ( -0.79 kg , 95%CI = -1.42 to -0.17 ) . Energy-adjusted protein intake was a positive predictor of change in aLM over 2.6 years ( β = 0.10 , P = .003 ) . Energy-adjusted intake of iron ( β = 0.07 , P = .02 ) , magnesium ( β = 0.07 , P=.02 ) , phosphorus ( β = 0.07 , P = .047 ) , and zinc ( β = 0.08 , P = .02 ) were positive predictors of change in aLM , whereas retinol ( β = -0.09 , P = .005 ) was a negative predictor of change in aLM after adjustment for protein intake . No significant associations were observed between nutrient intake and muscle strength . CONCLUSION Protein and several other dietary nutrients are associated with muscle mass and rate of muscle loss ( but not strength ) in older adults , suggesting that multiple dietary components may ameliorate the progression of sarcopenia Abstract Background Although muscle mass declines with testosterone deficiency in men , previous studies of muscle function have not demonstrated consistent deficits , likely due to relatively insensitive methodology . Our objective was to determine the effects of testosterone deprivation on the biomechanical function of individual lower‐limb muscles . Methods We conducted a 12‐month prospect i ve , observational case – control study of 34 men newly commencing and rogen deprivation treatment ( ADT ) for prostate cancer and 29 age‐matched prostate cancer controls . Participants were assessed at 0 , 6 , and 12 months while walking in a biomechanics laboratory . We combined video‐based motion capture and ground reaction force data with computerized musculoskeletal modelling to assess the following primary outcomes : ( i ) peak joint torques at the hip , knee and ankle , and corresponding individual muscle forces ; ( ii ) individual muscle contributions to acceleration of the body 's centre of mass ; and ( iii ) walking speed , stride length , and step width . A linear mixed model was used to compare mean differences between groups . Results Compared with controls over 12 months , men receiving ADT had a mean reduction in total testosterone level from 14.1 to 0.4 nmol/L , and demonstrated more marked decreases in peak hip flexor torque by 14 % [ mean difference −0.11 N/kg ( −0.19 , −0.03 ) , P = 0.01 ] and peak knee extensor torque by 16 % [ −0.11 N/kg ( −0.20 , −0.02 ) , P = 0.02 ] of the initial mean value . Correspondingly , iliopsoas force decreased by 14 % ( P = 0.006 ) , and quadriceps force decreased by 11 % , although this narrowly missed statistical significance ( P = 0.07 ) . Soleus decreased contribution to forward acceleration of the body 's centre of mass by 17 % [ mean difference −0.17 m/s2 ( −0.29 , −0.05 ) , P < 0.01 ] . No significant changes between groups were observed in other joint torques or individual muscle contributions to acceleration of the body . Step width increased by 18 % [ mean adjusted difference 1.4 cm ( 0.6 , 27.4 ) , P = 0.042 ] in the ADT group compared with controls , with no change in stride length or walking speed . Conclusions Testosterone deprivation selectively decreases lower‐limb muscle function , predominantly affecting muscles that support body weight , accelerate the body forwards during walking , and mediate balance . Future exercise and pro‐myogenic interventional studies to mitigate ADT‐associated sarcopenia should target these deficits BACKGROUND Lower muscle mass has been correlated with poor physical function ; however , no studies have examined this relationship prospect ively . This study aims to investigate whether low muscle mass , low muscle strength , and greater fat infiltration into the muscle predict incident mobility limitation . METHODS Our study cohort included 3075 well-functioning black and white men and women aged 70 - 79 years participating in the Health , Aging , and Body Composition study . Participants were followed for 2.5 years . Muscle cross-sectional area and muscle tissue attenuation ( a measure of fat infiltration ) were measured by computed tomography at the mid-thigh , and knee extensor strength by using a KinCom dynamometer .  