Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 648
Filtrar
1.
Anticancer Res ; 40(2): 1175-1181, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014971

RESUMO

BACKGROUND/AIM: This study aimed to evaluate the association of sarcopenia and Clinical Outcomes with esophageal cancer under neoadjuvant chemoradiotherapy (CRT). PATIENTS AND METHODS: A retrospective study assessing patients with esophageal cancer who underwent CRT between 2001 and 2014 was conducted in the medical center. Hospital patients' records on sarcopenia and treatment outcomes were statistically analyzed. RESULTS: The sarcopenia group had significantly lower body mass index than the non-sarcopenia group. CRT-related severe adverse events with mucositis, fever, and neutropenic fever were greater in the sarcopenia group. Overall survival and disease-free survival were significantly better in the non-sarcopenia group. Sarcopenic patients who received nutritional support with enteral access had less severe mucositis. There was no difference in mortality of sarcopenia patients with nutritional support via enteral access or without. Moreover, sarcopenia and advanced tumor stage were independent factors for mortality outcome. CONCLUSION: Sarcopenia before CRT may be associated with increased toxicities and worse overall survival/ disease-free survival in esophageal cancer patients.


Assuntos
Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/mortalidade , Sarcopenia/etiologia , Sarcopenia/mortalidade , Idoso , Composição Corporal , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/terapia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/métodos , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Sarcopenia/diagnóstico , Análise de Sobrevida , Resultado do Tratamento
2.
Surgery ; 166(6): 1041-1047, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31607486

RESUMO

BACKGROUND: Some studies have reported that sarcopenia is linked to clinical outcomes in multiple types of malignancies, but this association has not been established in esophageal cancer. We assessed how sarcopenia affects clinical outcomes of multidisciplinary treatments for esophageal cancer. METHODS: We included 165 esophageal cancer patients who had undergone neoadjuvant chemotherapy followed by esophagectomy. Computed tomography was used for cross-sectional measurement of the psoas muscle at the third lumbar vertebra; we then calculated the height-adjusted psoas muscle index. Pre- and postneoadjuvant chemotherapy psoas muscle indices were evaluated for associations with neoadjuvant chemotherapy response and neoadjuvant chemotherapy -related adverse events and postoperative complications, in addition to survival. Psoas muscle index cutoffs were 6.36 cm2/m2 for men and 3.92 cm2/m2 for women. RESULTS: Psoas muscle index decreased after neoadjuvant chemotherapy (from 7.17 to 6.96 cm2/m2; P = .0008), and specifically in men (from 7.45 to 7.23 cm2/m2; P = .0001) but not in women (from 5.21 to 5.17 cm2/m2; P = .810). Preneoadjuvant chemotherapy psoas muscle index (low versus high) was associated with neoadjuvant chemotherapy response (response rate: 65.1% vs 80.3%; P = .0494) and neoadjuvant chemotherapy-related adverse events (neutropenia: 93.0% vs 78.7%; P = .0337; febrile neutropenia: 53.5% vs 34.3%; P = .0278; hyponatremia: 51.2% vs 31.2%; P = .0190). Post-neoadjuvant chemotherapy psoas muscle index correlated with postoperative rate of complications (56.9% vs 33.3%; P = .0046), especially pneumonia (31.4% vs 9.7% P = .0008). Psoas muscle index was not associated with survival. CONCLUSION: Cross sectional measures of sarcopenia before and after neoadjuvant chemotherapy could predict tumor response, neoadjuvant chemotherapy -related adverse events, and postoperative complications in multidisciplinary treatments for esophageal cancer.


Assuntos
Neoplasias Esofágicas/terapia , Esofagectomia/efeitos adversos , Terapia Neoadjuvante/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Músculos Psoas/diagnóstico por imagem , Sarcopenia/diagnóstico , Fatores Etários , Idoso , Antineoplásicos/efeitos adversos , Intervalo Livre de Doença , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/mortalidade , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Valor Preditivo dos Testes , Prognóstico , Músculos Psoas/efeitos dos fármacos , Músculos Psoas/fisiopatologia , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/etiologia , Sarcopenia/fisiopatologia , Taxa de Sobrevida , Tomografia Computadorizada por Raios X
3.
Radiat Oncol ; 14(1): 166, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511012

