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1.
Ann R Coll Surg Engl ; 102(2): 120-132, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31508983

RESUMO

INTRODUCTION: The high morbidity and mortality rates after oesophagectomy indicate the need for rigorous patient selection and preoperative risk assessment. Although muscle mass depletion has been proposed as a potential prognostic factor for postoperative complications and decreased survival in gastrointestinal cancer patients, available data are conflicting. The purpose of the present meta-analysis is to determine whether sarcopenia predicts postoperative outcomes in patients undergoing oesophagectomy. METHODS: The databases MEDLINE, SCOPUS, Clinicaltrials.gov, CENTRAL and Google Scholar were searched for studies reporting on the effect of sarcopenia on postoperative outcomes following oesophageal cancer surgery. Outcomes included surgical complications, anastomotic leakage, respiratory complications, cardiovascular complications, postoperative infections, major complications and overall complications. The random effects model (DerSimonian-Laird) was used to calculate pooled effect estimates when high heterogeneity was encountered, otherwise the fixed-effects (Mantel-Haenszel) model was implemented. FINDINGS: A total of eight studies involving 1488 patients diagnosed with oesophageal cancer and who underwent oesophagectomy were included in the meta-analysis. The presence of sarcopenia did not significantly increase the rate of surgical complications (odds ratio, OR, 0.86, 95% confidence interval, CI, 0.40-1.85), anastomotic leakage (OR 0.75, 95% CI 0.42-1.35), respiratory complications (OR 0.56, 95% CI 0.21-1.48), cardiovascular complications (OR 0.94, 95% CI 0.31-2.83), postoperative infection (OR 1.14, 95% CI 0.52-2.50), major complications (OR 0.81, 95% CI 0.23-2.82) or overall postoperative complications (OR 0.80, 95% 0.32-1.99). CONCLUSION: Sarcopenia does not seem to affect postoperative complication rates of patients undergoing oesophagectomy for oesophageal cancer. Future research should focus on determining whether prognosis differs according to muscle mass in this patient population.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Sarcopenia/complicações , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Neoplasias Esofágicas/epidemiologia , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prognóstico , Sarcopenia/epidemiologia
2.
Am Surg ; 85(9): 985-991, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638511

RESUMO

Radiologic indicators of sarcopenia have been associated with adverse operative outcomes in some surgical populations. This study assesses the association of radiologic indicators of frailty with outcomes after open ventral hernia repair (OVHR). A prospective, institutional, hernia-specific database was queried for patients undergoing OVHR from 2007 to 2018 with preoperative CT. Psoas muscle cross-sectional area at L3 was measured and adjusted for height (skeletal muscle index (SMI)). L3 vertebral body density (L3 VBD) was measured. Demographics and outcomes were evaluated as related to SMI and L3 VBD. Of 1178 patients, 9.7 per cent of females and 15.8 per cent of males had sarcopenia and 11.6 per cent of females and 9.2 per cent of males had osteopenia. Neither sarcopenia nor osteopenia were associated with outcomes of wound infection, readmission, reoperation, hernia recurrence, or major complications. When examined as continuous variables or by quartile, SMI and L3 VBD were not associated with adverse outcomes, including in subsets of male or female patients, the elderly, contaminated cases, and the obese. Radiologic markers of sarcopenia and osteopenia are not associated with adverse outcomes after OVHR. Further study should examine age or other potential predictors of outcomes in this patient population, such as independent status.


