The global prevalence of and factors associated with sarcopenia in patients with gastrointestinal cancer: A systematic review and meta-analysis.

ABSTRACTBackgroundPeople receiving dialysis treatment are at higher risk of sarcopenia. This review aimed to determine the global prevalence of sarcopenia in people on peritoneal dialysis and hemodialysis. We investigated whether the prevalence of sarcopenia differs based on assessment criteria, timing of assessment, and measurement tools used and explored the risk factors for sarcopenia in people on dialysis.MethodsThis review followed JBI and PRISMA guidelines and included studies assessing sarcopenia in adults aged 18 and older with chronic kidney disease undergoing dialysis. Five databases were searched from inception to November 2022. The JBI SUMARI software was used to perform the meta‐analysis. Publication bias and risk factor analysis were performed using STATA (Version 18).ResultsA meta‐analysis of 62 studies (15,382 participants) found the global prevalence of sarcopenia to be 30.1% (95% CI: 25.6%–39.9%) for hemodialysis and 20.5% (95% CI: 15.1%–26.4%) for peritoneal dialysis. Sarcopenia prevalence ranged between 23.1% and 30.3% in HD and between 6.1% and 26.9% in PD, based on the assessment criteria. Post‐dialysis sarcopenia prevalence was higher (33%) than pre‐dialysis (24.2%) in hemodialysis patients. Measuring muscle mass after dialysis using dual‐energy X‐ray assessment yielded a lower prevalence of sarcopenia (22.5%) than bioimpedance analysis or spectroscopy (33%). Risk factors in the HD population included age, sex, diabetes, inflammation markers, nutritional indices, and dialysis vintage, although heterogeneity between studies was high.ConclusionThis study showed a high prevalence of sarcopenia among the dialysis population and identified many risk factors, emphasizing the need for early identification and intervention and standardized assessments.

Prevalence of Sarcopenia in Pain Patients and Correlation Between the Two Conditions: A Systematic Review and Meta-Analysis.

The prevalence of sarcopenia and its clinical predictors and clinical impact vary among kidney transplant recipients (KTRs), in part because of different diagnostic criteria. This study aimed to assess the reported diagnosis criteria of sarcopenia and compare them in terms of prevalence, clinical predictors, and impact of sarcopenia. The Medline, Embase, and Cochrane Library were searched for the full-length reports published until 28 January 2022. The subgroup analysis, meta-regression, and sensitivity analysis were performed and heterogeneity was assessed using the I2 . A total of 681 studies were retrieved, among which only 23 studies (including 2535 subjects, 59.7% men, mean age 49.8years) were eventually included in the final analysis. The pooled prevalence in these included studies was 26% [95% confidence interval (95% CI): 20-34%, I2 =93.45%], including 22% (95% CI: 14-32%, I2 =88.76%) in men and 27% (95% CI: 14-41%, I2 =90.56%) in women (P=0.554 between subgroups). The prevalence of sarcopenia diagnosed using low muscle mass was 34% (95% CI: 21-48%, I2 =95.28%), and the prevalence of using low muscle mass in combination with low muscle strength and/or low physical performance was 21% (95% CI: 15-28%, I2 =90.37%) (P=0.08 between subgroups). In meta-regression analyses, the mean age (regression coefficient: 1.001, 95% CI: 0.991-1.011) and percentage male (regression coefficient: 0.846, 95% CI: 0.367-1.950) could not predict the effect size. Lower body mass index (odds ratio (OR): 0.57, 95% CI: 0.39-0.84, I2 =61.5%), female sex (OR: 0.31, 95% CI: 0.16-0.61, I2 =0.0%), and higher age (OR: 1.08, 95% CI: 1.05-1.10, I2 =10.1%) were significantly associated with a higher risk for sarcopenia in KTRs, but phase angle (OR: 0.81, 95% CI: 0.16-4.26, I2 =84.5%) was not associated with sarcopenia in KTRs. Sarcopenia was not associated with rejections (risk ratio (RR): 0.67, 95% CI: 0.23-1.92, I2 =12.1%), infections (RR: 1.03, 95% CI: 0.34-3.12, I2 =87.4%), delayed graft functions (RR: 0.81, 95% CI: 0.46-1.43, I2 =0.0%), and death (RR: 0.95, 95% CI: 0.32-2.82, I2 =0.0%) in KRTs. Sarcopenia was found to be very common in KRTs. However, we have not found that sarcopenia had a negative impact on clinical health after kidney transplantation. Large study cohorts and multicentre longitudinal studies in the future are urgently needed to explore the prevalence and prognosis of sarcopenia in kidney transplant patients.

