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.

High neutrophil-to-lymphocyte ratio at intensive care unit admission is associated with nutrition risk in patients with COVID-19.

BACKGROUND: Inflammation plays a crucial role in nutrition status and can be useful in early nutrition risk screening of patients during the coronavirus disease 2019 (COVID-19) pandemic. Thus, this study aimed to assess the association between systemic inflammatory markers and nutrition risk tools in intensive care unit (ICU) patients with COVID-19. METHODS: Patients with confirmed COVID-19 and ICU admission were enrolled in a retrospective, observational, cross-sectional study. The medians of C-reactive protein (CRP; ≥13.8 mg/dl) and the neutrophil-to-lymphocyte ratio (NLR; ≥12.6) upon admission were used to dichotomize patients. RESULTS: Of the 73 patients, 63% were men; the average age was 56 years, and the median length of hospital stay was 10 (25th: 4; 75th: 17) days. When nutrition risk screening tools were used, 85% were at risk according to Nutritional Risk Screening (≥3 points), whereas 42% had high risk according to the Modified Nutrition Risk in the Critically Ill (mNUTRIC; ≥5 points), and 57% were moderately or severely malnourished according to the Subjective Global Assessment (B or C). Mortality was higher in the group with NLR ≥12.6 than in the group with NLR <12.6, with no difference between CRP groups. A significant association was found only between NLR and mNUTRIC, even when adjusted by sex, age, and body mass index (odds ratio, 1.36; 95% CI, 1.06-1.76; P = 0.016), but not between CRP and nutrition risk. CONCLUSION: Although the inflammatory marker CRP is the most used in hospital clinical practice, we found that only NLR was associated with nutrition risk (NUTRIC score).

High neutrophil to lymphocytes ratio is associated with nutritional risk in hospitalised, unselected cancer patients: a cross-sectional study.

Cancer patients possess metabolic and pathophysiological changes and an inflammatory environment that leads to malnutrition. This study aimed to (i) determine whether there is an association between neutrophil-to-lymphocyte ratio (NLR) and nutritional risk, and (ii) identify the cut-off value of NLR that best predicts malnutrition by screening for nutritional risk (NRS 2002). This cross-sectional study included 119 patients with unselected cancer undergoing chemotherapy and/or surgery. The NRS 2002 was applied within 24 h of hospitalisation to determine the nutritional risk. Systemic inflammation was assessed by blood collection, and data on C-reactive protein (CRP), neutrophils, and lymphocytes were collected for later calculation of NLR. A receiver operating characteristic (ROC) curve was used to identify the best cut-point for NLR value that predicted nutritional risk. Differences between the groups were tested using the Student's t-, Mann-Whitney U and Chi-Square tests. Logistic regression analyses were performed to assess the association between NLR and nutritional risk. The ROC curve showed the best cut-point for predicting nutritional risk was NLR > 5.0 (sensitivity, 60.9%; specificity, 76.4%). The NLR ≥ 5.0 group had a higher prevalence of nutritional risk than the NLR < 5.0 group (NLR ≥ 5.0: 73.6% vs. NLR < 5.0: 37.9%, p = 0.001). The NLR group ≥ 5.0 showed higher values of CRP and NLR than the NLR < 5.0 group. In addition, patients with NLR ≥ 5.0 also had higher NRS 2002 values when compared to the NLR < 5.0 group (NLR ≥ 5.0: 3.0 ± 1.1 vs. NLR < 5.0: 2.3 ± 1.2, p = 0.0004). Logistic regression revealed an association between NRS and NLR values. In hospitalised unselected cancer patients, systemic inflammation measured by NLR was associated with nutritional risk. Therefore, we highlight the importance of measuring the NLR in clinical practice, with the aim to detect nutritional risk.

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.

Phase angle is not associated with fatigue in cancer patients: the hydration impact.

Cancer patients suffer from metabolic and pathophysiological changes that contribute to malnutrition. These metabolic changes lead to loss of cell integrity, which induces dehydration intracellular and increase extracellular fluid. Bioelectrical impedance analysis (BIA)-derived phase angle (PhA) is considered a good tool to evaluate hydration status, but in cancer patients it is not fully elucidated. Thus, in cancer patients the aims of this study were to (1) verify the association between PhA and fatigue, (2) verify the association between PhA and fatigue after adjustment for extracellular fluid accumulation, and (3) assess the prevalence of fatigue. This cross-sectional study was conducted with 124 patients of both genders on cancer treatment. Body weight, height, body mass index, handgrip strength, performance status, and cachexia were collected. In addition, body composition was evaluated by BIA to obtain hydration status and PA. The cut-off point used to classify patients with low PhA was set <4°. To identify fatigue, the Functional Assessment of Cancer Therapy Fatigue questionnaire was applied. Of the 124 patients evaluated (n = 98/79% men), 26% had fatigue. The prevalence of fatigue was higher in patients with lower PhA <4° (65.63%). In the logistic regression analyses, we found that patients with PhA >4° had lower risk for fatigue (OR: 0.92 95% CI [0.86-0.99], p = 0.03) in the crude model, however after adjustments by weight loss percentage in 6 months, age, sex, and hydration the association was not maintained (OR: 0.94 95% CI [0.85-1.04], p = 0.26). In conclusion, we found that ~26% of cancer patients have fatigue. In spite of adjustment for extracellular fluid, PhA is not associated with fatigue. The importance of measuring PhA to assess intra and extracellular hydration in cancer patients is highlighted.

Sarcopenia as a predictor of nutritional status and comorbidities in hospitalized patients with cancer: A cross-sectional study.

OBJECTIVES: Sarcopenia promotes worsening of nutritional status and an increase in comorbidities. Likewise, use of validated instruments to assess nutritional and comorbidity factors are warranted. Thus, the objectives were to assess the prevalence of risk for sarcopenia and to determine whether there is an association between sarcopenia and nutritional status and comorbidities in hospitalized patients with cancer. METHODS: This was a cross-sectional study with 77 patients with different types of cancer. Both men and women were enrolled. The risk for sarcopenia was assessed by the Strength, Assistance With Walking, Rise From a Chair, Climb Stairs, and Falls (SARC-F) questionnaire. Patients were divided into two groups: risk for sarcopenia (SARC-F score ≥4) and no risk for sarcopenia (SARC-F score <4). The presence of comorbidities and nutritional risks were analyzed using Charlson Comorbidity Index (CCI) and Nutrition Risk Screening 2002 (NRS-2002), respectively. Logistic and multiple regression analyses were used to verify the association and predictive factors of SARC-F. RESULTS: Of the 77 patients, 40.2% (n = 31; 63.48 ± 10.59 y of age) were classified as having a risk for sarcopenia and 59.7% (n = 46; 51.20 ± 12.81 y of age) without risk. We found an association between the risk for sarcopenia and CCI and NRS-2002 in crude model and after adjustment for age. Additionally, SARC-F is a good predictor of the increase of CCI (ß = 0.357, R² = 0.29, P = 0.003) and NRS-2002 (ß = 0.519, R² = 0.49, P < 0.001). CONCLUSION: In the present study, ∼40% of patients with cancer had a risk for sarcopenia and a greater prediction for nutritional risk (49%) and comorbidities (29%).

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.