Assuntos
Fragilidade/complicações , Hérnia Ventral/complicações , Hérnia Ventral/cirurgia , Herniorrafia/efeitos adversos , Sarcopenia/complicações , Idoso , Doenças Ósseas Metabólicas/complicações , Doenças Ósseas Metabólicas/diagnóstico por imagem , Feminino , Fragilidade/diagnóstico por imagem , Herniorrafia/métodos , Humanos , Tempo de Internação , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Músculos Psoas/diagnóstico por imagem , Estudos Retrospectivos , Sarcopenia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
3.
Zhonghua Gan Zang Bing Za Zhi ; 27(9): 725-727, 2019 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-31594102

RESUMO

Nonalcoholic fatty liver disease (NAFLD) is one of the common causes for chronic liver diseases, which progress gradually from nonalcoholic type simple fatty liver disease to hepatitis, cirrhosis and even liver failure and hepatocellular carcinoma. Sarcopenia is a progressive disease characterized by reduced skeletal muscle mass and function in association to metabolic dysfunctions. Recent studies have shown that the occurrence and development of NAFLD and sarcopenia are related, and there is a common base for the pathogenesis between the two, which may promote each other for mutual risk factors. This article reviews the current research progress of this field in order to clinically further understand the pathogenesis and intrinsic links between the two to look for appropriate interventions.


Assuntos
Hepatopatia Gordurosa não Alcoólica/complicações , Sarcopenia/complicações , Carcinoma Hepatocelular , Humanos , Cirrose Hepática , Neoplasias Hepáticas , Fatores de Risco
4.
Arq Gastroenterol ; 56(4): 357-360, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618396

RESUMO

BACKGROUND: Non-alcoholic fatty liver disease is characterized by deposition of lipids in the hepatic parenchyma exceeding 5% of liver weight in the absence of other conditions, such as viral or alcoholic hepatitis and metabolic disease. Non-alcoholic fatty liver disease is the most common form of chronic liver disease in several countries. In addition to liver complications, recent studies have shown a relation between liver fat and sarcopenia. OBJECTIVE: Determine the association between sarcopenia and the severity of non-alcoholic hepatic steatosis diagnosed by abdominal ultrasonography. METHODS: A clinical, cross-sectional study was conducted with a sample of male and female adults (18 to 70 years of age) submitted to ultrasonography for the investigation of non-alcoholic hepatic steatosis. Evaluations were also performed for the determination of upper and lower limb muscle strength. Data analysis was performed with the aid of the SPSS 22.0 program and involved ANCOVA and the Bonferroni post hoc test, with P-value <0.05 considered indicative of statistical significance. RESULTS: One hundred two patients were submitted to abdominal ultrasonography, 57.8% of whom presented some degree of non-alcoholic hepatic steatosis. The presence and degree of fatty liver infiltration were significantly associated with the sarcopenic index, determined by the ratio between upper and lower limb strength and BMI (P=0.009 and post-test P=0.028 for upper limbs; P=0.006 and post-test P=0.013 for lower limbs). CONCLUSION: In the present study, an association was found between the sarcopenic index and non-alcoholic hepatic steatosis, with an inversely proportional relation between this index and the severity of fatty infiltration. This finding offers further evidence of the metabolic interaction of the liver, adipose tissue and muscle.


Assuntos
Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Sarcopenia/complicações , Adulto , Idoso , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Índice de Gravidade de Doença , Ultrassonografia , Adulto Jovem
6.
Nihon Ronen Igakkai Zasshi ; 56(3): 290-300, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31366750

RESUMO

AIM: This study aimed to examine the relationship of obesity, sarcopenia, and sarcopenic obesity (SO) with left ventricular diastolic dysfunction (LVDD) in elderly patients with diabetes. METHODS: Subjects included in this study were patients with diabetes ≥65 years of age and who were receiving treatment on an outpatient basis at the Ise Red Cross Hospital. To determine the presence of LVDD, we divided the early diastolic left ventricular filling velocity (E) by the early mitral annular motion velocity (E') (E/E'), which was measured using tissue Doppler imaging. To evaluate sarcopenia, SARC-F-J, a self-administered questionnaire consisting of five items, was used. Obesity was defined as a body mass index >25. Using a multiple logistic regression analysis with LVDD as the dependent variable and sarcopenia, obesity, and SO as explanatory variables, we calculated the odds ratios of LVDD for each variable. RESULTS: The subjects were 291 (157 male and 134 female) patients. Among male patients, the odds ratios after moderating for LVDD in the sarcopenia, obese, and SO groups were 0.82 (95% confidence interval [CI) ], 0.20 to 3.27, P=0.784), 1.92 (95% CI, 0.69 to 5.32, P=0.207), and 6.41 (95% CI, 1.43 to 28.53, P=0.015), respectively, whereas among female patients, these ratios were 1.31 (95% CI, 0.31 to 5.51, 0.708), 1.41 (95% CI, 0.45 to 4.37, P=0.551), and 3.18 (95% CI, 0.93 to 10.9, P=0.064), respectively. CONCLUSIONS: In male elderly patients with diabetes, SO was significantly correlated with LVDD. We believe that it is important to consider LVDD when examining male elderly patients with SO.