Incident mobility limitation was defined as two consecutive self-reports of any difficulty walking one-quarter mile or climbing 10 steps . RESULTS Mobility limitations were developed by 22.3 % of the men and by 31.8 % of the women . Cox 's proportional hazards models , adjusting for demographic , lifestyle , and health factors , showed a hazard ratio of 1.90 [ 95 % confidence interval ( CI ) , 1.27 - 2.84 ] in men and 1.68 ( 95 % CI , 1.23 - 2.31 ) in women for the lowest compared to the highest quartile of muscle area ( p < .01 for trend ) . Results for muscle strength were 2.02 ( 95 % CI , 1.39 - 2.94 ) and 1.91 ( 95 % CI , 1.41 - 2.58 ) , p < .001 trend , and for muscle attenuation were 1.91 ( 95 % CI , 1.31 - 2.83 ) and 1.68 ( 95 % CI , 1.20 - 2.35 ) , p < .01 for trend . When included in one model , only muscle attenuation and muscle strength independently predicted mobility limitation ( p < .05 ) . Among men and women , associations were similar for blacks and whites . CONCLUSION Lower muscle mass ( smaller cross-sectional thigh muscle area ) , greater fat infiltration into the muscle , and lower knee extensor muscle strength are associated with increased risk of mobility loss in older men and women . The association between low muscle mass and functional decline seems to be a function of underlying muscle strength Background : Muscle wasting is a component of the diagnosis of cancer cachexia and has been associated with poor prognosis . However , recommended tools to measure sarcopenia are limited by poor sensitivity or the need to perform additional scans . We hypothesized that pectoralis muscle area ( PMA ) measured objective ly on chest CT scan may be associated with overall survival ( OS ) in non – small cell lung cancer ( NSCLC ) . Methods : We evaluated 252 cases from a prospect ively enrolling lung cancer cohort . Eligible cases had CT scans performed prior to the initiation of surgery , radiation , or chemotherapy .  PMA was measured in a semi-automated fashion while blinded to characteristics of the tumor , lung , and patient outcomes . Results : Men had a significantly greater PMA than women ( 37.59 vs. 26.19 cm2 , P < 0.0001 ) . In univariate analysis , PMA was associated with age and body mass index ( BMI ) . A Cox proportional hazards model was constructed to account for confounders associated with survival . Lower pectoralis area ( per cm2 ) at diagnosis was associated with an increased hazard of death of 2 % ( HRadj , 0.98 ; confidence interval , 0.96–0.99 ; P = 0.044 ) while adjusting for age , sex , smoking , chronic bronchitis , emphysema , histology , stage , chemotherapy , radiation , surgery , BMI , and ECOG performance status . Conclusions : Lower PMA measured from chest CT scans obtained at the time of diagnosis of NSCLC is associated with a worse OS . Impact : PMA may be a valuable CT biomarker for sarcopenia-associated lung cancer survival . Cancer Epidemiol Biomarkers Prev ; 26(1 ) ; 38–43 . © 2016 AACR . See all the articles in this CEBP Focus section , “ The Obesity Paradox in Cancer : Evidence and New Directions . OBJECTIVES Severe skeletal muscle loss ( sarcopenia ) is associated with poor cancer outcomes , including reduced survival and increased treatment toxicity . Our goal was to evaluate if sarcopenia was associated with worse survival outcomes and chemotoxicity in EOC patients undergoing primary platinum and taxane-based chemotherapy .  METHODS EOC patients diagnosed between 06/2000 and 02/2017 who received treatment with platinum and taxane-based chemotherapy were included .  CT abdominal images closest to the time of diagnosis were retrospectively evaluated for skeletal muscle area at the 3rd lumbar vertebrae . Measurements were obtained with use of TomoVision ® radiological software ( SliceOmatic - version 5.0 , Quebec , Canada ) . Sarcopenia was defined as Skeletal Muscle Index ( SMI ) ≤ 41 . Data analysis included Kaplan-Meier plots to assess survival , and unpaired t-tests were used to compare the means by groups . RESULTS 201 EOC patients were evaluated . Sixty-four percent ( 128/201 ) met criteria for sarcopenia ( SMI ≤ 41 ) at time of diagnosis . The mean overall survival did not differ between patients with SMI > 41 and SMI ≤ 41 ( 36.5 vs 40.8 months , p = 0.4 , respectively ) . No difference in frequency of dose reduction , dose delay , hospital admissions , changes in regimen , blood transfusion , or toxicity was noted . There was no difference in distribution of toxicity grade . CONCLUSION Sarcopenia was not associated with worse survival outcomes or chemotoxcity in EOC patients receiving first-line platinum and taxane-based chemotherapy  in this cohort . Future prospect i ve studies should focus on interventions to prevent or reverse sarcopenia and possibly increase ovarian cancer survival , performance status , and quality of life Objective : Few studies have investigated the relationships between body composition , functional ability , and age-related disability in postmenopausal women . We investigated the relative role of fat mass , lean mass , and muscle strength in the development of disability in a group of healthy postmenopausal women younger than 75 years . Design : We performed a cross-sectional study among 396 independently living women aged 56 - 73 years , r and omly selected between 8 and 30 years after menopause .  