Absence of risk of sarcopenia protects cancer patients from fatigue.

BACKGROUND: Cancer and its treatments often lead to sarcopenia and fatigue. However, whether these factors are associated remains unproven. OBJECTIVE: To evaluate whether the risk of sarcopenia predicts the presence of fatigue. METHODS: A cross-sectional study was completed and included 198 cancer patients of both sexes, undergoing in- and outpatient treatment. The Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F) and the Functional Assessment of Cancer Therapy Fatigue (FACT-F) were used to assess the risk of sarcopenia and the presence of fatigue, respectively. The cut-off values used to identify the risk of sarcopenia and the severity of fatigue scale were SARC-F ≥ 4 and Fatigue <34, respectively. Logistic regression analysis was performed to evaluate the association between SARC-F and the FACT-F. RESULTS: Out of 198 patients, 35% were at risk of sarcopenia and of these 87% had fatigue. Patients at risk of sarcopenia had lower scores in the FACT-F subscales, lower handgrip strength, lower performance status, were mostly hospitalized and were sedentary. Logistic regression analysis revealed that patients with SARC-F < 4 had a lower risk of fatigue in both models, crude (OR: 0.83; CI 95% [0.79-0.88], p < 0.0001) as well as adjusted for age, gender, BMI, physical activity, current use of alcoholic beverages, smoking, performance status, cancer type, clinical setting and use of supplements (OR: 0.87; CI 95% [0.81-0.92], p < 0.0001). CONCLUSION: In patients with cancer, 35% presented risk of sarcopenia and of these 87% had fatigue. In addition, the absence of sarcopenia was considered protective against fatigue.

Short-term intradialytic NMES targeting muscles of the legs improves the phase angle: A pilot randomized clinical trial.

PURPOSE: Neuromuscular electrical stimulation (NMES) elicits muscle contraction and has been shown to attenuate muscle atrophy when physical activity is not possible. Thus, we hypothesized that intradialytic NMES would attenuate the loss leg lean mass and improve the phase angle in patients undergoing hemodialysis (HD). METHODS: A randomized controlled trial was performed with twenty-one adult HD patients (n = 8 F, n = 13 M; 45.8 ± 10.6 y) randomly assigned to usual care (control group, n = 11; 4F/7M) or to the NMES group (n = 10; 4F/6M). NMES was applied bilaterally at the origin and insertion points of the quadriceps or gastrocnemius muscles for 40 min during each HD session (3x/wk for one month). Pre-and post-intervention, we measured leg lean mass using dual-energy x-ray absorptiometry and phase angle using bioelectrical impedance analysis. RESULTS: NMES did not change leg lean mass compared to the control group. Phase angle increased in the NMES compared to the control group (Δ: +0.71 ± 0.27° vs. -0.46 ± 0.23°, p = 0.004) with interaction time x treatment (ANOVA p = 0.004). CONCLUSION: Short-term intradialytic NMES targeting muscles of the legs improved the phase angle but did not change leg lean mass. BRAZILIAN REGISTRY OF CLINICAL TRIALS UNDER THE CODE: RBR-98wzgn.

Association of SARC-F and dissociation of SARC-F + calf circumference with comorbidities in older hospitalized cancer patients.