Assuntos
Complicações do Diabetes , Diabetes Mellitus , Obesidade/complicações , Sarcopenia/complicações , Disfunção Ventricular Esquerda/complicações , Feminino , Humanos , Masculino
7.
Einstein (Sao Paulo) ; 17(4): eAO4632, 2019 Aug 19.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31433007

RESUMO

OBJECTIVE: To investigate the potential value of sarcopenia and sarcopenic obesity as prognostic predictors in hospitalized elderly patients with acute myocardial infarction. METHODS: A cross-sectional study based on data collected from elderly patients with acute myocardial infarction, admitted to a public hospital located in the Northeastern region of Brazil, from April to July 2015. The diagnosis of sarcopenia was based on muscle mass, muscle strength and physical performance measurements. Cardiovascular risk and prognostic markers, such as troponin and creatine kynase MB isoenzyme values, acute myocardial infarction classification according to ST segment elevation, and thrombolysis in myocardial infarction score were used. RESULTS: The sample comprised 99 patients with mean age of 71.6 (±7.4) years. Prevalence of sarcopenia and sarcopenic obesity was 64.6% and 35.4%, respectively. Sarcopenia was more prevalent among males (p=0.017) aged >80 years (p=0.008). Thrombolysis in myocardial infarction was the only marker of cardiovascular risk significantly associated with sarcopenia (p=0.002). CONCLUSION: Prevalence of sarcopenia was high and associated with thrombolysis in myocardial infarction risk score. Sarcopenic obesity affected approximately one-third of patients and was not associated with any of the prognostic predictors.


Assuntos
Atividade Motora/fisiologia , Força Muscular/fisiologia , Infarto do Miocárdio/etiologia , Obesidade/complicações , Sarcopenia/complicações , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/fisiopatologia , Obesidade/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Sarcopenia/fisiopatologia
8.
Int Urol Nephrol ; 51(8): 1415-1424, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31270740

RESUMO

PURPOSE: To investigate the effect of intradialytic resistance exercise on inflammation markers and sarcopenia indices in maintenance hemodialysis (MHD) patients with sarcopenia. METHODS: Forty-one MHD patients with sarcopenia were divided into an intervention group (group E, n = 21) and a control group (group C, n = 20). Group C patients only received routine hemodialysis care, whereas group E patients received progressive intradialytic resistance exercise with high or moderate intensity for 12 weeks at three times per week (using the weight of the lower limbs and elastic ball movement of the upper limb) on the basis of routine hemodialysis care. RESULTS: After 12 weeks, a significant difference in physical activity status (maximum grip strength, daily pace, and physical activity level), Kt/V, and C-reactive protein was found between groups E and C. Inflammatory factors (interleukin (IL)-6, IL-10, and tumor necrosis factor(TNF)-α) increased or decreased more significantly in group E than in group C. CONCLUSIONS: This study showed that intradialytic resistance exercise can improve physical activity effectively and reduce microinflammatory reactions even if this simple exercise does not affect the muscle mass in MHD patients with sarcopenia.


