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BACKGROUND & AIMS: Although it is widely recognized that muscle quality significantly influences adverse outcomes in patients with cancer, the precise definition of muscle quality remains elusive. The muscle quality index (MQI), also known as muscle-specific strength, is a relatively recent functional concept of muscle quality. It is obtained through the ratio of muscle strength to muscle mass, but its predictive value in patients with cancer remains unknown. In this study, we explored the prognostic significance of MQI in patients with cancer. Furthermore, we introduce and assess the prognostic potential of a novel muscle quality metric: the strength-to-muscle-radiodensity index (SMRi). METHODS: A secondary analysis was conducted on a prospective cohort study. CT scans were opportunistically used to assess body composition parameters, including skeletal muscle mass (SM in cm2) and muscle radiodensity (SMD in HU) at the third lumbar vertebra (L3). Handgrip strength (HGS) was measured. MQICT was calculated using the ratio of HGS to SM (cm2). SMRi was calculated as the ratio of HGS to SMD (HU). For analysis purposes, low MQICT and SMRi were defined using two approaches: statistical cutoffs associated with survival, and median-based distribution data. RESULTS: A total of 250 patients were included (52.8% females, 52% adults, 20-90 years). Gastrointestinal tumors and stage III-IV were the most frequent diagnosis and stages. SMRi and MQICT were strongly positively correlated (ρ = 0.71 P < 0.001). Individual components of MQICT and SMRi were also positively correlated. Patients with both low MQICT and SMRi had shorter survival (log-rank P = 0.023 and P = 0.003, respectively). When applying median distribution cutoffs, SMRi emerged as the most accurate predictor of mortality (HR adjusted 3.18, 95% CI 1.50 to 6.75, C-index: 0.71), when compared to MQICT (HR adjusted 1.49, 95% CI 0.77 to 2.87, C-index: 0.68). CONCLUSION: This study introduces the concept and potential prognostic significance of the SMRi. The physiological and clinical implications of this new index warrant further investigation across a spectrum of diseases, including cancer.
Assuntos
Composição Corporal , Força da Mão , Músculo Esquelético , Neoplasias , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiopatologia , Estudos Prospectivos , Idoso , Força da Mão/fisiologia , Neoplasias/mortalidade , Neoplasias/diagnóstico por imagem , Neoplasias/fisiopatologia , Prognóstico , Tomografia Computadorizada por Raios X/métodos , Força Muscular/fisiologia , Adulto , Sarcopenia/diagnóstico por imagem , Sarcopenia/fisiopatologia , Idoso de 80 Anos ou maisRESUMO
OBJECTIVES: To assess the concurrent and predictive validity of different combinations of Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with colorectal cancer considering different indicators of reduced muscle mass (MM) and the effects of the disease. METHODS: A secondary analysis with patients with colorectal cancer. The reduced MM was assessed by arm muscle area, arm muscle circumference, calf circumference, fat-free mass index, skeletal muscle index (SMI) and skeletal muscle. Cancer diagnosis or disease staging (TNM) was considered for the etiologic criterion referred to as the effect of the disease. The other phenotypic and etiologic criteria were also evaluated, and we analyzed 13 GLIM combinations. Concurrent validity between GLIM criteria and Patient-Generated Subjective Global Assessment was evaluated. Logistic and Cox regression were used in the predictive validation. RESULTS: For concurrent validity (n = 208), most GLIM combinations (n = 6; 54.5%) presented a moderate agreement with Patient-Generated Subjective Global Assessment and none showed satisfactory sensitivity and specificity (>80%). Reduced MM evaluated by SMI and SMI were present in the GLIM combinations associated with postoperative complications (odds ratio, ≥2.0), independent of other phenotypic and etiologic criteria. The combinations with reduced MM considering any method and fixed phenotypic criteria and TNM were associated with mortality (hazard ratio, ≥2.0). CONCLUSIONS: Satisfactory concurrent validity was not verified. The GLIM diagnosis of malnutrition was associated with postoperative complications and mortality.