To clarify the prevalence and risk factors of sarcopenia in commuting rehabilitation service users. The 104 participants of the plant [Sorry, the English is unclear: please clarify the meaning of the highlighted text] (56 men, 48 women; average age 78.6±7.7 years). The diagnosis of sarcopenia was classified based on the AWGS diagnostic algorithm. The following 10 items were investigated for their causal relationship with sarcopenia as risk factors: risk factor survey (1) cerebrovascular disease, (2) hypertension, (3) respiratory disease, (4) cardiovascular disease, (5) orthopedic disease, (6) fracture, (7) cancer, (8) intractable diseases, (9) diabetes mellitus, and (10) fall history in the past year. The prevalence of sarcopenia was 51.9%. Significant differences were observed in the items of "cancer" and "fall history in the past year" as risk factors for sarcopenia. Elderly people needing support or care (especially those with cancer and a history of falling) have a very high risk of sarcopenia and are expected to require early intervention.

Nutritional status and body fat mass: Determinants of sarcopenia in community-dwelling older adults.

BackgroundIt has been speculated that patients with sarcopenia are aggravated by the current novel coronavirus disease 2019 (COVID-19) epidemic. However, there is substantial uncertainty regarding the prevalence of sarcopenia in patients with COVID-19.ObjectivesThe purpose of the study was to systematically evaluate the prevalence of sarcopenia in patients with COVID-19, including stratification by gender, study location, study population, study design, and diagnostic criteria.DesignThis is the systematic literature review and meta-analysis.MethodsAn electronic search was performed in MEDLINE/PubMed, Embase, Cochrane Library, and Web of Science and Scopus to identify observational studies reporting a prevalence estimate for sarcopenia in patients with COVID-19. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and a meta-analysis was performed. Risk of bias (RoB) was assessed using the Newcastle–Ottawa Scale (NOS) for cohort studies and Joanna Briggs Institute (JBI) manual for cross-sectional studies, and Stata 14.0 was used to perform meta-analyses.ResultsA total of 4,639 studies were initially identified. After removing the duplicates and applying the selection criteria, we reviewed 151 full-text studies. A total of 21 studies, including 5,407 patients, were eligible for inclusion in this review finally. The prevalence of sarcopenia in patients with COVID-19 in individual studies varied from 0.8 to 90.2%. The pooled prevalence of sarcopenia in COVID-19 was 48.0% (95% confidence interval, CI: 30.8 to 65.1%, I2 = 99.68%, p = 0.000). We did not find any significant differences in the prevalence estimates between gender specificity (OR = 1.34; 95% CI = 0.80–2.26; p = 0.001). By sex, the prevalence was 42.5% (95% CI: 31.7 to 53.4%) in men and 35.7% (95% CI: 24.2 to 47.2%) in women. The prevalence estimates significantly varied based on population settings and different diagnostic criteria of sarcopenia. ICU patients (69.7, 95% CI: 51.7 to 85.2%) were more likely to suffer from sarcopenia compared to other population settings.ConclusionTo our knowledge, this is the first meta-analysis reporting on the prevalence of sarcopenia in patients with COVID-19. Sarcopenia is frequently observed in patients with COVID-19, with varying prevalence across population settings. This study would be useful for clinicians to prompt the increasing awareness of identifying sarcopenia and developing interventions at patients with COVID-19 with high risk of sarcopenia. Further prospective longitudinal studies to define the association of sarcopenia and its prognostic outcomes in COVID-19 survivors are urgently needed to propose the most appropriate treatment strategies during their admission and discharge.Systematic Review Registration[www.crd.york.ac.uk/prospero/], identifier [CRD42022300431].

Chronic low back pain is prevalent among older adults, who are at a higher risk for sarcopenia. The waist-to-calf circumference ratio has emerged as a health indicator, reflecting the balance between central adiposity and muscle mass. This study examined the association between waist-to-calf circumference ratio and sarcopenia, as well as factors like muscle mass, strength, and physical performance in older patients with chronic low back pain. Ambulatory patients aged 65 years and older with chronic low back pain were included. Sarcopenia was assessed using the 2019 diagnostic criteria from the Asian Working Group for Sarcopenia. We compared demographic data, pain-related factors, comorbidities, and measurements related to sarcopenia and obesity across quartiles of the waist-to-calf circumference ratio. The prevalence of sarcopenia and severe sarcopenia was investigated, and multivariable analysis was conducted to identify independent factors associated with sarcopenia. Among 592 patients, 85had sarcopenia (14.3%), and 71had severe sarcopenia (11.9%). Patients with a high waist-calf circumference ratio had more comorbidities and longer pain duration. The prevalence of severe sarcopenia increased with higher quartile of waist-calf circumference ratio (Q1=7.9%, Q2=8.6%, Q3=14.8%, Q4=16.9%, P=0.006). When recommended cut-off values for the parameters used to diagnose sarcopenia were applied, the numbers of patients with low grip strength and low physical performance but not low muscle mass were greater among patients with a high waist-calf circumference ratio. Also, a high waist-calf circumference ratio was significantly associated with severe sarcopenia. In older patients with chronic low back pain, a high waist-calf circumference ratio was associated with severe sarcopenia, characterized by reduced muscle strength and impaired physical performance. The waist-calf circumference ratio might serve as a useful tool for assessing sarcopenia in this population.