RESUMO

BACKGROUND: Sarcopenia, the critical depletion of skeletal muscle mass, is an independent prognostic factor in several tumor entities for treatment-related toxicity and survival. In esophageal cancer, there have been conflicting results regarding the value of sarcopenia as prognostic factor, which may be attributed to the heterogeneous patient populations and the retrospective nature of previous studies. The aim of our study was therefore to determine the impact of sarcopenia on prospectively collected specific outcomes in a subgroup of patients treated within the phase III study SAKK 75/08 with trimodality therapy (induction chemotherapy, radiochemotherapy and surgery) for locally advanced esophageal cancer. METHODS: Sarcopenia was assessed by skeletal muscle index at the 3rd lumbar vertebra (L3) in cross-sectional computed tomography scans before induction chemotherapy, before radiochemotherapy and after neoadjuvant therapy in a subgroup of 61 patients from four centers in Switzerland. Sarcopenia was determined by previously established cut-off values (Martin et al., PMID: 23530101) and correlated with prospectively collected outcomes including treatment-related toxicity, postoperative morbidity, treatment feasibility and survival. RESULTS: Using the published cut-off values, the prevalence of sarcopenia increased from 29.5% before treatment to 63.9% during neoadjuvant therapy (p < 0.001). Feasibility of neoadjuvant therapy and surgery was not different in initially sarcopenic and non-sarcopenic patients. We observed in sarcopenic patients significantly increased grade ≥ 3 toxicities during chemoradiation (83.3% vs 52.4%, p = 0.04) and a non-significant trend towards increased postoperative complications (66.7% vs 42.9%, p = 0.16). No difference in survival according to sarcopenia could be observed in this small study population. CONCLUSIONS: Trimodality therapy in locally advanced esophageal cancer is feasible in selected patients with sarcopenia. Neoadjuvant chemoradiation increased the percentage of sarcopenia. Sarcopenic patients are at higher risk for increased toxicity during neoadjuvant radiochemotherapy and showed a non-significant trend to more postoperative morbidity.


Assuntos
Adenocarcinoma/terapia , Quimiorradioterapia/efeitos adversos , Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas do Esôfago/terapia , Músculo Esquelético/patologia , Terapia Neoadjuvante/efeitos adversos , Sarcopenia/patologia , Adenocarcinoma/patologia , Adulto , Idoso , Terapia Combinada , Estudos Transversais , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/patologia , Esofagectomia/efeitos adversos , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Prognóstico , Sarcopenia/diagnóstico por imagem , Sarcopenia/etiologia , Taxa de Sobrevida , Tomografia Computadorizada por Raios X/métodos
4.
Medicina (Kaunas) ; 55(10)2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31554294

RESUMO

Background and Objectives: Recent studies have shown that low skeletal muscle mass can contribute to non-alcoholic fatty liver disease through insulin resistance. However, the association between muscle mass/strength and hepatic fat content remains unclear in postmenopausal women. Methods: In this study, we assessed the associations between muscle mass/strength and various severities of non-alcoholic fatty liver disease. Using single-voxel proton magnetic resonance spectroscopy, 96 postmenopausal women between the ages of 50 and 65 were divided into four groups (G0-G3) by hepatic fat content: G0 (hepatic fat content <5%, n = 20), G1 (5% ≤ hepatic fat content < 10%, n = 27), G2 (10% ≤ hepatic fat content < 25%, n = 31), and G3 (hepatic fat content ≥25%, n = 18). Muscle mass indexes were estimated as skeletal muscle index (SMI)% (total lean mass/weight × 100) and appendicular skeletal muscular mass index (ASM)% (appendicular lean mass/weight × 100) by dual energy X-ray absorptiometry. Maximal isometric voluntary contraction of the handgrip, elbow flexors, and knee extensors was measured using an adjustable dynamometer chair. Fasting plasma glucose, insulin, and follicle-stimulating hormones were assessed in venous blood samples. Results: The results showed negative correlations between hepatic fat content and SMI% (r = -0.42, p < 0.001), ASM% (r = -0.29, p = 0.005), maximal voluntary force of grip (r = -0.22, p = 0.037), and knee extensors (r = -0.22, p = 0.032). Conclusions: These significant correlations almost remained unchanged even after controlling for insulin resistance. In conclusion, negative correlations exist between muscle mass/strength and the progressed severity of non-alcoholic fatty liver disease among post-menopausal women, and the correlations are independent of insulin resistance.


Assuntos
Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Hepatopatia Gordurosa não Alcoólica/fisiopatologia , Pós-Menopausa/fisiologia , Absorciometria de Fóton , Idoso , Composição Corporal , Cotovelo/fisiologia , Feminino , Força da Mão , Humanos , Contração Isométrica , Joelho/fisiologia , Fígado , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Hepatopatia Gordurosa não Alcoólica/complicações , Espectroscopia de Prótons por Ressonância Magnética , Sarcopenia/etiologia
5.
World J Gastroenterol ; 25(35): 5257-5265, 2019 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-31558871

RESUMO

Minimal hepatic encephalopathy (MHE) represents the mildest type of hepatic encephalopathy (HE). MHE is considered as a preclinical stage of HE and is part of a wide spectrum of typical neurocognitive alterations characteristic of patients with liver cirrhosis, particularly involving the areas of attention, alertness, response inhibition, and executive functions. MHE can be detected by testing the patients' psychometric performance, attention, working memory, psychomotor speed, and visuospatial ability, as well as by means of electrophysiological and other functional brain measures. MHE is very frequent, affecting from 20% up to 80% of patients tested, depending of the diagnostic tools used. Although subclinical, MHE is considered to be clinically relevant. In fact, MHE has been related to the patients' falls, fitness to drive, and working ability. As a consequence, MHE affects the patients and caregivers lives by altering their quality of life and even their socioeconomic status. Recently sarcopenia, a very common condition in patients with advanced liver disease, has been shown to be strictly related to both minimal and overt HE. Aim of this review is to summarize the most recently published evidences about the emerging relationship between sarcopenia and cognitive impairment in cirrhotic patients and provide suggestions for future research.