Assuntos
Exercício , Inflamação/terapia , Diálise Renal , Treinamento de Resistência , Sarcopenia/terapia , Adulto , Idoso , Feminino , Humanos , Inflamação/complicações , Inflamação/fisiopatologia , Masculino , Pessoa de Meia-Idade , Sarcopenia/complicações , Sarcopenia/fisiopatologia
9.
Surg Today ; 49(12): 1022-1028, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31309328

RESUMO

PURPOSE: To investigate the change in skeletal muscle mass and evaluate the prognostic impact of sarcopenia on esophageal cancer (EC) patients METHODS: The subjects of this retrospective study were 90 EC patients who were treated with neoadjuvant chemotherapy (NAC) and subsequent esophagectomy. The skeletal muscle index (SMI) was defined according to computed tomography (CT) imaging of the total cross-sectional muscle tissue, measured at the third lumbar level using a volume analyzer before NAC and surgery. The SMI was calculated by normalization according to height, and skeletal muscle loss (SML) was defined as (pre-NAC SMI value - preoperative SMI value) × 100/pre-NAC SMI. RESULTS: Sarcopenia was evident in 72 (80.0%) patients before NAC and 77 (85.6%) patients before NAC and surgery. The SMI value was decreased in 28 (68.9%) patients and the median SML was 3.3%. The 3-year overall survival rate was 68.9% in the low SML group and 0% in the high SML group (P < 0.001). Sarcopenia before NAC or surgery was not significantly associated with overall survival. Multivariable analysis identified high SML as an independent prognostic factor. CONCLUSIONS: These results suggest that skeletal muscle loss is associated with a worse long-term outcome for EC patients treated with NAC.


Assuntos
Músculos do Dorso/diagnóstico por imagem , Músculos do Dorso/patologia , Quimioterapia Adjuvante , Neoplasias Esofágicas/terapia , Terapia Neoadjuvante , Sarcopenia/complicações , Adulto , Idoso , Neoplasias Esofágicas/complicações , Esofagectomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sarcopenia/diagnóstico por imagem , Sarcopenia/patologia , Fatores de Tempo
10.
BMC Endocr Disord ; 19(1): 70, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262307

RESUMO

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in young women and increases risk of cardiovascular and metabolic disease, and infertility. Women with PCOS share many characteristics commonly associated with aging including chronic inflammation and insulin resistance, which may be associated with "sarcopenic obesity", a term used to describe low appendicular skeletal muscle mass relative to total body mass. The purpose of this work was to determine the prevalence of sarcopenic obesity in women with PCOS. We hypothesized there would be a high prevalence of sarcopenic obesity, and that % appendicular skeletal muscle mass and markers of inflammation and insulin resistance would be inversely correlated in this population. METHODS: Dual energy X-ray absorptiometry was used to assess body composition in 68 women with PCOS aged 18-35y and 60 healthy age-matched women from the same geographic area. Sarcopenic obesity was defined as having % appendicular skeletal muscle mass 2 standard deviations below the mean for the healthy age-matched controls and a % body fat above 35%. Data were analyzed with Mann-Whitney U-tests and Spearman correlations. RESULTS: 53% of women with PCOS were classified as sarcopenic obese. Women with PCOS had a median (interquartile range) appendicular skeletal muscle mass of 23.8 (22.3-25.8)% which was lower than the control median of 30.4 (28.6-32.4)% (p < 0.0001). Among women with PCOS, there were negative correlations between % appendicular skeletal muscle mass and the homeostasis model assessment insulin resistance index (r = - 0.409; p < 0.01), high sensitivity C-reactive protein (r = - 0.608; p < 0.0001) and glycosylated hemoglobin (r = - 0.430; p < 0.0001). Furthermore, % appendicular skeletal muscle mass correlated positively with vitamin D (r = 0.398; p < 0.0001) in women with PCOS, which is thought to positively affect skeletal muscle mass. CONCLUSIONS: Women with PCOS have a high prevalence of sarcopenic obesity, which is correlated to insulin resistance and inflammation.