ObjectiveTo examine the sarcopenia risk factors and the association between metformin use and sarcopenia in female patients with Type 2 diabetes mellitus (T2DM) through a cross-sectional analysis of data from the UK Biobank.MethodsIn a cross-sectional analysis of 7,731 women with T2DM from the UK Biobank, participants were categorized into nonsarcopenia, probable sarcopenia, and sarcopenia groups based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. Logistic regression models were employed to investigate the association between metformin use and sarcopenia, adjusting for age, education, physical activity, and comorbidities.ResultsThe prevalence of probable sarcopenia and sarcopenia was 16.2% and 3.4%, respectively, with rates increasing with age. Metformin use was significantly associated with a higher risk of sarcopenia (adjusted OR 1.13; 95% CI 1.01–1.26). This association remained consistent across various subgroups, including different age ranges and levels of physical activity.ConclusionMetformin use was cross-sectionally associated with higher odds of sarcopenia, particularly in older women with low physical activity and comorbidities. These findings highlight the need for further longitudinal and mechanistic studies to confirm the relationship and explore potential underlying mechanisms.

BackgroundSarcopenia, defined as a loss of muscle mass, has become a major health problem in older people. Few prospective studies report the incidence and risk of sarcopenia. Therefore, this study aimed to explore the prevalence of sarcopenia at the baseline and follow-up after 2 years in community-dwelling older Thai individuals.MethodsIn 2019, 330 older people were recruited from a community-dwelling population, and these participants were requested to present again in 2021. Sarcopenia was diagnosed using the criteria for the Asia Working Group for Sarcopenia (AWGS). All participants were asked to perform a 6-meter walk test, handgrip strength test, and bioelectric impedance assessment, and complete the Global Physical Activity Questionnaire.ResultsThe study found that the prevalence of sarcopenia was 65 (19.70%) in 330 older people in 2019, and 44 of 205 participants (21.46%) were reported to have sarcopenia after 2 years. The incidence of sarcopenia was noted to be 2.44% in 2021. Analysis with ANOVA and pairwise comparisons showed that the reversibility of sarcopenia was attributed to high level of physical activity in the 2-year follow-up group (p = 0.014, 95% CI [−1753.25–−195.49]). Further, participants with moderate and high physical activity had a reduced incidence of sarcopenia (odds ratio = 9.00 and 14.47, respectively). Therefore, low physical activity in older people led to the development of sarcopenia from the baseline to the 2-year follow-up, indicating that increased physical activity may be useful in reversing sarcopenia, as suggested in the 2-year follow-up study. Low physical activity could be a risk factor for the incidence of sarcopenia. Hence, the prevention of sarcopenia could promote health improvement through moderate to high physical activity.

Associations of nutritional intake and inflammatory factors with sarcopenia in community-dwelling older adults: a cross-sectional study.

Sarcopenia, characterized by loss of skeletal muscle mass and function, is a highly prevalent yet often overlooked condition in patients with gastrointestinal (GI) cancers. Emerging evidence suggests that sarcopenia is a significant predictor of poor prognosis across various stages of GI cancers. Among surgical candidates, preoperative sarcopenia is consistently associated with higher rates of postoperative complications, longer hospital stays, and lower recurrence-free and overall survival rates. Among patients receiving neoadjuvant, adjuvant, or palliative chemotherapy, sarcopenia is associated with increased treatment-related toxicity, reduced adherence to treatment, impaired quality of life, and shorter survival. These findings suggest that sarcopenia is a modifiable risk factor that can critically influence the clinical trajectory of GI cancer patients; i.e., it is not merely a comorbidity. Early detection of sarcopenia through imaging or functional assessment before cancer treatment allows for risk stratification and implementation of targeted interventions such as nutritional optimization and personalized exercise programs. As a primary strategy, the optimal management of sarcopenia in GI cancer patients should combine nutritional and exercise interventions. Pharmacologic therapy, such as anamorelin, may be considered for refractory cachexia accompanied by significant anorexia. Early and sustained multidisciplinary intervention involving collaboration among oncologists, dietitians, physiotherapists, and other specialists is crucial for improving outcomes, enhancing treatment tolerance, and ultimately prolonging survival. This review summarizes the current understanding of sarcopenia in GI cancers, highlights its clinical impact across different treatment settings, and discusses strategies for assessment and integrated management. Addressing sarcopenia is an essential component of personalized cancer care in GI oncology.