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Neoplasias Colorretais , Desnutrição , Humanos , Liderança , Gravidade do Paciente , Desnutrição/complicações , Desnutrição/diagnóstico , Músculo Esquelético , Complicações Pós-Operatórias , Neoplasias Colorretais/complicações , Neoplasias Colorretais/diagnóstico , Avaliação Nutricional , Estado NutricionalRESUMO
BACKGROUND: Considering that the validation of the Global Leadership Initiative on Malnutrition (GLIM) remains unclear in patients with colorectal cancer, the present study aimed to assess the agreement, accuracy, sensitivity, specificity, and prognostic effect of the GLIM on survival when compared with the Patient-Generated Subjective Global Assessment (PG-SGA). METHODS: Patients with colorectal cancer who were scheduled to undergo a routine abdominal computed tomography (CT) scan were recruited. Using the GLIM two-step approach, the patients were first screened for malnutrition by using the PG-SGA Short Form (score ≥3). The malnutrition diagnosis was based on the etiologic (disease burden [cancer] or reduced food intake) and phenotypic GLIM criteria, including weight loss, body mass index, and skeletal muscle index at the third lumbar vertebra when using the CT scans. The food intake was assessed by the PG-SGA. RESULTS: This study included 191 patients (age, 60.5 ± 11.3 years; 57% men), and 23% and 32% were malnourished according to the GLIM and the PG-SGA, respectively. The GLIM revealed fair sensitivity (64%), good agreement (kappa = 0.65), specificity (96%), and diagnostic accuracy for detecting malnutrition (area under the receiver operating characteristic curve = 0.80; 95% CI, 0.72-0.88) when compared with the PG-SGA. The malnutrition value according to the GLIM and the PG-SGA was associated with short-term survival. However, only the PG-SGA was associated with long-term survival. CONCLUSIONS: Although showing fair sensitivity, the GLIM had good agreement, specificity, and diagnostic accuracy for malnutrition detection and was an independent predictor of short-term survival in patients with colorectal cancer.
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Neoplasias Colorretais , Desnutrição , Masculino , Humanos , Pessoa de Meia-Idade , Idoso , Feminino , Liderança , Índice de Massa Corporal , Efeitos Psicossociais da Doença , Avaliação Nutricional , Estado NutricionalRESUMO
BACKGROUND AND AIMS: Considering the applicability of phase angle (PhA) as a marker of muscle mass and function, we aimed to investigate whether PhA is a predictor of muscle abnormalities and function in patients with cancer. METHODS: In a sample of patients with colorectal cancer (CRC), PhA was obtained from measurements of resistance and reactance from bioelectrical impedance analysis. Computerized tomography imaging at the third lumbar vertebra was used to evaluate muscle abnormalities by quantifying skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD). Muscle function was assessed by handgrip strength (HGS) and gait speed (GS). RESULTS: This cross-sectional study included 190 participants (X±SD), mean age 60.5 ± 11.3 years; 57% men; 78% had cancer stages III to IV. PhA was highly correlated with SMI (r = 0.70) and moderately correlated with HGS (r = 0.54). PhA explained 48% of the SMI variability (R2 = 0.485), 21% of the SMD variability (R2 = 0.214), 26% of HGS (R2 = 0.261) and 9.8% of GS (R2 = 0.098). In the multivariate model adjusted for age, sex, body mass index, performance status, comorbidities and cancer stage, 1-degree decrease in PhA was associated with low SMI (Odds Ratio (OR) = 6.56, 95% CI: 2.90-14.86) and with low SMI and HGS combined (OR = 11.10, 95% CI: 2.61-47.25). In addition, Receiving Operating Characteristics curve analysis showed that PhA had a good diagnostic accuracy for detecting low SMI, low SMI and SMD combined, low SMD and HGS and low SMI and HGS combined (AUC = 0.81, 95% CI: 0.74-0.88; AUC = 0.88, 95% CI: 0.81-0.95; AUC = 0.80, 95% CI: 0.70-0.91; AUC = 0.82, 95% CI: 0.74-0.89; respectively). CONCLUSIONS: PhA was a predictor of muscle abnormalities and function and had a good diagnostic accuracy for detecting low muscle mass, low muscle mass and radiodensity, low muscle radiodensity and strength, and low muscle mass and strength in patients with CRC.