Assuntos
Disfunção Cognitiva/fisiopatologia , Encefalopatia Hepática/etiologia , Cirrose Hepática/complicações , Qualidade de Vida , Sarcopenia/etiologia , Encéfalo/fisiopatologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Feminino , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Sarcopenia/fisiopatologia , Classe Social
6.
Biol Pharm Bull ; 42(9): 1437-1445, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31474705

RESUMO

Chronic kidney disease (CKD), a chronic catabolic condition, is characterized by muscle wasting and decreased muscle endurance. Many insights into the molecular mechanisms of muscle wasting in CKD have been obtained. A persistent imbalance between protein degradation and synthesis in muscle causes muscle wasting. During muscle wasting, high levels of reactive oxygen species (ROS) and inflammatory cytokines are detected in muscle. These increased ROS and inflammatory cytokine levels induce the expression of myostatin. The myostatin binding to its receptor activin A receptor type IIB stimulates the expression of atrogenes such as atrogin-1 and muscle ring factor 1, members of the muscle-specific ubiquitin ligase family. Impaired mitochondrial function also contributes to reducing muscle endurance. The increased protein-bound uremic toxin, parathyroid hormone, glucocorticoid, and angiotensin II levels that are observed in CKD all have a negative effect on muscle mass and endurance. Among the protein-bound uremic toxins, indoxyl sulfate, an indole-containing compound has the potential to induce muscle atrophy by stimulating ROS-mediated myostatin and atrogenes expression. Indoxyl sulfate also impairs mitochondrial function. Some potential therapeutic approaches based on the muscle wasting mechanisms in CKD are currently in the testing stages.


Assuntos
Proteínas Musculares/biossíntese , Músculo Esquelético/metabolismo , Insuficiência Renal Crônica/complicações , Sarcopenia/etiologia , Citocinas/imunologia , Humanos , Indicã/biossíntese , Músculo Esquelético/imunologia , Miostatina/biossíntese , Estresse Oxidativo/imunologia , Proteólise , Espécies Reativas de Oxigênio/metabolismo , Insuficiência Renal Crônica/imunologia , Insuficiência Renal Crônica/metabolismo , Sarcopenia/imunologia , Sarcopenia/metabolismo
7.
Anticancer Res ; 39(9): 4603-4612, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519557

RESUMO

BACKGROUND/AIM: Sarcopenia describes the loss of skeletal muscle mass. While this condition is associated with a high mortality in cancer patients, its influence on survival is still underestimated. PATIENTS AND METHODS: A systematic review for articles was performed using the PubMed database, Cochrane Library, Biomed Central, Science Direct and by manual search. We used data of overall survival in sarcopenic patients for assessing the death risk. We extracted hazard ratio estimates from univariate and multivariate Cox proportional hazards models for meta-analysis. RESULTS: A total of 15 studies were eligible for meta-analysis including a total of 2,521 lung cancer patients. Univariate meta-analysis revealed a two-fold increased death risk in sarcopenic patients; multivariate meta-analysis yielded a significant, three-fold elevated risk of death. This higher mortality is independent of tumour stage. CONCLUSION: Muscle loss is an independent risk factor for increased death risk in lung cancer patients independent of cancer stage. This argues for implementing screening for sarcopenia into cancer care.


Assuntos
Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/mortalidade , Sarcopenia/etiologia , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Músculo Esquelético/patologia , Estadiamento de Neoplasias , Tamanho do Órgão , Prognóstico , Modelos de Riscos Proporcionais , Sarcopenia/diagnóstico , Sarcopenia/epidemiologia
8.
World J Gastroenterol ; 25(28): 3823-3837, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31391776