(1) Background: Sarcopenia has gained much interest in recent years due to an increase in morbidity. Sarcopenia is associated with type 2 diabetes mellitus (T2DM) and vice versa. There is a paucity of information regarding the prevalence and predictors of sarcopenia among T2DM individuals. The aim of the present study was to determine the prevalence and predictors of sarcopenia among T2DM individuals. (2) Methods: This study included 159 diabetics (cases) and 79 non-diabetics (controls) aged >50 years. The subjects were assessed for demographic and anthropometric parameters. Sarcopenia (according to the Asian Working Group for Sarcopenia 2019 criteria) was assessed using Jammer’s hydraulic dynamometer for handgrip strength, dual-energy X-ray absorptiometry for muscle mass, and 6m gait speed. The biochemical investigations included glycated hemoglobin; fasting and prandial glucose; fasting insulin; lipid, renal, liver, and thyroid profiles; serum calcium; phosphorous; vitamin D; and parathyroid hormone (PTH). Appropriate statistical methods were used to determine the significance of each parameter, and a multivariate regression analysis was applied to determine the predictors. (3) Results: The prevalence of sarcopenia was significantly higher among the cases than the controls (22.5% vs. 8.86%, p—0.012). Body mass index (BMI) (OR—0.019, CI—0.001–0.248), physical activity (OR—0.45, CI—0.004–0.475), serum calcium levels (OR—0.155, CI—0.035–0.687), hypertension (OR—8.739, CI—1.913–39.922), and neuropathy (OR—5.57, CI—1.258–24.661) were significantly associated with sarcopenia following multivariate regression analysis. (4) Conclusions: T2DM individuals are prone to sarcopenia, especially those with a low BMI, low physical activity, hypertension, neuropathy, and low serum calcium levels. Hence, by modifying these risk factors among the elderly T2DM, sarcopenia can be prevented.

Introduction: Low serum albumin is a marker of protein malnutrition and is commonly associated with worse outcomes in various clinical settings. Furthermore, significant overlap exists between malnutrition and sarcopenia, which can be an independent predictor of worse outcomes. Hypothesis: We assessed the hypothesis that the presence of sarcopenia with low albumin (SLA) would lead to synergistically worse outcomes in patients with acute decompensated heart failure (ADHF). Methods: Patients hospitalized for ADHF from 2017 to 2019 with computed tomography of the abdomen/pelvis within 30 days and albumin level within 24 hours before discharge were studied (n=181). Given the high prevalence of hypoalbuminemia, low albumin was defined as the lower fiftieth percentile. Semi-automatic measurements of skeletal muscle area were made at L3 (Figure 1A) and adjusted using height squared to obtain skeletal muscle index (SMI). Sarcopenia was defined as the lowest sex-stratified SMI tertile. Results: The prevalence of sarcopenia alone was 11.6%, low albumin alone 28.7%, and SLA 20.4%. The groups had similar demographics but differed in BMI (lowest in sarcopenia alone, p<0.001) and admission NT-proBNP (highest in SLA, p=0.029). Patients with SLA were discharged to facilities most often (55.2%, p<0.001). All-cause mortality differed among the groups (p<0.001) during a median follow-up of 23.4 (4.2-45.0) months (Figure 1B). Compared to controls, those with SLA were at the highest risk (HR 2.46, 95%CI 1.50-4.02, p<0.001), followed by patients with low albumin alone (HR 1.77, 95%CI 1.11-2.83, p=0.016) or sarcopenia alone (HR 1.73, 95%CI 0.93-3.20, p=0.082), the latter not reaching significance. Conclusions: In conclusion, sarcopenia with low serum albumin is associated with higher mortality. Available resources and interventions should be utilized during ADHF hospitalization to optimize nutrition for these patients.

Purpose: In view of high cancer-specificity, DNA methylation alterations have emerged as front-runners in biomarker development, especially as cell-free DNA (cf-DNA) biomarkers for early detection of cancer. However, much effort to date has focused on developing cancer type-specific biomarkers, but have not explored the possibility of developing a pan-cancer diagnostic assay. In this context, gastrointestinal (GI) cancers, including colorectal (CRC), esophageal squamous cell and adenocarcinoma (ESCC and EAC), gastric (GC), liver (HCC) and pancreatic ductal adenocarcinoma (PDAC) constitute the second leading cause of cancer-related deaths worldwide; yet there is no blood-based assay for the early detection and population screening of GI cancers. Here we undertook a genomewide DNA methylation analysis for multiple GI cancers, followed by development of a novel cf-DNA methylation biomarker panels for the early detection of GI cancers (EpiPanGI Dx). Experimental design: By analyzing the DNA methylation data from 1940 tumor and adjacent normal tissues from TCGA and GSE72872 datasets, we first identified the differentially methylated regions (DMRs) between individual GI cancers and adjacent normal tissues, as well as across all GI cancers. We next prioritized a list of DMRs encompassing a 25.6 Mb genomic region by incorporating all identified DMRs across various GI cancers to design a custom SeqCap Epi, targeted bisulfite sequencing platform, optimized for analysis of low-abundance cf-DNA derived from plasma specimens. Using this approach, we sequenced 300 plasma specimens from all GI cancers, as well as age-matched healthy controls, with a 40X coverage. Finally, using machine learning algorithms, we identified unique DMR panels for the detection of various GI cancers. Results: Methylation profiling data from various GI tissues led to the identification of 67,832 DMRs with an adjusted p<0.001 and a delta beta value of 0.2, in all the comparisons across all GI cancers. Subsequent investigation of these tissue-specific DMRs in 300 cf-DNA specimens using our custom SeqCap panel led to the development of three distinct categories of DMR panels: 1) Cancer-specific biomarker panels with an AUC values of 0.98 (CRC), 0.94 (ESCC), 0.90 (EAC), 0.90 (GC), 0.98 (HCC), and 0.85 (PDAC); 2) A pan-GI biomarker panel that detected all GI cancers with an AUC of 0.90; and 3) A multi-cancer prediction panel, EpiPanGI Dx, with a prediction accuracy around 0.85 for most GI cancers. All three groups of DMR panels when trained and tested in the cf-DNA cohorts achieved excellent diagnostic accuracy with AUC values ranging from 0.74-0.98, even for each of the early-stage GI cancers. Conclusions: Utilizing a novel biomarker discovery approach, we provide first evidence for cell-free DNA methylation biomarkers that offer a robust diagnostic accuracy for the identification of specific cancer types, and demonstrate their potential clinical application as a Pan-cancer panel for the early detection of all gastrointestinal cancers. Citation Format: Raju Kandimalla, Jianfeng Xu, Alexander Link, Takatoshi Matsuyama, Kensuke Yamamura, Iqbal Parker, Hiroyuki Uetake, Eva Hernandez-Illan, Juanjo Lozano, Erkut Borazanci, Susan Tsai, Douglas Evans, Stephen J. Meltzer, Hideo Baba, Randall Brand, Daniel Von Hoff, Francesc Balaguer, Wei Li, Ajay Goel. EpiPanGI-Dx: A cell-free DNA methylation fingerprint for the early detection of gastrointestinal cancers [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1084.

Patients undergoing maintenance hemodialysis dialysis (MHD) are at high risk of sarcopenia. Diagnosing sarcopenia requires measurement of both muscle mass and muscle function. However, few studies have rigorously evaluated the best timing for assessment. This study aimed to evaluate the changes in body composition following hemodialysis in an Asian population. Overall, 87 MHD patients were included. Body composition was estimated using bioelectrical impedance analysis. Handgrip strength was measured using a quantitative handgrip dynamometer, and physical performance was assessed using the 6-m usual gait speed. All measurements were performed pre and post dialysis. Blood samples were collected before and after the same dialysis session. The prevalence of sarcopenia ranged from 6.9% to 18.8% pre dialysis (40-59-year group, 6.9%; 60-80-year group, 16.7%; >80-year group, 18.8%) and from 13.8% to 62.5% post dialysis. The body weight decreased from 59.32 ± 11.20 kg pre dialysis to 57.71 ± 11.05 kg post dialysis. Both the extracellular and intracellular water levels decreased post dialysis (from 14.70 ± 3.81 to 13.6 ± 2.82 L, P < 0.001, and from 21.30 ± 4.20 to 20.8 ± 4.13 L, P < 0.001, respectively). Albumin and creatinine levels were significantly lower in patients with sarcopenia. Elevated high-sensitivity C-reactive protein and interleukin-6 levels were observed in sarcopenia patients. The prevalence of sarcopenia in MHD patients varies greatly according to the timing of measurements. Although predialysis measurement is preferred, it underestimates the prevalence of sarcopenia in MHD patients.