The Strength, Assistance for walking, Rise from a chair, Climb stairs and Falls (SARC-F) score is a tool recommended for screening the risk of sarcopenia in older patients. However, the association between SARC-F or SARC-F + calf circumference (SARC-F + CC) and the Charlson Comorbidity Index (CCI) in hospitalized older cancer patients is not fully understood. Thus, our aim is to evaluate the association between the SARC-F or SARC-F + CC and the presence of comorbidities and risk of death in older hospitalized cancer patients. A cross-sectional study involving 90 (42 M/48F) hospitalized cancer patients over 60 years old with ongoing chemotherapy or surgical treatment is carried out. The SARC-F is performed to assess the muscle function loss (MFL if SARC-F ≥ 4), sarcopenia (SARC-F ≥ 6) and sarcopenia using the calf circumference (SARC-F + CC ≥11). CC is assessed using an inelastic tape. The CCI is used to assess the presence of comorbidities. Logistic regression is used to evaluate the association between the SARC-F and Charlson Comorbidity Index. Mean of age is 67.8 years and half (49%) of the patients present MFL (SARC-F ≥ 4), 31% present sarcopenia using the SARC-F ≥ 6 and 60% using the SARC-F + calf circumference ≥ 11. Although no association in the crude model, there is association after adjusting by age, sex, alcohol use, smoking habit, physical activity, use of oral nutritional supplementation, body mass index, performance status, tumor, and treatment type between SARC-F ≥ 4 or ≥ 6 and CCI (SARC-F ≥ 4 × CCI: OR: 2.31 [95%CI: 1.02-5.23], p = 0.04) and (SARC-F ≥ 6 × CCI: OR: 3.24 [95%CI: 1.21-8.65], p = 0.01), respectively. However, this association is lost when using the SARC-F + calf circumference (SARC-F + CC ≥11 × CCI: OR: 1.12 [95%CI: 0.63-1.90], p = 0.68). In conclusion, screening for the risk of sarcopenia in older cancer patients is highly recommended as sarcopenia is tightly associated with the clinical outcome. The use of the SARC-F score using a cut-off ≥4 or ≥ 6 is more relevant for clinical practice to detect comorbidities and risk of death than the use of SARC-F with the calf circumference.

Low phase angle is associated with the risk for sarcopenia in unselected patients with cancer: Effects of hydration.

OBJECTIVE: Individuals with cancer are affected by a loss of cell membrane integrity due to electrolyte imbalance between the intra- and extracellular fluids. Cell membrane integrity and hydration status can be assessed according to the phase angle (PhA) and the risk for sarcopenia, by using the Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire. To our knowledge, this approach has not been validated in patients with cancer. The aims of this study were to verify the prevalence of the risk for sarcopenia, and to analyze the association between PhA and the risk for sarcopenia with and without adjustment for extracellular water content. METHODS: This was a cross-sectional study conducted with 124 male and female cancer patients (77.4% men). PhA and hydration status were assessed using bioelectrical impedance analysis (BIA), and the risk for sarcopenia (cutoff ≥4) was assessed using the SARC-F questionnaire. RESULTS: Of the 124 patients, 28 (22.5%) were at risk for sarcopenia (SARC-F ≥4). There was no association between PhA and the risk for sarcopenia in the crude model, nor in the model adjusted for age, sex, smoking, alcohol consumption, and physical activity, nor after adjusting for use of supplements, body mass index, treatment type, performance status, and type and stage of cancer. However, we found an association between lower PhA values and a higher risk for sarcopenia after adjusting for hydration abnormalities (odds ratio, 1.74; 95% confidence interval, 1.03-2.93; P < 0.035). CONCLUSION: We found that 22.5% of patients with cancer presented with a risk for sarcopenia. Additionally, an association between lower PhA values and enhanced risk for sarcopenia highlighted the importance of adequate hydration and evaluation of fluid status via BIA as a new recommendation to prevent sarcopenia.

Dietary recommendations during the COVID-19 pandemic.

Optimal nutrition can improve well-being and might mitigate the risk and morbidity associated with coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review summarizes nutritional guidelines to support dietary counseling provided by dietitians and health-related professionals. The majority of documents encouraged the consumption of fruits, vegetables, and whole grain foods. Thirty-one percent of the guidelines highlighted the importance of minerals and vitamins such as zinc and vitamins C, A, and D to maintain a well-functioning immune system. Dietary supplementation has not been linked to COVID-19 prevention. However, supplementation with vitamins C and D, as well as with zinc and selenium, was highlighted as potentially beneficial for individuals with, or at risk of, respiratory viral infections or for those in whom nutrient deficiency is detected. There was no convincing evidence that food or food packaging is associated with the transmission of COVID-19, but good hygiene practices for handling and preparing foods were recommended. No changes to breastfeeding recommendations have been made, even in women diagnosed with COVID-19.

High neutrophil to lymphocytes ratio is associated with sarcopenia risk in hospitalized cancer patients.