RESUMO

BACKGROUND: Malnutrition is prevalent in inflammatory bowel disease (IBD). Multiple nutrition screening (NST) and assessment tools (NAT) have been developed for general populations, but the evidence in patients with IBD remains unclear. AIM: To systematically review the prevalence of abnormalities on NSTs and NATs, whether NSTs are associated with NATs, and whether they predict clinical outcomes in patients with IBD. METHODS: Comprehensive searches performed in Medline, CINAHL Plus and PubMed. Included: English language studies correlating NSTs with NATs or NSTs/NATs with clinical outcomes in IBD. Excluded: Review articles/case studies; use of body mass index/laboratory values as sole NST/NAT; age < 16. RESULTS: Of 16 studies and 1618 patients were included, 72% Crohn's disease and 28% ulcerative colitis. Four NSTs (the Malnutrition Universal Screening Tool, Malnutrition Inflammation Risk Tool (MIRT), Saskatchewan Inflammatory Bowel Disease Nutrition Risk Tool (SaskIBD-NRT) and Nutrition Risk Screening 2002 (NRS-2002) were significantly associated with nutritional assessment measures of sarcopenia and the Subjective Global Assessment (SGA). Three NSTs (MIRT, NRS-2002 and Nutritional Risk Index) were associated with clinical outcomes including hospitalizations, need for surgery, disease flares, and length of stay (LOS). Sarcopenia was the most commonly evaluated NAT associated with outcomes including the need for surgery and post-operative complications. The SGA was not associated with clinical outcomes aside from LOS. CONCLUSION: There is limited evidence correlating NSTs, NATs and clinical outcomes in IBD. Although studies support the association of NSTs/NATs with relevant outcomes, the heterogeneity calls for further studies before an optimal tool can be recommended. The NRS-2002, measures of sarcopenia and developments of novel NSTs/NATs, such as the MIRT, represent key, clinically-relevant areas for future exploration.


Assuntos
Doenças Inflamatórias Intestinais/diagnóstico , Desnutrição/diagnóstico , Programas de Rastreamento/métodos , Inquéritos Nutricionais/métodos , Sarcopenia/diagnóstico , Humanos , Doenças Inflamatórias Intestinais/etiologia , Desnutrição/complicações , Desnutrição/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Sarcopenia/epidemiologia , Sarcopenia/etiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-31370245

RESUMO

There is a growing body of evidence that links nutrition to muscle mass and function in the elderly, suggesting that it has an important role to play both in the prevention and management of age-related sarcopenia. Some nutrients have been studied, but less is known about the influence of overall diet quality on the loss of skeletal muscle mass and function. This study investigated the interrelationship between the recommended food score (RFS), as an indicator of overall diet quality, and muscle mass function among the Korean elderly. The sample consisted of 521 participants (263 men and 258 women), aged >65 years, who participated in the 2014-2015 National Fitness Award project. Appendicular skeletal muscle mass (ASM) was assessed by bioelectrical impedance analysis. Low muscle mass was defined as having an ASM corrected for height lower than the cutoff value established by the European Working Group on Sarcopenia in Older People. Muscle function, assessed by handgrip strength (HGS), was defined as low if it was below the 20th percentile of elderly men and women. Low muscle mass-function, defined as low muscle mass with low muscle strength (HGS), was found in 29 men (11.0%) and 22 women (8.5%). In elderly men, the low muscle mass-function group had significantly lower RFS values than the normal group after adjustments for age, body fat percentage, drinking, smoking, education, and physical activity (p = 0.019). However, there was no association between RFS and muscle mass-function in elderly women. Our findings suggest that better diet quality may be associated with higher muscle mass in elderly Korean men.


Assuntos
Dieta , Valor Nutritivo , Sarcopenia/etiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Força da Mão , Inquéritos Epidemiológicos , Humanos , Masculino , Fatores de Proteção , República da Coreia , Fatores de Risco , Sarcopenia/diagnóstico , Sarcopenia/fisiopatologia , Fatores Sexuais
10.
Int J Mol Sci ; 20(15)2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31387214

RESUMO

Sarcopenia is characterized by the progressive loss of skeletal muscle mass and strength. In older people, malnutrition and physical inactivity are often associated with sarcopenia, and, therefore, dietary interventions and exercise must be considered to prevent, delay, or treat it. Among the pathophysiological mechanisms leading to sarcopenia, a key role is played by an increase in reactive oxygen and nitrogen species (ROS/RNS) levels and a decrease in enzymatic antioxidant protection leading to oxidative stress. Many studies have evaluated, in addition to the effects of exercise, the effects of antioxidant dietary supplements in limiting age-related muscle mass and performance, but the data which have been reported are conflicting. In skeletal muscle, ROS/RNS have a dual function: at low levels they increase muscle force and adaptation to exercise, while at high levels they lead to a decline of muscle performance. Controversial results obtained with antioxidant supplementation in older persons could in part reflect the lack of univocal effects of ROS on muscle mass and function. The purpose of this review is to examine the molecular mechanisms underlying the dual effects of ROS in skeletal muscle function and the analysis of literature data on dietary antioxidant supplementation associated with exercise in normal and sarcopenic subjects.


Assuntos
Músculo Esquelético/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Adaptação Fisiológica , Envelhecimento/metabolismo , Animais , Antioxidantes/metabolismo , Antioxidantes/farmacologia , Suplementos Nutricionais , Exercício , Humanos , Oxirredução , Espécies Reativas de Nitrogênio/metabolismo , Sarcopenia/etiologia , Sarcopenia/metabolismo , Sarcopenia/fisiopatologia , Sarcopenia/prevenção & controle , Transdução de Sinais
11.
J Clin Neurosci ; 70: 96-101, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31444048

RESUMO

Associations of sarcopenia and physical frailty in cognitive and affective (depression, apathy, and behavioral and psychological symptoms of dementia) functions of mild cognitive impairment (MCI) and Alzheimer's disease (AD) were not fully evaluated previously, especially not for gender differences. 165 AD, 84 MCI, and 48 control participants (175 female, 122 male) were evaluated for cognitive, affective, activities of daily living (ADL), and physical functions associated with sarcopenia and physical frailty. In both sexes, cognitive and affective functions, ADL, and physical functions worsened in MCI and AD compared to control subjects. Physical dysfunctions, especially slow gait speed (3 m up and go test), were significantly associated with cognitive, affective, and ADL declines in participants (control subjects, MCI, and AD) of each gender, which were especially noticeable in females. The present study may be the first to suggest significant associations of sarcopenia and physical frailty with cognitive and affective functions of MCI and AD, especially in females.