Assuntos
Composição Corporal , Obesidade/complicações , Síndrome do Ovário Policístico/complicações , Sarcopenia/complicações , Absorciometria de Fóton , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Humanos , Insulina/metabolismo , Resistência à Insulina , Obesidade/epidemiologia , Fatores de Risco , Sarcopenia/epidemiologia , Vitamina D/sangue
12.
Nutrients ; 11(6)2019 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-31181771

RESUMO

Sarcopenic obesity (SO) is referred to as the combination of obesity with low skeletal muscle mass and function. However, its definition and diagnosis is debated. SO represents a sizable risk factor for the development of disability, possibly with a worse prognosis in women. The present narrative review summarizes the current evidence on pharmacological, nutrition and exercise strategies on the prevention and/or treatment of SO in middle-aged and older-aged women. A literature search was carried out in Medline and Google Scholar between 29th January and 14th March 2019. Only controlled intervention studies on mid-age and older women whose focus was on the prevention and/or treatment of sarcopenia associated with obesity were included. Resistance training (RT) appears effective in the prevention of all components of SO in women, resulting in significant improvements in muscular mass, strength, and functional capacity plus loss of fat mass, especially when coupled with hypocaloric diets containing at least 0.8 g/kg body weight protein. Correction of vitamin D deficit has a favorable effect on muscle mass. Treatment of SO already established is yet unsatisfactory, although intense and prolonged RT, diets with higher (1.2 g/kg body weight) protein content, and soy isoflavones all look promising. However, further confirmatory research and trials combining different approaches are required.


Assuntos
Dieta , Força Muscular , Músculo Esquelético , Obesidade/terapia , Desempenho Físico Funcional , Treinamento de Resistência , Sarcopenia/terapia , Tecido Adiposo/metabolismo , Envelhecimento , Proteínas na Dieta/administração & dosagem , Proteínas na Dieta/uso terapêutico , Feminino , Humanos , Isoflavonas/uso terapêutico , Músculo Esquelético/metabolismo , Obesidade/complicações , Obesidade/metabolismo , Obesidade/prevenção & controle , Sarcopenia/complicações , Sarcopenia/prevenção & controle , Soja/química , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/terapia
13.
Lancet ; 393(10191): 2636-2646, 2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31171417

RESUMO

Sarcopenia is a progressive and generalised skeletal muscle disorder involving the accelerated loss of muscle mass and function that is associated with increased adverse outcomes including falls, functional decline, frailty, and mortality. It occurs commonly as an age-related process in older people, influenced not only by contemporaneous risk factors, but also by genetic and lifestyle factors operating across the life course. It can also occur in mid-life in association with a range of conditions. Sarcopenia has become the focus of intense research aiming to translate current knowledge about its pathophysiology into improved diagnosis and treatment, with particular interest in the development of biomarkers, nutritional interventions, and drugs to augment the beneficial effects of resistance exercise. Designing effective preventive strategies that people can apply during their lifetime is of primary concern. Diagnosis, treatment, and prevention of sarcopenia is likely to become part of routine clinical practice.


Assuntos
Fragilidade/etiologia , Sarcopenia/diagnóstico , Sarcopenia/reabilitação , Adulto , Idoso , Diagnóstico Precoce , Feminino , Fragilidade/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sarcopenia/complicações , Sarcopenia/prevenção & controle
14.
J Bone Miner Metab ; 37(6): 1058-1066, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31222550