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Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/fisiopatologia , Músculo Esquelético/diagnóstico por imagem , Sarcopenia/diagnóstico , Idoso , Biomarcadores/análise , Neoplasias Colorretais/complicações , Impedância Elétrica , Feminino , Força da Mão , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Razão de Chances , Valor Preditivo dos Testes , Curva ROC , Tomografia Computadorizada por Raios X , Velocidade de CaminhadaRESUMO
BACKGROUND: We aimed to evaluate the agreement between computed tomography (CT) and surrogate methods applied in clinical practice for the assessment of low muscle mass. In addition, we assessed the association between different muscle-assessment methods and nutrition status, as well as the prognostic value of low muscle mass on survival in patients with colorectal cancer (CRC). METHODS: This is a cohort including 188 CRC patients with 17 months' follow-up (interquartile range: 12-23 months) for mortality. Low muscle mass was evaluated by corrected mid-upper arm muscle area (AMAc) and calf circumference, skeletal muscle mass by bioelectrical impedance analysis (BIA), muscle deficit by physical examination with the Patient-Generated Subjective Global Assessment (PG-SGA), and lumbar muscle cross-sectional area by CT (reference method). RESULTS: The prevalence of low muscle mass ranged from 9.6% to 54.3% according to the method used. The physical examination had the highest κ coefficient compared with CT. Low muscularity was associated with the presence of malnutrition, lower body fat, and low phase angle. The Cox regression models-adjusted for age, sex, and treatment 3 months before study inclusion-showed that severe muscle loss measured by BIA and CT and low muscle mass measured by PG-SGA predicted higher mortality rates. CONCLUSIONS: Compared with CT, the physical examination had the best agreement to assess low muscle mass. Low muscle mass assessed by PG-SGA, BIA, and CT showed similar prognostic values for survival.
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Neoplasias Colorretais , Desnutrição , Composição Corporal , Índice de Massa Corporal , Neoplasias Colorretais/diagnóstico por imagem , Impedância Elétrica , Humanos , Lactente , Desnutrição/diagnóstico , Músculo Esquelético/diagnóstico por imagem , Avaliação Nutricional , Estado Nutricional , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND & AIMS: We aimed to explore the determinants of muscle fat infiltration and to investigate whether myosteatosis, assessed as muscle fat infiltration percentage (%MFI) and muscle attenuation from computed tomography (CT), is associated with frailty in a group of patients with colorectal cancer (CRC). METHODS: Cross sectional study including CRC patients. CT scan of the third lumbar vertebra was used to quantify body composition and the degree of %MFI (reported as percentage of fat within muscle area). Frailty was defined by Fried et al. (2001) as the presence of more than 3 criteria: unintentional weight loss, self-reported exhaustion, weakness (low handgrip strength), slow walking speed (gait speed) and low physical activity. Obesity was defined according to sex-and-age-specific body fat percentage (%BF) cutoff. RESULTS: A sample of 184 patients (age 60 ± 11 years; 58% men; 29% of patients with frailty) was studied. The sample was divided according to tertiles of MFI% (1st tertile 0 to 2.89%, n = 60; 2nd tertile ≥ 3.9-8.19%, n = 64; 3rd tertile ≥ 8.2-26%, n = 60). Age, females, body mass index, %BF, subcutaneous and visceral adipose tissue and the proportion of patients with frailty were significantly higher in the 3rd %MFI tertile. Phase angle and muscle attenuation were significantly lower in the 3rd %MFI tertile. The determinants of %MFI (r2 = 0.49), which was log transformed due to its normal distribution, were %BF (ß = 0.54; eß = 1.72; 95% CI: 0.032 to 0.051; P < 0.01), age (ß = 0.34; eß = 1.40; 95% CI: 0.016 to 0.032; P < 0.01) and gait speed (ß = -0.12; eß = 0.87; 95% CI: -0.84 to -0.001; P = 0.049). In addition, in obese patients (n = 74) presenting 4 or 5 frailty criteria increased the chance of having higher %MFI and lower muscle attenuation, after adjustment for sex, age and comorbidities when compared to none or 1 criteria. CONCLUSIONS: In a sample of CRC patients, %BF and gait speed were the determinants of %MFI. In addition, markers of myostetatosis were associated with frailty in the obese patients.