Assuntos
Doença de Alzheimer/complicações , Disfunção Cognitiva/complicações , Fragilidade/etiologia , Sarcopenia/etiologia , Atividades Cotidianas , Idoso , Apatia , Depressão/etiologia , Feminino , Fragilidade/epidemiologia , Humanos , Masculino , Sarcopenia/epidemiologia , Fatores Sexuais
12.
Diabetes Metab Syndr ; 13(4): 2519-2524, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31405671

RESUMO

AIM: No studies have evaluated the contribution of major dietary patterns to Sarcopenic Obesity (SO) in obese and overweight people based on quintile of skeletal muscle mass (SMM) and fat mass (FM). This study was conducted to examine the association between major dietary patterns and SO. METHOD AND MATERIAL: A total of 301 overweight and obese women were included in the cross-sectional study. Body composition was measured by body composition analyzer. Resting metabolic rate was measured by indirect calorimetry. The usual food intake was evaluated by a semi-quantitative FFQ. Serum HDL-c, LDL-c, TG, FBS, total cholesterol and hs-CRP were measured. RESULT: The prevalence of sarcopenia (is referred to as two lower quintiles of SMM) and obesity (is referred to as two highest quintiles of FM) and SO was 19.6%, 20.4% and 9.9% respectively. We used the principal component analysis and three major dietary patterns were determined: the DASH, western and unhealthy dietary pattern, they covering 30.63% of total dietary pattern of our population. Participants in the in the upper category of DASH dietary pattern had lower odds of SO (OR = 0.27, 95% CI = 0.08 to 0.96, P = 0.04). After adjustment for age, physical activity and total energy intake, the association between the DASH and SO, was still significantly negative (OR = 0.20, 95% CI = 0.05 to 0.77, P = 0.01) and the risk of sarcopenia reduced by 80%. CONCLUSION: The present evidence indicates, adherence of the DASH Diet, has a significant effect on reducing the risk of SO.


Assuntos
Índice de Massa Corporal , Dieta/efeitos adversos , Músculo Esquelético/fisiopatologia , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Sarcopenia/epidemiologia , Adolescente , Adulto , Composição Corporal , Estudos de Casos e Controles , Estudos Transversais , Feminino , Seguimentos , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/etiologia , Obesidade/patologia , Sobrepeso/etiologia , Sobrepeso/patologia , Prevalência , Prognóstico , Sarcopenia/etiologia , Sarcopenia/patologia , Adulto Jovem
13.
Pancreatology ; 19(6): 850-857, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31362865

RESUMO

BACKGROUND: Pancreatic Cancer remains a lethal disease for the majority of patients. New chemotherapy agents such as Folfirinox offer therapeutic potential for patients who present with Borderline Resectable disease (BRPC). However, results to date are inconsistent, with factors such as malnutrition limiting successful drug delivery. We sought to determine the prevalence of sarcopenia in BRPC patients at diagnosis, and to quantify body composition change during chemotherapy. METHODS: The diagnostic/restaging CT scans of BRPC patients were analysed. Body composition was measured at L3 using Tomovision Slice-O-Matic™. Total muscle and adipose tissue mass were estimated using validated regression equations. Sarcopenia was defined as per gender- and body mass index (BMI)-specific lumbar skeletal muscle index (LSMI) and muscle attenuation reference values. RESULTS: Seventy-eight patients received neo-adjuvant chemotherapy, and 67 patients underwent restaging CT, at which point a third were deemed resectable. Half were sarcopenic at diagnosis, and sarcopenia was equally prevalent across all BMI categories.. Skeletal muscle and adipose tissue (intra-muscular, visceral and sub-cutaneous) area decreased during chemotherapy (p < 0.0001). Low muscle attenuation was observed in half of patients at diagnosis, and was associated with increased mortality risk. Loss of lean tissue parameters during chemotherapy was associated with an increased mortality risk; specifically fat-free mass, HR 1.1 (95% CI 1.03-1.17, p = 0.003) and skeletal muscle mass, HR 1.21 (95%CI 1.08-1.35, p = 0.001). CONCLUSIONS: Sarcopenia was prevalent in half of patients at the time of diagnosis with BRPC. Low muscle attenuation at diagnosis, coupled with lean tissue loss during chemotherapy, independently increased mortality risk.