RESUMO

This study aimed to estimate the prevalence of locomotive syndrome, sarcopenia, and frailty and clarify their co-existence in a population-based cohort. The third survey of Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study was conducted between 2012 and 2013, examining 963 subjects (aged ≥ 60 years; 321 men, 642 women). Locomotive syndrome, sarcopenia, and frailty were defined using three tests proposed by Japanese Orthopaedic Association, Asian Working Group for Sarcopenia criteria, and Fried's definition, respectively. Prevalence of locomotive syndrome stages 1 and 2 were 81.0% (men, 80.4%; women, 81.3%) and 34.1% (men, 30.5%; women, 35.8%), respectively, and those of sarcopenia and frailty were 8.7% (men, 9.7%; women, 8.3%) and 4.5% (men, 2.8%; women, 5.3%), respectively. Locomotive syndrome stage 1, sarcopenia, and frailty co-existed in 2.1%; 6.5% had locomotive syndrome stage 1 and sarcopenia, 2.4% had locomotive syndrome stage 1 and frailty, while none had sarcopenia and frailty. Locomotive syndrome stage 1 presented alone in 70.0%, sarcopenia in 0.1%, and no frailty. The remaining 18.9% had none of these conditions. Co-existence of locomotive syndrome stage 2, sarcopenia, and frailty was observed in 2.0%; 5.0% had locomotive syndrome stage 2 and sarcopenia, 2.2% had locomotive syndrome stage 2 and frailty, and 0.1% had sarcopenia and frailty. Locomotive syndrome stage 2, sarcopenia, and frailty alone, presented in 24.9%, 1.7%, and 0.2%, respectively. The remaining 64.0% had none of these conditions. Most subjects with sarcopenia and/or frailty also had locomotive syndrome. Preventing locomotive syndrome may help prevent frailty and sarcopenia and subsequent disability.


Assuntos
Avaliação da Deficiência , Fragilidade/complicações , Fragilidade/epidemiologia , Osteoartrite/epidemiologia , Osteoporose/epidemiologia , Sarcopenia/complicações , Sarcopenia/epidemiologia , Inquéritos e Questionários , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Osteoartrite/complicações , Osteoporose/complicações , Prevalência , Síndrome , Adulto Jovem
15.
World J Surg ; 43(10): 2518-2526, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31222643

RESUMO

BACKGROUND: Sarcopenia at time of diagnosis predicts worse survival outcomes. It is currently unknown how changes in muscle mass over time interact with sarcopenia in colorectal patients treated with curative intent. Objectives of this study were to quantify sarcopenia and skeletal muscle loss from time of diagnosis to end of surveillance and determine its effect on survival outcomes after completion of 2 years of surveillance. METHODS: Retrospective cohort study of stage I-III colorectal cancer patients from 2007-2009, who underwent resection and had preoperative and 2-year surveillance computed tomography scans, without recurrence during that time. Body composition analysis was done at both time points to determine lumbar skeletal muscle index, radiodensity and adiposity. Change over time was standardized as a percentage per year. Cox proportional hazard regression modeling was used for survival analysis. RESULTS: Of 667 patients included, median survival from surgery was 7.96 years, with 75 recurrences occurring after 2 years. On average patients lost muscle mass (-0.415%/year; CI -0.789, -0.042) and radiodensity (-5.76 HU/year; CI -6.74, -4.80), but gained total adipose tissue (7.06%/year; CI 4.34, 9.79). Patients with sarcopenia at diagnosis (HR 1.80; CI 1.13, 2.85) or muscle loss over time (HR 1.55; CI 1.01, 2.37) had worse overall survival, with significantly worse joint effect (HR 2.73; CI 1.32, 5.65). CONCLUSIONS: Sarcopenia at diagnosis combined with ongoing skeletal muscle loss over time resulted in significantly worse survival. Patients with these features who are recurrence-free at 2 years are more likely to have a non-colorectal cancer cause of death.


Assuntos
Neoplasias Colorretais/complicações , Músculo Esquelético/fisiopatologia , Sarcopenia/complicações , Adiposidade , Idoso , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Tomografia Computadorizada por Raios X
16.
Surgery ; 166(3): 297-304, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31072665

RESUMO

BACKGROUND: Increasing evidence has suggested that sarcopenia is linked with cancer prognosis, but only limited data have focused on the impact of myosteatosis on cancer outcomes. This study evaluates the influence of myosteatosis on postoperative complications and survival in those patients who underwent radical resection of gastric carcinoma. METHODS: Patients who underwent elective radical gastrectomy for gastric cancer and had computed tomographic images available were identified from a prospectively collected database between 2008 and 2013. Myosteatosis was diagnosed by the cutoff values obtained from the method of optimum stratification. To obtain 2 well-balanced cohorts for available variables influencing clinical outcomes, the myosteatosis group was matched 1:1 with nonmyosteatosis group by using a propensity score match. RESULTS: Of 973 patients, 584 were matched for analyses. Compared with the nonmyosteatosis group, the myosteatosis group manifested significantly higher severe postoperative complications rates, shorter overall survival, and disease-free survival. Before matching, multivariate analyses identified that myosteatosis was an independent risk factor for severe postoperative complications, and Cox proportions hazards model showed that myosteatosis was an independent predictor for shorter overall survival and disease-free survival. In addition, subgroup analyses of each muscle phenotype showed that patients with both sarcopenia and myosteatosis had a poorer overall survival and disease-free survival than other patients. CONCLUSION: Myosteatosis in gastric cancer is associated with poor prognosis. Classifying the skeletal muscle into subranges of radio density is a promising strategy to understand the impact of skeletal muscle on unfavorable surgical outcomes in gastric cancer patients.


Assuntos
Sarcopenia/complicações , Neoplasias Gástricas/complicações , Neoplasias Gástricas/mortalidade , Idoso , Idoso de 80 Anos ou mais , Composição Corporal , Estudos de Coortes , Comorbidade , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Estadiamento de Neoplasias , Prognóstico , Pontuação de Propensão , Modelos de Riscos Proporcionais , Sarcopenia/diagnóstico , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada por Raios X
17.
PLoS One ; 14(5): e0215915, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31059520

RESUMO

BACKGROUND: Incidence and mortality of pancreatic ductal adenocarcinoma (PDAC) are on the rise. Sarcopenia and sarcopenic obesity have proven to be prognostic factors in different types of cancers. In the context of previous findings, we evaluated the impact of body composition in patients undergoing surgery in a national pancreatic center. METHODS: Patient's body composition (n = 133) was analyzed on diagnostic CT scans and defined as follows: Skeletal muscle index ≤38.5 cm2/m2 (women), ≤52.4 cm2/m2 (men); obesity was classified as BMI ≥25kg/m2. RESULTS: Sarcopenia showed a negative impact on overall survival (OS; 14 vs. 20 months, p = 0.016). Sarcopenic patients suffering from obesity showed poorer OS compared to non-sarcopenic obese patients (14 vs. 23 months, p = 0.007). Both sarcopenia and sarcopenic obesity were associated with sex (p<0.001 and p = 0.006; males vs. females 20% vs. 38% and 12% vs. 38%, respectively); sarcopenia was further associated with neoadjuvant treatment (p = 0.025), tumor grade (p = 0.023), weight loss (p = 0.02) and nutritional depletion (albumin, p = 0.011) as well as low BMI (<25 kg/m2, p = 0.038). Sarcopenic obese patients showed higher incidence of major postoperative complications (p<0.001). In addition, sarcopenia proved as an independent prognostic factor for OS (p = 0.031) in the multivariable Cox Regression model. CONCLUSION: Patients with sarcopenia and sarcopenic obesity undergoing resection for PDAC have a significantly shorter overall survival and a higher complication rate. The assessment of body composition in these patients may provide a broader understanding of patients' individual condition and guide specific supportive strategies in patients at risk.