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Tecido Adiposo/diagnóstico por imagem , Composição Corporal , Neoplasias Colorretais/epidemiologia , Fragilidade/epidemiologia , Obesidade/epidemiologia , Brasil/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodosRESUMO
Background/objectives Patients with chronic kidney disease (CKD) are subjected to muscle wasting. Therefore, it is important to investigate surrogate methods that enable the assessment of muscle mass loss in the clinical setting. We aimed to analyze the agreement between computed tomography (CT) and surrogate methods for the assessment of muscle mass in non-dialysis CKD patients. Subjects/methods Cross-sectional study including 233 non-dialysis patients on CKD stages 3 to 5 (61±11 years; 64% men; glomerular ï¬ltration rate 22 (1433) mL/min/1.73m2). The muscle mass was evaluated by CT and bioelectrical impedance, skinfold thicknesses, midarm muscle circumference (MAMC), the predictive equations of Janssen and Baumgartner and the physical examination of muscle atrophy from the subjective global assessment. Results In males, the MAMC showed the best agreement with CT as indicated by the kappa test (k=0.57, P<0.01), sensitivity (S=68%), speciï¬city (S=89%) and accuracy (area under the curveAUC=0.78), followed by the Baumgartner equation (kappa=0.46, P<0.01; sensitivity=60%; speciï¬city=87% and AUC=0.73). In female, the Baumgartner equation showed the best agreement with CT (kappa=0.43, P<0.01; sensitivity=57%; speciï¬city=86% and AUC=0.71). (AU)
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Humanos , Masculino , Feminino , Atrofia Muscular/diagnóstico por imagem , Biomarcadores , Músculo Esquelético/fisiologia , Insuficiência Renal Crônica , Taxa de Filtração GlomerularRESUMO
BACKGROUND/OBJECTIVES: Patients with chronic kidney disease (CKD) are subjected to muscle wasting. Therefore, it is important to investigate surrogate methods that enable the assessment of muscle mass loss in the clinical setting. We aimed to analyze the agreement between computed tomography (CT) and surrogate methods for the assessment of muscle mass in non-dialysis CKD patients. SUBJECTS/METHODS: Cross-sectional study including 233 non-dialysis patients on CKD stages 3 to 5 (61 ± 11 years; 64% men; glomerular filtration rate 22 (14-33) mL/min/1.73 m2). The muscle mass was evaluated by CT and bioelectrical impedance, skinfold thicknesses, midarm muscle circumference (MAMC), the predictive equations of Janssen and Baumgartner and the physical examination of muscle atrophy from the subjective global assessment. RESULTS: In males, the MAMC showed the best agreement with CT as indicated by the kappa test (k = 0.57, P < 0.01), sensitivity (S = 68%), specificity (S = 89%) and accuracy (area under the curve-AUC = 0.78), followed by the Baumgartner equation (kappa = 0.46, P < 0.01; sensitivity = 60%; specificity = 87% and AUC = 0.73). In female, the Baumgartner equation showed the best agreement with CT (kappa = 0.43, P < 0.01; sensitivity = 57%; specificity = 86% and AUC = 0.71). CONCLUSIONS: The MAMC and Baumgartner equation showed the best agreement with CT for the assessment of muscle mass in non-dialysis CKD patients.
Assuntos
Atrofia Muscular/diagnóstico por imagem , Insuficiência Renal Crônica/diagnóstico por imagem , Dobras Cutâneas , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Idoso , Braço/diagnóstico por imagem , Braço/fisiopatologia , Biomarcadores/análise , Estudos Transversais , Impedância Elétrica , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiopatologia , Atrofia Muscular/etiologia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/fisiopatologia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodosRESUMO
Introduction; Sarcopenia are frequently observed in cancer patients and was associated with poor prognosis. Objectives; to determine the association of nutritional status, body composition, and clinic parameters with sarcopenia in patients with colorectal cancer (CRC). Methods; We conducted a cross-sectional study of 197 patients with CRC. The sarcopenia elements, including lumbar skeletal muscle index (SMI), handgrip strength, and gait speed were measured. The SMI was assessed by computed tomography at third lumbar vertebra. Phase angle (PA), serum albumin (SAlb), muscle attenuation (MA), and the scored patient-generated subjective global assessment (PG-SGA) were also evaluated. Univariate and multivariate analysis of factors associated with sarcopenia were performed. Results; Sarcopenia was present in 29 of 195 patients (15%) and was significantly correlated with advance age, lower body mass index (BMI), SAlb, PA, MA, higher PG-SGA score, and malnutrition (PG-SGA B). In univariate analysis, age, BMI, SAlb, PA, MA, PG-SGA score, and malnutrition (PG-SGA B) were associated with sarcopenia. Multivariable analysis revealed that BMI, SAlb, PA, MA, and PG-SGA score were independent predictors of sarcopenia. Conclusion; BMI, SAlb, PA, MA, and PG-SGA score were independent predictors of sarcopenia in patients with CRC.