Assuntos
Composição Corporal/efeitos dos fármacos , Terapia Neoadjuvante/efeitos adversos , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/metabolismo , Tecido Adiposo/diagnóstico por imagem , Tecido Adiposo/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Avaliação Nutricional , Neoplasias Pancreáticas/mortalidade , Prevalência , Estudos Retrospectivos , Risco , Sarcopenia/epidemiologia , Sarcopenia/etiologia , Sarcopenia/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
Anticancer Res ; 39(8): 4297-4303, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366521

RESUMO

BACKGROUND/AIM: The aim of this study was to evaluate the impact of sarcopenia diagnosed by the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm on long-term outcome after gastrectomy. PATIENTS AND METHODS: A total of 90 elderly gastric cancer patients without distant metastasis aged 65 years or older who underwent gastrectomy at the Osaka National Hospital between July 2012 and January 2015 were included in the current analysis. RESULTS: The sarcopenic group (n=19) had a poorer overall survival (OS) (p<0.0001) compared to the non-sarcopenic group (n=79). OS after recurrence was also worse in the sarcopenic group. Multivariate analysis indicated that sarcopenia was an independent risk factor for worse OS after gastrectomy (hazard ratio(HR)=2.92; 95% confidence interval(CI)=1.15-7.75; p=0.025), along with N stage ≥2, age ≥75 years, and presence of severe postoperative complications. CONCLUSION: Sarcopenia is a potential target for preoperative intervention in elderly gastric cancer patients to improve prognosis after gastrectomy. (UMIN-CTR: R000041532).


Assuntos
Gastrectomia , Prognóstico , Sarcopenia/patologia , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia/patologia , Complicações Pós-Operatórias/patologia , Fatores de Risco , Sarcopenia/etiologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia
15.
Transplant Proc ; 51(6): 1853-1860, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256871

RESUMO

OBJECTIVE: The development of sarcopenia leads to adverse postoperative outcomes. However, no study has investigated perioperative loss in core muscle and the correlation between core muscle and residual liver volume in living donors for liver transplant. PATIENTS AND METHODS: A total of 457 adult healthy donors who underwent a right lobe hepatectomy without the middle hepatic vein for elective liver transplant were retrospectively analyzed. Abdominal computed tomography was performed within 1 month before surgery and the first week and 3 months after the surgery. The average psoas muscle area between lumbar vertebrae 3 and 4 was measured and normalized by height squared (psoas muscle index [PMI] = psoas muscle area/height2). The initial whole liver volume and remnant left lobe volume were measured on computed tomography images. RESULTS: The study cohort included 279 men (61.1%) and 178 women (38.9%). The median preoperative PMIs were 420.9 mm2/m2 (interquartile range, 360.6-487.0 mm2/m2) in men and 280.9 mm2/m2 (interquartile range, 243.5-318.7 mm2/m2) in women. The PMIs in men and women significantly decreased during the first week after surgery, and gradually recovered to preoperative levels during the first 3 months after surgery. Based on the ratio between the remnant left lobe and initial whole liver volume (≥30%), the increase in remnant left lobe volume was not correlated with the decrease in PMI on postoperative day 7. A postoperative U-shaped recovery in the core muscles was present in both male and female donors, independent of the remnant liver ratio. CONCLUSIONS: Despite the requirements of partial liver regeneration and surgical wound repair, healthy donors did not suffer from sustained core muscle loss after surgery.


Assuntos
Hepatectomia/efeitos adversos , Doadores Vivos , Complicações Pós-Operatórias/fisiopatologia , Músculos Psoas/fisiopatologia , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Feminino , Hepatectomia/métodos , Veias Hepáticas , Humanos , Fígado/patologia , Fígado/cirurgia , Regeneração Hepática , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Músculos Psoas/cirurgia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Sarcopenia/etiologia , Sarcopenia/fisiopatologia , Tomografia Computadorizada por Raios X
16.
Transplant Proc ; 51(6): 1874-1879, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31262437

RESUMO

BACKGROUND: Patients on a waiting list for liver transplantation frequently show core muscle wasting, referred to as sarcopenia, which results in poor prognosis. To date, there has been a lack of research on the association between inflammation mediators, including cytokines, and loss of core muscle mass in cirrhotic patients scheduled for living donor liver transplantation (LDLT). METHODS: Cytokines in serum, such as interleukin (IL)-2, IL-6, IL-10, IL-12, IL-17, interferon-γ, and tumor necrosis factor (TNF)-α, were retrospectively investigated in 234 LDLT patients 1 day before surgery. The psoas muscle area was measured using abdominal computed tomography within 1 month before surgery and used to calculate the psoas muscle index (PMI = psoas muscle area/height2). The study population was classified into 2 groups according to the interquartile range of PMI: a non-sarcopenia group (> 25th quartile) and a sarcopenia group (≤ 25th quartile) in each sex. RESULTS: In both sexes, IL-10 and TNF-α levels were significantly higher in the sarcopenia group than the non-sarcopenia group. In a univariate analysis, male patients showed that serum IL-10 and TNF-α levels were potentially associated with sarcopenia. Serum TNF-α was independently associated with sarcopenia in a multivariate analysis. In female patients, TNF-α was significantly associated with sarcopenia in both univariate and multivariate analyses. Male patients with a PMI ≤ 25th quartile had significantly higher TNF-α levels than those in other quartile ranges, and female patients with a PMI ≤ 25th quartile had a significantly higher TNF-α level than those with a PMI > 75th quartile. CONCLUSIONS: Serum levels of TNF-α are inversely associated with skeletal muscle wasting in both male and female patients scheduled for LDLT.