Assuntos
Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Obesidade/complicações , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Sarcopenia/complicações , Adenocarcinoma/metabolismo , Adenocarcinoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Composição Corporal , Comorbidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
18.
Med Hypotheses ; 127: 46-48, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31088646

RESUMO

Hyponatremia is the most frequent electrolyte disorder found in clinical practice, particularly in hospitalized elderly patients, where it is associated with fractures, falls, hospital readmission, prolonged hospital stay and increased mortality. Pathophysiologically, hyponatremia can be induced by the reduction in sodium or potassium body content, and/or the increase in water body content. Sarcopenia is an ageing-associated progressive and generalized loss of musculoskeletal mass and strength which leads to low physical performance, particularly in the frail elderly. Since muscle mass is the main potassium body store, this condition usually represents a reduced body potassium content. In the present article it is hypothesized that sarcopenia, as a cause of low potassium body content, could induce or co-induce hyponatremia, particularly in elderly individuals suffering from frailty phenotype.


Assuntos
Acidentes por Quedas , Idoso Fragilizado , Hiponatremia/etiologia , Debilidade Muscular/etiologia , Sarcopenia/complicações , Idoso , Idoso de 80 Anos ou mais , Animais , Doença Crônica , Humanos , Pessoa de Meia-Idade , Modelos Biológicos , Estresse Oxidativo , Potássio/sangue , Sódio/sangue
19.
Maturitas ; 124: 48-54, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31097179

RESUMO

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children and adults of all ethnicities. NAFLD is commonly seen in individuals with metabolic abnormalities, such as obesity and insulin resistance, which are closely associated with sarcopenia. Sarcopenia, defined as low muscle mass and impaired muscle function, is associated with NAFLD and worse outcomes in patients with NAFLD. As the world's elderly population and the prevalence of obesity continues to grow at an unprecedented rate, NAFLD and sarcopenia are projected to increase. Given that there are no approved pharmacologic treatments for NAFLD, it is imperative to gain a better understanding of the disease pathophysiology, to guide treatment options. Recent studies have given new insight into sarcopenic obesity, but there is no consensus on its definition. In this review, we attempt to address the impact of sarcopenia and obesity on NAFLD, especially in the elderly population.


Assuntos
Resistência à Insulina , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Obesidade/epidemiologia , Sarcopenia/epidemiologia , Fatores Etários , Idoso , Humanos , Estilo de Vida , Hepatopatia Gordurosa não Alcoólica/complicações , Obesidade/complicações , Obesidade/fisiopatologia , Prevalência , Sarcopenia/complicações , Sarcopenia/fisiopatologia
20.
EuroIntervention ; 15(8): 671-677, 2019 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-31062696

RESUMO

AIMS: Sarcopaenia is a prevalent disease of ageing, associated with adverse clinical outcomes. We aimed to compare in-hospital adverse outcomes and overall mortality in sarcopaenic and non-sarcopaenic patients undergoing transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: This was a retrospective cohort study including 602 patients who underwent TAVR. Sarcopaenia was defined as skeletal muscle mass index <55.4 cm2/m2 in males and <38.9 cm2/m2 in females obtained through pre-TAVR CT scan. Mortality, length of hospital stay, ICU admission, and Valve Academic Research Consortium (VARC)-2-defined post-TAVR complications were defined as outcomes. Study participants (mean age 80.9±8.9 years and 56.8% male) were followed for a median of 1.5 years. Two thirds of the TAVR population was sarcopaenic. In-hospital outcomes were similar in both groups; however, overall survival was worse in sarcopaenic patients (HR for mortality=1.46 [1.06-2.14], p=0.02). In a multivariable model, sarcopaenia, porcelain aorta, pre-TAVR atrial fibrillation/flutter, severe chronic kidney disease, chronic pulmonary disease, VARC-2 bleeding, acute renal failure following TAVR, and post-TAVR cardiac arrest were predictors of mortality. CONCLUSIONS: Sarcopaenic patients had similar in-hospital clinical outcomes to non-sarcopaenic patients following TAVR which reveals TAVR safety in sarcopaenic patients. However, sarcopaenia was an independent risk factor for midterm mortality indicating its potential value in systematic evaluation of this highly comorbid population in order to decide the best treatment approaches.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Sarcopenia/complicações , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/mortalidade , Sarcopenia/fisiopatologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
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