Lean mass and fat mass were assessed by dual-energy x-ray absorptiometry . Muscle strength ( grip and leg extensors ) was assessed using dynamometry . Functional ability was estimated by Physical Performance Score , physical activity during the preceding year , and impairment in activities of daily living . Results : Of the participants , 43.7 % were overweight ( 25 ≥ BMI < 30 kg/m2 ) , and 17.7 % were obese ( BM I ≥ 30 kg/m2 ) . Higher muscle strength was observed with increasing lean body mass , and participants with higher muscle strength scored better in the physical performance score and activities of daily living . Higher fat mass was significantly associated with a lower physical performance score , lower physical activity , and a higher frequency of disability . Increasing fat mass was associated with increasing lean mass and decreasing lean/fat ratio . The increase in lean mass and muscle strength associated with higher fat mass was mainly localized in the legs . Conclusions : Our results support the role of fat mass as the primary risk marker for disability , which might later accelerate by the age-related decrease in lean mass and the development of sarcopenia after the age of 75 years Objectives Leucine-rich milk and whey proteins have been suggested for prevention of age related loss of muscle mass and strength i.e. sarcopenia . The effects of milk protein supplementation and low intensity home based physical exercise on body composition and muscle functions were investigated . Design A r and omized double blind crossover trial . Setting Community dwelling members of Helsinki rheumatoid association . Participants Older people ( N = 47 , mean age 69.5 years ) suffering from polymyalgia rheumatica . Intervention Patients performed as many st and ups as possible twice a day after which they ingested a regular ( Control ) or a whey protein enriched dairy product with high leucine content ( Test ) . The 8-week intervention periods were separated by a 4-week wash-out . Measurements Body composition was measured by dual x-ray absorptiometry and muscle functions by h and grip strength , force platform countermovement jump performance , chair st and test , and walking speed . Results The 16-week home-based post-exercise supplementation result ed in a 1.8 % increase ( p = 0.052 ) in lower limb muscle mass . Walking speed ( + 5.3 % , p = 0.007 ) and chair st and test performance ( −12.2 % , p < 0.001 ) were also improved . Furthermore , a tendency for increased jump power ( + 3.0 % , p = 0.084 ) was observed . However , significant and consistent differences were not found in the changes of muscle mass indices or muscle functions between supplements , but the test supplement tended to prevent accumulation of body fat . Conclusion A low intensity home based exercise program combined with post-exercise milk protein supplementation is feasible despite some gastrointestinal complaints and seems effective in improving the muscle mass and functions of older persons with a inflammatory disease . Further studies are needed to establish , whether and to what extent the use of leucine-enriched whey products prevent or treat age-associated sarcopenia and whether they are superior to the present commercial milk products
Sarcopenia , as defined by reduced muscle mass alone , was found to be very prevalent in patients with lung cancer , regardless of body mass index , and where present was associated with poorer functional status and overall survival .
The effect of nutritional supplements and ATP infusions on muscle mass showed conflicting results .
There are very limited data on the correlation between degree of sarcopenia and muscle function , which has a non-linear relationship in older non-cancer population s. CONCLUSIONS Loss of muscle mass is a significant contributor to morbidity in patients with lung cancer .
OBJECTIVES There is growing awareness of the relationship between sarcopenia ( loss of muscle mass and function ) , and outcomes in cancer , making it a potential target for future therapies .
In order to inform future research and practice , we undertook a systematic review of factors associated with loss of muscle mass , and the relationship between muscle function and muscle mass in lung cancer , a common condition associated with poor outcomes .