Assuntos
Hepatopatias/sangue , Transplante de Fígado , Sarcopenia/sangue , Índice de Gravidade de Doença , Fator de Necrose Tumoral alfa/sangue , Adulto , Citocinas/sangue , Feminino , Humanos , Hepatopatias/complicações , Hepatopatias/cirurgia , Transplante de Fígado/métodos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Músculos Psoas/patologia , Estudos Retrospectivos , Sarcopenia/etiologia , Sarcopenia/patologia , Tomografia Computadorizada por Raios X , Listas de Espera
17.
Zhonghua Gan Zang Bing Za Zhi ; 27(7): 563-566, 2019 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-31357787

RESUMO

Sarcopenia is the main constituent of malnutrition and is a frequent complication of chronic liver diseases, which affects up to 70% of patients with advanced liver diseases. It has been associated with adverse clinical outcomes and prognosis, including poor quality of life, development of other complications and reduction in survival rate of non-transplant patients and transplant recipients. Chronic liver disease causes alteration in glucose metabolism, lipid oxidation, ketogenesis and protein catabolism, leading to the loss of adipose and muscle tissue. In addition, inadequate nutrients intake and limited or lack of physical activity perpetuate the reduction of muscle mass. Recently, the roles and mechanisms of muscle growth-related hormones, hyperammonemia-mediated signaling pathways and gut microbiota have been recognized. In view of its impact in chronic liver disease, sarcopenia can be considered as a powerful prognostic factor and a useful additional tool in the global assessment of patients with advanced liver disease. Rational nutritional intervention, appropriate physical exercise, effective ammonia lowering strategies, hormone supplements and targeted molecular therapy (use of myostatin blockers), and liver transplantation, may improve sarcopenia, but still needs more studies for validation.


Assuntos
Hepatopatias/patologia , Sarcopenia/patologia , Sarcopenia/terapia , Humanos , Transplante de Fígado , Desnutrição/complicações , Qualidade de Vida , Sarcopenia/etiologia
18.
Ann Surg Oncol ; 26(11): 3727-3735, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31313039

RESUMO

BACKGROUND: Skeletal muscle loss during the early postoperative period frequently occurs during post-esophagectomy. Preoperative sarcopenia is a known prognostic factor. However, the prognostic significance of postoperative skeletal muscle loss remains unclear. This study was designed to clarify the impact of skeletal muscle loss during the early postoperative period on the prognosis of elderly patients undergoing esophagectomy. METHODS: We included 316 patients (age ≥ 65 years) who underwent esophagectomy. The skeletal muscle index (SMI) at the third lumber vertebra's bottom level was measured using computed tomography (CT) before surgery and 4 months after surgery. The SMI reduction rate, patient's prognosis, and recurrence rates were evaluated. RESULTS: The SMI reduction rates in tertiles were < 1.25% in the first tertile (t1, n = 105), between 1.25 and 9.13% in the second tertile (t2, n = 106), and > 9.13% in the third tertile (t3, n = 105). Both relapse-free survival (RFS) and overall survival (OS) in t3 were significantly worse than those in t1 and t2 (p < 0.001). Therefore, we defined t3 as the massive reduction (MR) group and t1 and t2 as the limited reduction (LR) group. By univariate analysis, both RFS and OS were significantly poorer in the MR group than in LR. By multivariate analysis, the massive skeletal muscle loss during the early postoperative period was an independent factor for both RFS and OS. CONCLUSIONS: Early postoperative skeletal muscle loss predicts both recurrence and poor survival.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Músculo Esquelético/patologia , Complicações Pós-Operatórias , Sarcopenia/etiologia , Idoso , Neoplasias Esofágicas/patologia , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Sarcopenia/mortalidade , Sarcopenia/patologia , Taxa de Sobrevida
19.
Breast Cancer Res Treat ; 177(3): 569-579, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31292800