BACKGROUND & AIMS: Systemic inflammation has been reported as a new predictor for cancer outcomes. This study aimed i) to identify the neutrophil to lymphocytes ratio (NLR) cut-off point that best predicts sarcopenia and ii) to verify the association between NLR and sarcopenia risk in hospitalized cancer patients. METHODS: A cross-sectional study enrolled a total of 123 hospitalized cancer patients receiving chemotherapy and/or undergoing surgery. Systemic inflammation was assessed as revealed by circulating levels of C-reactive protein, neutrophils, platelet, and by calculating platelet-lymphocytes ratio (PLR) and NLR. Sarcopenia risk was assessed using the Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F; score≥4 identifies sarcopenia risk). ROC curve were used to identify the best NLR cut-off value which predicts sarcopenia risk. Differences between groups were tested using the T Student, Mann-Whitney, or Chi-Square tests. Logistic regression analyses were done to assess the association between NLR and sarcopenia risk. RESULTS: ROC curve revealed that the best cut-off point to predict sarcopenia risk was NLR ≥6.5 (sensitivity of 45% and specificity of 81%). Those with NLR ≥6.5 presented higher C-reactive protein, neutrophils, platelet-lymphocytes ratio (PLR), and SARC-F than NLR <6.5 group. A negative correlation was found between NLR and gait speed (r = -0.48, p = 0.0001), handgrip strength (r = -0.29, p = 0.002), arm circumference (r = -0.29, p = 0.002) and calf circumference (r = -0.28, p = 0.003). Those with increased NLR values were associated with high sarcopenia risk in crude model, as well as if adjusted by smoking, alcohol intake, and sex (OR:1.19 [95%CI:1.03-1.37], p = 0.013) or by BMI (OR:1.20 [95%CI:1.05-1.38], p = 0.006). CONCLUSION: In hospitalized cancer patients, systemic inflammation measured by NLR was associated with increased sarcopenia risk.

Plasma Lipid Profile and Systemic Inflammation in Patients With Cancer Cachexia.

Cancer cachexia affects about 80% of advanced cancer patients, it is linked to poor prognosis and to date, there is no efficient treatment or cure. The syndrome leads to progressive involuntary loss of muscle and fat mass induced by systemic inflammatory processes. The role of the white adipose tissue (WAT) in the onset and manifestation of cancer cachexia gained importance during the last decade. WAT wasting is not only characterized by increased lipolysis and release of free fatty acids (FFA), but in addition, owing to its high capacity to produce a variety of inflammatory factors. The aim of this study was to characterize plasma lipid profile of cachectic patients and to correlate the FA composition with circulating inflammatory markers; finally, we sought to establish whether the fatty acids released by adipocytes trigger and/or contribute to local and systemic inflammation in cachexia. The study selected 65 patients further divided into 3 groups: control (N); weight stable cancer (WSC); and cachectic cancer (CC). The plasma FA profile was significantly different among the groups and was positively correlated with pro-inflammatory cytokines expression in the CC patients. Therefore, we propose that saturated to unsaturated FFA ratio may serve as a means of detecting cachexia.

Short-Term Creatine Supplementation May Alleviate the Malnutrition-Inflammation Score and Lean Body Mass Loss in Hemodialysis Patients: A Pilot Randomized Placebo-Controlled Trial.

BACKGROUND: Creatine supplementation has been proposed to alleviate muscle loss in various populations, but has not been investigated in hemodialysis (HD) patients. Thus, our objective was to evaluate whether creatine supplementation could attenuate the loss of lean body mass (LBM) and malnutrition-inflammation score (MIS) in HD patients. METHODS: A randomized, placebo-controlled, double blind, parallel-design study included HD patients, of both sexes, aged 18-59 years. The patients were allocated to a Placebo Group (PG; n = 15; received maltodextrin, 1st week: 40 g/day and 2nd-4th weeks: 10 g/day) and a Creatine Group (CG; n = 15; received creatine plus maltodextrin, 1st week: 20 g/day of creatine plus 20 g/day of maltodextrin and 2nd-4th weeks: 5 g/day of creatine plus 5 g/day of maltodextrin). Pre and post the intervention, patients were evaluated for food intake, MIS, body composition and biochemical parameters. RESULTS: CG group attenuated the MIS (Pre: 5.57 ± 0.72 vs. Post: 3.85 ± 0.47 score, P = 0.003) compared with PG (Pre: 5.71 ± 0.97 vs. Post: 5.36 ± 0.95 score, P = 0.317) (supplement × time P = 0.017, effect size: 0.964). The change of LBM was greater in CG than in PG (CG: Δ0.95 vs PG: Δ0.13 kg). At post-intervention, 28.6% of PG patients presented LBM loss and 71.4% remain stable. In contrast, 14.4% of CG patients had LBM loss, 42.8% remain stable and 42.8% gained. Food intake and quality of life did not change. CG increased the BMI and gait speed in post-compared to pre-moment, but no difference among the groups. CONCLUSION: In HD patients, four weeks of creatine supplementation may alleviate the MIS as well as attenuate the LBM loss compared to placebo.

Are depression and anxiety disorders associated with adductor pollicis muscle thickness, sleep duration, and protein intake in cancer patients?

INTRODUCTION: Psychological disturbances may be associated with compromised body composition and food intake. However, this has not been elucidated totally. Thus, this study aimed to evaluate the prevalence of anxiety and depression, and whether there is an association between these disorders and adductor pollicis muscle thickness (APMT), protein intake and sleep duration, in gastrointestinal cancer patients. METHODS: A cross-sectional study evaluated 117 patients of both genders diagnosed with gastrointestinal cancer. Protein intake was assessed by the USDA food database; sleep duration by self-administered questionnaire; and APMT using the skinfold. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety (HADS-A) and depression (HADS-D). RESULTS: A total of 117 (65% male) patients were assessed, of which 40 (34%) had anxiety and 39 (33%) depression. There was a negative correlation between APMT and anxiety (r = -0.20, p = .020) and depression (r = -0.19, p = .03), and between anxiety and sleep duration (r = -0.30, p = .001). Although there was an inverse association between anxiety and APMT (OR: 0.88, 95%CI: 0.79-0.99, p = .032) and sleep duration (OR: 0.71, 95%CI: 0.58-0.87, p = .001), when adjusted for gender and age, the association remained only between anxiety and sleep duration (OR: 0.71, 95%CI: 0.58-0.87, p = .001). CONCLUSION: One-third of gastrointestinal cancer patients were classified as expressing anxiety and depression. Additionally, only sleep duration is associated with anxiety.

Total protein or leucine intakes are not associated with handgrip strength in hemodialysis patients: A pilot study.

BACKGROUND & AIMS: Inadequate protein intake is associated with lean body mass (LBM) loss. However, it is unclear whether high protein diet and leucine intake are associated with handgrip strength (HGS), a validated marker of muscle function. This study aims to: i) assess the prevalence of patients with low HGS; and ii) verify if HGS is correlated with high protein diet and leucine consumption in hemodialysis patients. METHODS: This cross-sectional study analysed patients at two center hemodialysis (HD) clinic and sixty-two patients aged ∼39 years with length of time on HD ∼60 months undergoing HD was carried out. Body weight (kg), LBM (kg) and body fat mass (%) assessments were performed by dual-energy X-ray absorptiometry and height (m) through portable stadiometer. Body mass index (BMI) (kg/m2) was calculated using the body weight and height. HGS (kg) was measured using a hydraulic dynamometer. Fisher's exact test, Chi-square, Pearson's correlation, and logistic regression were done to test the hypothesis. RESULTS: Out of 62 patients, 47 (75.8%) presented low HGS. In addition, no correlation was found between protein intake (if in percentage or g/kg/d) and HGS (r = 0.07, p = 0.58; r = -0.04, p = 0.70, respectively). Although there is a low correlation among leucine intake (g/d) and HGS (r = 0.39, p = 0.01), low HGS was not associated with leucine intake in the crude model (OR: 0.86 95%CI(0.60-1.24) p = 0.441), nor after adjustment for age, sex and BMI (OR: 0.84 95%CI(0.56-1.26), p = 0.422). CONCLUSIONS: Approximately 75% of patients undergoing hemodialysis presented low HGS. Additionally, neither a high protein diet nor leucine intake was associated with the HGS values.

Tumour-derived transforming growth factor-ß signalling contributes to fibrosis in patients with cancer cachexia.

BACKGROUND: Cachexia is a paraneoplastic syndrome related with poor prognosis. The tumour micro-environment contributes to systemic inflammation and increased oxidative stress as well as to fibrosis. The aim of the present study was to characterise the inflammatory circulating factors and tumour micro-environment profile, as potentially contributing to tumour fibrosis in cachectic cancer patients. METHODS: 74 patients (weight stable cancer n = 31; cachectic cancer n = 43) diagnosed with colorectal cancer were recruited, and tumour biopsies were collected during surgery. Multiplex assay was performed to study inflammatory cytokines and growth factors. Immunohistochemistry analysis was carried out to study extracellular matrix components. RESULTS: Higher protein expression of inflammatory cytokines and growth factors such as epidermal growth factor, granulocyte-macrophage colony-stimulating factor, interferon-α, and interleukin (IL)-8 was observed in the tumour and serum of cachectic cancer patients in comparison with weight-stable counterparts. Also, IL-8 was positively correlated with weight loss in cachectic patients (P = 0.04; r = 0.627). Immunohistochemistry staining showed intense collagen deposition (P = 0.0006) and increased presence of α-smooth muscle actin (P < 0.0001) in tumours of cachectic cancer patients, characterizing fibrosis. In addition, higher transforming growth factor (TGF)-ß1, TGF-ß2, and TGF-ß3 expression (P = 0.003, P = 0.05, and P = 0.047, respectively) was found in the tumour of cachectic patients, parallel to p38 mitogen-activated protein kinase alteration. Hypoxia-inducible factor-1α mRNA content was significantly increased in the tumour of cachectic patients, when compared with weight-stable group (P = 0.005). CONCLUSIONS: Our results demonstrate TGF-ß pathway activation in the tumour in cachexia, through the (non-canonical) mitogen-activated protein kinase pathway. The results show that during cachexia, intratumoural inflammatory response contributes to the onset of fibrosis. Tumour remodelling, probably by TGF-ß-induced transdifferentiation of fibroblasts to myofibroblasts, induces unbalanced inflammatory cytokine profile, angiogenesis, and elevation of extracellular matrix components (EMC). We speculate that these changes may affect tumour aggressiveness and present consequences in peripheral organs.

Cancer cachexia induces morphological and inflammatory changes in the intestinal mucosa.

BACKGROUND: Cachexia is a multifactorial and multiorgan syndrome associated with cancer and other chronic diseases and characterized by severe involuntary body weight loss, disrupted metabolism, inflammation, anorexia, fatigue, and diminished quality of life. This syndrome affects around 50% of patients with colon cancer and is directly responsible for the death of at least 20% of all cancer patients. Systemic inflammation has been recently proposed to underline most of cachexia-related symptoms. Nevertheless, the exact mechanisms leading to the initiation of systemic inflammation have not yet been unveiled, as patients bearing the same tumour and disease stage may or may not present cachexia. We hypothesize a role for gut barrier disruption, which may elicit persistent immune activation in the host. To address this hypothesis, we analysed the healthy colon tissue, adjacent to the tumour. METHODS: Blood and rectosigmoid colon samples (20 cm distal to tumour margin) obtained during surgery, from cachectic (CC = 25) or weight stable (WSC = 20) colon cancer patients, who signed the informed consent form, were submitted to morphological (light microscopy), immunological (immunohistochemistry and flow cytometry), and molecular (quantification of inflammatory factors by Luminex® xMAP) analyses. RESULTS: There was no statistical difference in gender and age between groups. The content of plasma interleukin 6 (IL-6) and IL-8 was augmented in cachectic patients relative to those with stable weight (P = 0.047 and P = 0.009, respectively). The number of lymphocytic aggregates/field in the gut mucosa was higher in CC than in WSC (P = 0.019), in addition to those of the lamina propria (LP) eosinophils (P < 0.001) and fibroblasts (P < 0.001). The area occupied by goblet cells in the colon mucosa was decreased in CC (P = 0.016). The M1M2 macrophages percentage was increased in the colon of CC, in relation to WSC (P = 0.042). Protein expression of IL-7, IL-13, and transforming growth factor beta 3 in the colon was significantly increased in CC, compared with WSC (P = 0.02, P = 0.048, and P = 0.048, respectively), and a trend towards a higher content of granulocyte-colony stimulating factor in CC was also observed (P = 0.061). The results suggest an increased recruitment of immune cells to the colonic mucosa in CC, as compared with WSC, in a fashion that resembles repair response following injury, with higher tissue content of IL-13 and transforming growth factor beta 3. CONCLUSIONS: The changes in the intestinal mucosa cellularity, along with modified cytokine expression in cachexia, indicate that gut barrier alterations are associated with the syndrome.

Muscle function loss is associated with anxiety in patients with gastrointestinal cancer.

OBJECTIVE: To verify the prevalence of patients with muscle function loss (MFL) and whether it is associated with anxiety and depression scores in gastrointestinal (GI) cancer patients. METHODS: A cross-sectional study with seventy-one adult GI cancer patients was conducted. The MFL was evaluated by the SARC-F questionnaire, and participants were divided into MFL (cut-off ≥4 SARC-F) and normal muscle function (NMF) groups (cut-off <4 SARC-F). Anxiety and depression were analyzed using the Hospital Anxiety and Depression Scale (HADS). RESULTS: From 71 patients, 25.4% (n = 18) were classified as MFL and 74.6% (n = 53) as NMF. Body weight was lower in the MFL group when compared to the NMF group (MFL: 57.6 ± 11.3 vs. NMF: 64.8 ± 11.6 kg, p = 0.032). MFL showed higher anxiety (MFL: 7.5 (0-21) vs. NMF: 2 (0-17), p = 0.030) and depression scores (MFL: 6.5 (0-13) vs. NMF: 2 (0-17), p = 0.034) compared to NMF. A positive correlation between the SARC-F and the anxiety (r = 0.34, p = 0.004) and depression score (r = 0.32, p = 0.006) was found. When adjusted by sex and body weight, MFL saw an increase with the anxiety score (OR: 1.15 95%CI(1.01-1.31), p = 0.023), but not with the depression score. In addition, LMF was responsible for anxiety in 12% of the population. CONCLUSION: In our study, 25% of GI cancer patients presented LMF and an association with the anxiety score.

Liver lipid metabolism disruption in cancer cachexia is aggravated by cla supplementation -induced inflammation.

BACKGROUND & AIMS: The liver is the main organ regulating metabolism. In spite of that, few studies examine liver metabolism in cachexia, a wasting syndrome associated with increased morbidity and mortality in cancer. Cachexia induces major metabolic disruption, inflammation and fat and lean mass loss. We have previously shown impairment of hepatic lipid metabolism in cancer cachexia that contributes to the aggravation of the symptoms. The present study addresses the effects of Conjugated Linoleic Acid supplementation upon liver lipid metabolism in cachectic rats. METHODS: Male Wistar rats were randomly assigned to control groups (C) receiving 0.9 NaCl (Placebo CP); or to groups supplemented with sunflower oil (CSF), supplemented with CLA (CCLA), or still, to tumour bearing animals (T) receiving NaCl (TP), sunflower oil (TSF), or CLA (TCLA). Supplementation (0.5 ml) by gavage was carried out for 14 days. Body weight, dietary intake, glucose, cholesterol and triacylglycerol plasma content, liver glycogen and triacylglycerol content and mRNA expression of liver carnitine palmitoyltransferase I and II (CPT I and II), as well as microsomal triglyceride transfer protein (MTP), liver fatty acid-binding protein (L-FABP), peroxisome proliferator-activated receptor-alpha (PPAR-alpha), and apolipoprotein B (apoB), were assessed. RESULTS: Liver CPT II activity was reduced in all groups, when compared with CP. Hepatic mRNA expression of MTP, apoB and FABP was reduced in TCLA, when compared with all groups. TCLA also presented increased hepatic and plasma triacylglycerol content, when compared with all T groups. Adipose tissue-derived inflammatory factors were assessed. No differences among the groups were observed in regard to Retro Peritoneal Adipose Tissue cytokine (IL-1ß, IL-6, and TNF-α) protein content and expression, with the exception of IL-10 in tumour-bearing animals. In the Epididymal Adipose Tissue, the inflammatory cytokines were augmented in TCLA, compared with all other groups. CONCLUSION: CLA supplementation fails to promote the re-establishment of hepatic lipid metabolism in tumour-bearing animals, and therefore is not recommended in cancer-related cachexia.

Pre-sarcopenia in patients undergoing hemodialysis: Prevalence and association with biochemical parameters.

BACKGROUND & AIMS: Albumin and C reactive protein (CRP) concentrations are associated with the loss of lean body mass in the elderly. However, it remains to be ascertained whether these parameters are associated with pre-sarcopenia of chronic renal failure adult's patients undergoing replacement therapy. Therefore, we aimed to investigate the prevalence of pre-sarcopenia and it association with serum albumin and CRP concentrations in adult patients. METHODS: A cross-sectional study was conducted enrolling hemodialysis patients. Body weight, body mass index (BMI), and arm, thigh and calf circumferences were assessed using the inelastic tape; handgrip strength using a dynamometer; and body fat mass and appendicular lean mass (ALM) using the DXA. The classification of pre-sarcopenia was obtained by ALM values. RESULTS: From sixty-two patients, 35.5% were diagnosed with pre-sarcopenia. Logistic regression analysis revealed no show association between pre-sarcopenia (absence or presence) with serum CRP or albumin concentrations in both models, crude or adjusted by body fat mass. CONCLUSIONS: Approximately one-third of patients undergoing replacement therapy presented pre-sarcopenia, but no association with serum albumin and CRP concentrations were found.

Assessing pathophysiology of cancer anorexia.

PURPOSE OF REVIEW: Cancer anorexia is a negative prognostic factor and is broadly defined as the loss of the interest in food. However, multiple clinical domains contribute to the phenotype of cancer anorexia. The characterization of the clinical and molecular pathophysiology of cancer anorexia may enhance the efficacy of preventive and therapeutic strategies. RECENT FINDINGS: Clinical trials showed that cancer anorexia should be considered as an umbrella encompassing different signs and symptoms contributing to appetite disruption in cancer patients. Loss of appetite, early satiety, changes in taste and smell are determinants of cancer anorexia, whose presence should be assessed in cancer patients. Interestingly, neuronal correlates of cancer anorexia-related symptoms have been revealed by brain imaging techniques. SUMMARY: The pathophysiology of cancer anorexia is complex and involves different domains influencing eating behavior. Limiting the assessment of cancer anorexia to questions investigating changes in appetite may impede correct identification of the targets to address.

Sarcopenia and chemotherapy-mediated toxicity / Sarcopenia e toxicidade mediada pela quimioterapia

ABSTRACT This narrative review focuses on the role of sarcopenia and chemotherapy-induced toxicity in cancer patients. Consistent evidence shows that sarcopenia in cancer patients leads to decreased overall survival by influencing treatment discontinuation and dose reduction. Therefore, sarcopenia should be considered a robust prognostic factor of negative outcome as well as a determinant of increased healthcare costs.

RESUMO Esta revisão narrativa descreve o papel da sarcopenia e a toxicidade mediada pela quimioterapia em pacientes com câncer. Diversas evidências consistentes mostram que a sarcopenia em pacientes com câncer induz à menor sobrevida global, por influenciar na interrupção do tratamento e na redução da dose. Portanto, a sarcopenia pode ser considerada um importante fator de prognóstico de desfecho negativo, além de um determinante de maiores custos em saúde.

Sarcopenia and chemotherapy-mediated toxicity.

This narrative review focuses on the role of sarcopenia and chemotherapy-induced toxicity in cancer patients. Consistent evidence shows that sarcopenia in cancer patients leads to decreased overall survival by influencing treatment discontinuation and dose reduction. Therefore, sarcopenia should be considered a robust prognostic factor of negative outcome as well as a determinant of increased healthcare costs. RESUMO Esta revisão narrativa descreve o papel da sarcopenia e a toxicidade mediada pela quimioterapia em pacientes com câncer. Diversas evidências consistentes mostram que a sarcopenia em pacientes com câncer induz à menor sobrevida global, por influenciar na interrupção do tratamento e na redução da dose. Portanto, a sarcopenia pode ser considerada um importante fator de prognóstico de desfecho negativo, além de um determinante de maiores custos em saúde.