RESUMO

PURPOSE: Breast cancer is the most common cancer and leading cause of cancer death in women. Body composition parameters, especially those related to muscle, have become a growing focus of cancer research. In this review, we summarize the literature on breast cancer and muscle parameters as well as combine their outcomes for overall survival (OS), time to tumor progression (TTP), and chemotherapy toxicity in a meta-analysis. METHODS: A systematic search of the literature for randomized controlled trials and observational studies was conducted on MEDLINE, Cochrane CENTRAL, and EMBASE through May 1, 2019. Two reviewers independently searched and selected. Meta-analysis was conducted using a random-effects model. The risk of bias was evaluated using the Newcastle-Ottawa quality assessment for cohorts and GRADE summary of findings tool from Cochrane. RESULTS: A total of 754 articles were screened from which 6 articles and one abstract were selected. Using skeletal muscle index (SMI), patients classified as sarcopenic had a 68% greater mortality risk compared to non-sarcopenic patients (HR 1.68 95% CI 1.09-2.59, 5 studies) (p = .02) (i2 = 70%). Low muscle density was not predictive of OS (HR 1.44 95% CI 0.77-2.68, 2 studies) (p = .25) (i2 = 87%). Patients with sarcopenia (56%) had more grade 3-5 toxicity compared to non-sarcopenic (25%) (RR 2.17 95% CI 1.4-3.34, 3 studies) (p = .0005) (i2 = 0%). TTP was nearly 71 days longer in advanced/metastatic patients classified as non-sarcopenic compared to patients with sarcopenia (MD - 70.75 95% CI - 122.32 to - 19.18) (p = .007) (i2 = 0%). CONCLUSION: Our synthesis of the literature shows that patients with sarcopenia have more severe chemotherapy toxicity as well as shorter OS and TTP, and that low muscle density is prognostic of OS for women with metastatic breast cancer. Our findings suggest that in clinical practice, body composition assessment is valuable as a prognostic parameter in breast cancer.


Assuntos
Composição Corporal , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Músculo Esquelético/patologia , Sarcopenia/etiologia , Sarcopenia/patologia , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Progressão da Doença , Feminino , Humanos , Avaliação de Resultados da Assistência ao Paciente , Prognóstico
20.
PLoS One ; 14(6): e0218761, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31220163

RESUMO

BACKGROUND: Sarcopenia, the presence of skeletal muscle mass depletion, can be objectively quantified, whereas subjective global assessment (SGA) is a widely utilized subjective instrument to assess nutritional status. Both the presence of sarcopenia and SGA-assessed malnutrition, in isolation, have been shown to be associated with worse overall survival in a wide range of cancers. However, there is no research evaluating the independent prognostic significance of both the presence of sarcopenia and malnutrition as part of the same analysis. We investigated the impact of sarcopenia on overall survival in colorectal cancer specifically controlling for malnutrition. METHODS: We examined a consecutive case series of 112 patients with colorectal cancer first seen at our institution between August 2012 and October 2017. Using computed tomography (CT) imaging, the cross-sectional area of muscles at the L3 vertebral level was measured and then divided by height squared to calculate skeletal muscle index (SMI). Sarcopenia was defined as SMI ≤38.5 cm2/m2 for women and ≤52.4 cm2/m2 for men. SGA assessments were completed within 2 weeks of CT imaging. The association of sarcopenia and malnutrition with overall survival was assessed using univariate and multivariate Cox regression analysis. RESULTS: Median age at presentation was 53.3 years. Sixty-six (58.9%) patients had metastatic disease at diagnosis. Using SMI, 46 (41.1%) patients were sarcopenic, while 66 (58.9%) were non-sarcopenic. Using SGA, 69 (61.6%) patients were assessed as well-nourished, while 43 (38.4%) were malnourished. Of 69 patients classified as well-nourished by SGA, 22 (31.9%) were sarcopenic. Similarly, of 43 patients categorized as malnourished by SGA, 19 (44.2%) were non-sarcopenic. On multivariate analysis, after adjusting for age, gender, tumor stage, BMI, treatment history and SGA, patients with sarcopenia had 3 times greater risk of mortality compared to those without sarcopenia (p = 0.001). The median survival of patients with both sarcopenia and malnutrition (n = 24) was 14.6 months (95% CI: 10.5 to 18.6) compared to the median survival of 25.9 months (95% CI: 7.8 to 44.0) in patients who were either sarcopenic or malnourished but not both (n = 41; p = 0.001). The median survival of patients who were non-sarcopenic and well nourished (n = 48; p = 0.001) was 38.6 months (95% CI: 25.6 to 51.6). CONCLUSIONS: The exploratory study suggests that presence of sarcopenia supersedes the presence of malnutrition as a predictor of survival in colorectal cancer. Co-existence of sarcopenia and malnutrition is associated with worse survival in colorectal cancer compared to just one of those conditions being present. Prospective studies with large sample sizes are needed to confirm these findings.


Assuntos
Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidade , Biomarcadores Tumorais , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/mortalidade , Sarcopenia/diagnóstico , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Adulto , Idoso , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/normas , Camptotecina/análogos & derivados , Camptotecina/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Feminino , Fluoruracila/uso terapêutico , Humanos , Irinotecano/uso terapêutico , Leucovorina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Oxaliplatina/uso terapêutico , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Sarcopenia/etiologia , Sarcopenia/mortalidade , Análise de Sobrevida
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA