M2 In Men Research Articles

Prognostic significance of nutritional markers in metastatic gastric and esophageal adenocarcinoma.

BackgroundMalnutrition and sarcopenia are poor prognostic factors in many cancers. Studies in gastric and esophageal (GE) cancer have focused on curative intent patients. This study aims to evaluate the prognostic utility of malnutrition and sarcopenia in de novo metastatic GE adenocarcinoma.MethodsPatients with de novo metastatic GE adenocarcinoma seen at the Princess Margaret Cancer Centre from 2010 to 2016 with an available pre‐treatment abdominal computed tomography (CT) were included. Malnutrition was defined as nutritional risk index (NRI) <97.5. Skeletal muscle index (SMI) was measured at the L3 level (sarcopenia defined as SMI <34.4 cm2/m2 in women and <45.4 cm2/m2 in men). Patients receiving chemotherapy had NRI and SMI recalculated at the time of first restaging CT.ResultsOf 175 consecutive patients, 33% were malnourished and 39% were sarcopenic at baseline. Patients with pretreatment malnourishment had significantly shorter overall survival (OS; 5.8 vs. 10.9 months, p = 0.000475). Patients who became malnourished during chemotherapy had worse OS compared to those who maintained their nutrition (12.2 vs. 17.5 months p = 0.0484). On univariable analysis, ECOG (p < 0.001), number of metastatic sites (p = 0.029) and NRI (p < 0.001) were significant prognostic factors while BMI (p = 0.57) and sarcopenia (p = 0.19) were not. On multivariable analysis, ECOG (p < 0.001), baseline NRI (p = 0.025), and change in NRI during treatment (p < 0.001) were significant poor prognostic factors for OS.ConclusionsIn de novo metastatic GE adenocarcinoma patients, ECOG, pretreatment NRI and change in NRI were significant prognostic factors for OS while sarcopenia was not. Use of NRI at baseline and during treatment can provide useful prognostic information.

Use of Skeletal Muscle Index as a Predictor of Wait-List Mortality in Patients With End-Stage Liver Disease.

The aim of this study is to validate a proposed definition of sarcopenia in predicting wait-list mortality. We retrospectively evaluated 355 adults (age ≥18 years) with cirrhosis listed for first-time LT from January 1, 2010, to April 1, 2018 from our center. Demographic, laboratory, and outcome data were collected in conjunction with computed tomography scans performed within 3months of listing. Using imaging analysis software, the skeletal muscle index (SMI), which is a marker for sarcopenia-related mortality, was calculated. A survival analysis was performed to evaluate the association of the proposed sarcopenia definition of SMI<50cm2 /m2 for men or <39cm2 /m2 for women with wait-list mortality or delisting. Median SMI was 54.1cm2 /m2 (range, 47-60cm2 /m2 ). A total of 61 (17.2%) patients exhibited sarcopenia according to the proposed threshold, and 24.6% (57/232) of men were sarcopenic compared with 3.3% (4/123) of women (P<0.001). Mean (standard deviation [SD]) SMI was also higher for men (56.6±9.6 cm2 /m2 ) than for women (50.7±8.0 cm2 /m2 ; P<0.001). Median follow-up time among patients was 2.1 months (0-12 months), and 30 events were observed (hazard ratio, 0.98; 95% confidence interval, 0.95-1.02; P=0.41). There was no statistically significant difference in time on the waiting list between patients with and without sarcopenia (P=0.89) as defined at the threshold. Using the prespecified definitions of sarcopenia based on SMI, there was no statistically significant difference in mortality and delisting from the transplant waiting list between patients with and without sarcopenia in this population. Practice and region-specific patterns for pretransplant selection and median Model for End-Stage Liver Disease at transplant may affect SMI as a predictor of wait-list mortality.

Bisphosphonate utilization across the spectrum of eGFR.

Osteoporosis is common in patients with chronic kidney disease (CKD). Bisphosphonates (BSP) are the most common treatment but there are concerns regarding its efficacy and toxicity in CKD. We evaluated the frequency of BSP use by level of estimated glomerular filtration rate (eGFR) in patients with osteoporosis. We assessed BSP use in patients with incident osteoporosis from the SCREAM-Cohort, Stockholm-Sweden, and Geisinger Healthcare, PA, USA. Osteoporosis was defined as the first encountered ICD diagnosis, and BSP use was defined as the dispensation or prescription of any BSP from 6months prior to 3years after the diagnosis. Multinomial logistic regression was used to account for the competing risk of death. A total of 15,719 women and 3011 men in SCREAM and 17,325 women and 3568 men in Geisinger with incident osteoporosis were included. Overall, 56% of individuals used BSP in both studies, with a higher proportion in women. After adjustments, the odds of BSP was lower across lower eGFR in SCREAM, ranging from 0.90 (0.81-0.99) for eGFR 75-89mL/min/1.73m2 to 0.56 (0.46-0.68) for eGFR 30-44mL/min/1.73m2 in women and from 0.72 (0.54-0.97) for eGFR of 60-74 to 0.42 (0.25-0.70) for eGFR 30-44mL/min/1.73m2 in men. In Geisinger, odds were lower for eGFR < 30mL/min/1.73m2 in both sexes and the frequency of BSP use dropped over time. In the two healthcare systems, approximately half of the people diagnosed with osteoporosis received BSP. Practices of prescription in relation to eGFR varied, but those with lower eGFR were less likely to receive BSP.

Analysis of the optimal psoas muscle mass index cut-off values, as measured by computed tomography, for the diagnosis of loss of skeletal muscle mass in Japanese people.

We evaluated PMI in two groups of normal controls: a medical check-up group and a liver donation candidate group. We analyzed two novel PMI cut-off values, one based on the mean -two standard deviations (2SD) and one based on the lower 5%. Skeletal muscle mass index (SMI) evaluations using computed tomography (sliceOmatic; TomoVision) and bioelectrical impedance analysis and PMI evaluation were undertaken simultaneously. We analyzed the correlation between our PMI cut-off values and the Japan Society of Hepatology-defined SMI cut-off values. The prevalence of skeletal muscle mass loss in patients with liver disease was assessed using the novel PMI cut-off values. In 504 normal controls aged ≤50years, the PMI cut-off values based on mean -2SD and the lower 5% were set at 3.30cm2 /m2 for men and 1.69cm2 /m2 for women and 3.74cm2 /m2 for men and 2.29cm2 /m2 for women, respectively. The PMI cut-off values based on the lower 5% alone showed that skeletal muscle mass loss increased with age. Furthermore, they correlated well with Japan Society of Hepatology-defined SMI (sliceOmatic) cut-off values and showed a significantly higher prevalence of skeletal muscle mass loss in patients with liver cirrhosis than those without liver cirrhosis. We propose the following PMI cut-off values: 3.74cm2 /m2 for male individuals and 2.29cm2 /m2 for female individuals. These cut-off values can facilitate accurate diagnosis and management of sarcopenia in patients with chronic liver disease.

Middle-aged adults with knee osteoarthritis present worse sarcopenia parameters, symptoms and functional performance

Purpose: Osteoarthritis (OA) is the most common joint dysfunction in individuals from 40 years of age, presenting, among its characteristics, inflammation and degeneration caused by the destruction of articular cartilage, being the knee one of the most affected joints. In addition to OA, sarcopenia is another chronic health dysfunction, characterized by degenerative loss of skeletal muscle mass, quality, and strength associated with aging and immobility. Although there is still no evidence of a direct effect of sarcopenia on OA development nor the opposite relation, both musculoskeletal disorders may lead to common functional consequences. However, it is still unknown whether middle-aged adults with knee OA have a higher risk of developing sarcopenia in association with symptoms and functional impairment. Thus, the aim of this study was to evaluate sarcopenia parameters in middle-aged adults with knee OA (OA group - OAG) compared to non-knee OA individuals (control group-CG), as well as their clinical and functional parameters. Methods: Participants aged between 40 and 65 years old and BMI <35Kg/m2were included in this study. Individuals with knee OA, diagnosed and classified as grades 2 and 3 by the Kellgren & Lawrence (K&L) criteria were included in the OAG and individuals with K&L 0 and 1 were included in the CG. The European Working Group on Sarcopenia in Older People (EWGSOP) criteria was used for the diagnosis and classification of sarcopenia parameters. Three evaluation criteria were measured: appendicular skeletal muscle mass (ASM), muscle strength, and physical performance. For the evaluation of muscle mass, the Dual-energy X-ray absorptiometry (DXA) (Discovery A - Hologic) was used. Cutoff points of 7.26 kg / m2 for men and 5.5 kg / m2 for women were established. The skeletal muscle mass values extracted from DXA were described from the formula: ASM/height2(kg/m2). To evaluate the muscle strength, the Jamar handgrip dynamometer was used. Cutoff points of 30 kg for men and 20 kg for women were established. Physical performance was measured using the 40-meter Fast-paced Walk Test to obtain gait speed measured in m/s. The established cutoff point was 1m/s. In addition, the performance-based tests 30-seconds chair test and Stair climb test were also performed to evaluate the participants’ functional capacity, according to OARSI recommendations. The Western Ontario and McMaster Universities (WOMAC) questionnaire was used to evaluate participants’ clinical symptoms. For comparison between groups, the unpaired t-test was applied to each of the dependent variables. For all analyzes, a significance level of 0.05 (p<0.05) was adopted. Results: 40 participants were evaluated in this study. No statistically significant differences were observed between the groups in the participants' characteristics (age, weight, height and BMI - p>0.05). OAG presented statistically significant worse values in sarcopenia parameters than CG group, presenting lower ASM (p=0.041), worse performance on 40-meter Fast-paced Walk Test (p=0.020) and lower right (p<0.01) and left (p<0.01) handgrip strength. In addition, as expected, OAG participants had statistically significant higher scores for pain, stiffness, physical function, and total scores for the WOMAC questionnaire (p <0.001 for all domains) and lower functional performance in the 30s Chair Stand Test. (p = 0.001) and Stair climb test (p <0.001). Conclusions: In addition to worse symptoms and functional performance, middle-aged adults with knee OA have worse sarcopenia parameters than non-knee OA individuals. This may indicate that sarcopenia may be present early in these patients, so treatment and prevention strategies should also focus on these parameters.

Relationship of Age With the Hemodynamic Parameters in Individuals With Elevated Blood Pressure.

Age is known to be associated with the prevalence and pathophysiology of hypertension. However, there is little information on whether age stands as a good proxy for the specific hemodynamic profile of an individual with elevated blood pressure (BP), which could be important in the selection of therapy. This is a cross-sectional study. People who underwent a noninvasive, hemodynamic assessment using impedance cardiography at 51 sites of iKang Health Checkup Centers throughout China between January 2012 and October 2018. We included 116,851 individuals, aged 20 to 80 years. Relationship between age and hemodynamic parameters (cardiac index, systemic vascular resistance index [SVRI]), among individuals with elevated BP (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg). Final study population included 45,082 individuals with elevated BP: 29,194 men and 15,888 women with a mean (±SD) age of 48 (±13) and 54 (±12) years, respectively. Cardiac index was negatively associated with age with an adjusted, per decade decrease of 0.17 (95% confidence interval [CI] = 0.17-0.18) L/min/m2 in men and 0.24 (95% CI = 0.23-0.25) L/min/m2 in women. SVRI was positively associated with age with an adjusted, per-decade increase of 174.2 (95% CI = 168.8-179.7) dynes·s·cm-5 ·m2 in men and 214.1 (95% CI = 204.3-223.8) dynes·s·cm-5 ·m2 in women. However, there was substantial overlap in the distribution of these parameters across different age groups in both sexes. In this large study, we observed that cardiac index decreased and SVRI increased with age among individuals with elevated BP. Even though there was a general trend with age, we observed heterogeneity within age strata, suggesting that age alone is inadequate to indicate the hemodynamic profile for an individual. J Am Geriatr Soc 68:1520-1528, 2020.

Sarcopenia is associated with worse overall survival in patients with anal squamous cell cancer

Sarcopenia is associated with poor long-term outcomes in many gastrointestinal cancers, but its role in anal squamous cell carcinoma (ASCC) is not defined. We hypothesized that patients with sarcopenic ASCC experience worse long-term outcomes. A retrospective review of patients with ASCC treated at an academic medical center from 2006 to 2017 was performed. Of 104 patients with ASCC, 64 underwent PET/computed tomography before chemoradiation and were included in the analysis. The skeletal muscle index was calculated as total L3 skeletal muscle divided by height squared. Sarcopenia thresholds were 52.4 cm2 /m2 for men and 38.5 cm2 /m2 for women. Cox regression analysis was performed to assess overall and progression-free survival. Twenty-five percent of the patients were sarcopenic (n = 16). Demographics were similar between groups. There was no difference in the clinical stage or comorbidities between groups. On multivariate analysis, factors associated with worse overall survival were male gender (hazard ratio [HR] 3.7, P = .022) and sarcopenia (HR 3.6, P = .019). Male gender was associated with worse progression-free survival (HR 2.6, P = .016). Sarcopenia is associated with worse overall survival in patients with anal cancer. Further studies are indicated to determine if survival can be improved with increased attention to nutritional status in sarcopenic patients.

Preoperative skeletal muscle index predicts postoperative supplemental nutrition needs in patients undergoing pancreatoduodenectomy

Presenter: Andrew DeAtkine | University of Alabama - Birmingham Background: Significant loss of skeletal muscle mass, or sarcopenia, is a common sequela of pancreatic cancer. Sarcopenic patients often exhibit decreased overall survival and major postoperative complications following pancreatoduodenectomy (PD). Few studies have investigated postoperative nutritional requirements for sarcopenic patients compared to non-sarcopenic patients following PD. We hypothesized that preoperative skeletal muscle index (SMI) may predict postoperative supplemental nutrition needs in patients undergoing PD. Methods: A retrospective review of all patients with preoperative CT imaging within 3 weeks of an elective PD from 2013 to March 2019 were identified by billing codes. The skeletal muscle area was measured at the third lumbar vertebra (L3) on CT imaging and indexed to patient height to calculate SMI. Sarcopenia was based on gender-specific cutoffs of SMI (≤52.4 cm2 /m2 in men and ≤38.5 cm2 /m2 in women). Results: We identified 159 patients in the study period undergoing PD with appropriate imaging for analysis. Median SMI of males (n=71) was 49.6 cm2 /m2 and females (n=88) was 37.2 cm2 /m2. The median SMI of female patients who required tube feeds at discharge (dTF) compared to females who did not was lower (32.0 [IQR 28.4-36.8] vs. 38.2 [IQR 34.7-45.7] cm2 /m2; p= 0.019). The median SMI of male patients who required dTF compared to patients who did not was also lower (42.9 [IQR 38.5-50.0] vs. 51.0 [IQR 45.3-56.4] cm2 /m2; p= 0.023). Receiver operating characteristic (ROC) curve analysis suggested SMI may be used to predict dTF for both females (AUC = 0.748) and males (AUC = 0.702). Youden’s index analysis of these curves suggested a SMI cut-off of ≤32.5 cm2/m2 for females and ≤42.9 cm2/m2 for males as prognostic of dTF. Standard cutoffs for sarcopenia did not show a significant association with dTF by univariate logistic regression; however, the above proposed SMI cutoffs did correlate with dTF for both female (OR: 6.76, 95%CI 1.08-42.88) and male (OR: 4.54, 95%CI 1.01-20.45) patient populations. Conclusion: A significant association exists between very low SMI and postoperative enteral nutrition requirements, suggesting that the patients with severe sarcopenia undergoing PD may benefit from the placement of a feeding tube at the time of resection.

Trajectories of kidney function and associated factors among community-dwelling older Japanese: a 16-year longitudinal study.

No study has reported trajectories of kidney function in later life. This long-term prospective study attempted to classify trajectories of estimated glomerular filtration rate (eGFR) and identify factors associated with these trajectories. We collected data from annual geriatric health checkups conducted during 2002-2017 in Kusatsu Town, Gunma Prefecture, Japan. The participants were 1990 adults aged 65-90years (mean [SD] age, 71.0 [5.7] years; 57.0% women), and the total number of observations was 9291. Data were analyzed with a group-based semiparametric mixture model and age-adjusted univariable cumulative logit models. Trajectory of kidney function, as determined by eGFR, was classified as low, middle, and high (4.8%, 38.9%, and 56.3% of men, respectively, and 5.2%, 31.5%, and 63.3% of women). Among men and women in the low trajectory group, chronic kidney disease (CKD) stage worsened from stage G3a (51.8ml/min/1.73 m2 in men and 53.6 in women) at age 65years to stage G4 (28.0ml/min/1.73 m2 in men and 28.5 in women) by age 85years. A history of hypertension (men and women) and heart disease (men) were more likely in the low trajectory group than in the middle and high trajectory groups. About 5% of community-dwelling older adults had an eGFR < 30 later in life. Our findings suggest that those with stage G3a CKD at age 65years should be managed intensively, to control risk factors for CKD progression.

Lefkoşa’da Yaşayan Yetişkin Bireylerin Beslenme Alışkanlıkları ve Beslenme Durumlarının Saptanması

Amaç: Bu çalışma, Lefkoşa’da yaşayan yetişkin bireylerin beslenme alışkanlıkları ve beslenme durumlarının saptanması amacıyla yapılmıştır.&#x0D; Bireyler ve Yöntem: Çalışma 1550 yetişkin birey ile yapılmıştır. Sosyodemografik özellikleri belirlemek için 26 sorudan oluşan bir anket formu yüz yüze görüşme yöntemi ile uygulanmıştır. Bireylerin antropometrik ölçümleri alınmış, besin tüketim kayıtları24 saatlik geriye dönük hatırlatma yöntemi kullanılarak kaydedilmiştir.&#x0D; Bulgular: Yaş ortalaması 34.9±13.66 yıl olan bireylerin %47.3’ü kadın %52.7’si erkektir. Beden kütle indeksi (BKİ) kadınlarda 24.9±5.40 kg/m2 ve erkeklerde ise 25.3±4.11 kg/m2’dir. BKİ sınıflamasına göre kadınların %44.1’i, erkeklerin %50.6’sı hafif şişman ve obezdir. Obezite ile birlikte kronik hastalık görülme sıklığının artığı (p&lt;0.001), eğitim düzeyi yüksek olanlarda ise obezite sıklığının azaldığı belirlenmiştir (p&lt;0.05). Cinsiyete göre bel çevresi ölçümü kadınlarda 83.4±16.64 cm, erkeklerde ise 90.3±13.38 cm’dir. Kadınların %37.9’unun erkeklerin %18.1’nin yüksek riskli grupta yer aldığı belirlenmiştir (p&lt;0.001). Riskli ve yüksek riskli bel/boy oranına sahip kadınların sıklığı %50.2, erkeklerin ise %53.0 olarak bulunmuştur. Kadınların %51.8’inin diyetle karbonhidrat alımları önerilerin altında iken erkeklerde bu sıklık %49.6’dır. Enerjinin yağdan gelen oranı ise kadınlarda %58.9, erkeklerde %51.9 ile önerilerin üzerinde olduğu belirlenmiştir.&#x0D; Sonuç: Bu araştırma, Lefkoşa bölgesinde toplumun sağlığının korunması ve geliştirilmesi için bireylerin yeterli ve dengeli beslenmeleri hususunda beslenme eğitimine ihtiyaç olduğuna ışık tutmaktadır.

Prognostic and predictive implications of sarcopenia in Western patients undergoing gastric resections for carcinoma of the stomach.

Sarcopenia is highly prevalent in patients with gastrointestinal malignancies, including gastric cancer, but there is a lack of adequate data from Western populations. Computed tomography scans of 138 Caucasian patients subject to stomach resections due to gastric adenocarcinoma between 2012 and 2015 were reviewed to evaluate the impact of sarcopenia. The definition of sarcopenia was based on the lumbar skeletal muscle index (SMI) using cut-off values formulated by the international consensus definitions of sarcopenia (SMI <52.4 cm2 /m2 for men and <38.5 cm2 /m2 for women). Sixty (43%) of 138 patients were sarcopenic. Sarcopenia was associated with postoperative morbidity (43% vs 23%; P = .011), major postoperative complications (Clavien-Dindo ≥3a; 36% vs 21%; P = .035), and reoperations (23% vs 9%; P = .020). Patients with sarcopenia also had prolonged postoperative hospital stay (8.0 vs 6.5 days; P = .010). The overall median survival of patients with sarcopenia was significantly lower than those with normal skeletal muscles (11.0 vs 36.7 months; P = .005) and sarcopenia remained an independent prognostic factor with an odds ratio of 1.94 (95% confidence interval, 1.08 to 3.48; P = .026). Sarcopenia, defined by SMI, is associated with an increased risk of postoperative morbidity and impaired long-term survival.

Skeletal muscle volume loss during transarterial chemoembolization predicts poor prognosis in patients with hepatocellular carcinoma.

Sarcopenia has a negative impact on the prognosis of patients with hepatocellular carcinoma (HCC). We investigated the significance of skeletal muscle volume and its changes in HCC patients receiving transarterial chemoembolization (TACE). We retrospectively analyzed 179 HCC patients receiving TACE from 2006 to 2017. Skeletal mass index was calculated as the left-right sum of the major × minor axis of the psoas muscle at the third lumbar vertebra, divided by height squared (psoas muscle index [PMI]). Patients were classified into two groups (low and normal PMI) depending on an index <6.0 and <3.4cm2 /m2 for men and women, respectively. We assessed overall survival (OS) and TACE period (between the first TACE [Pre] and the time of TACE refractoriness [Post]). Changes in PMI per month during the TACE period (CPMI; (PMI [Pre] - PMI [Post])/TACE period) were calculated as an index of progressive muscle atrophy. There were no significant differences in OS between groups with low and normal PMI at Pre. Multivariate analysis showed that CPMI was significantly associated with poor OS (hazard ratio, 1.884; P= 0.001). Patients with severe muscle atrophy (CPMI above the upper quartile) had a significantly lower OS than those with mild muscle atrophy (CPMI below the upper quartile). Compared with patients with mild muscle atrophy, patients with severe muscle atrophy had a significant loss of liver function reserves at Post. Progressive loss of skeletal muscle volume is an important predictor of poor prognosis in HCC patients treated with TACE.

Abdominal skeletal muscle mass as a predictor of mortality in Japanese patients undergoing left ventricular assist device implantation.

AimsWe assessed preoperative muscle wasting in patients undergoing left ventricular assist device (LVAD) implantations using abdominal skeletal muscle images on computed tomography (CT) and explored the associations between the preoperative muscle wasting and clinical outcomes after LVAD implantation.Methods and resultsWe retrospectively examined the records of 111 patients who underwent continuous‐flow LVAD implantations as bridge‐to‐transplant therapy from January 2010 to December 2016 at our institution. After 33 patients were excluded, the study cohort consisted of 78 individuals. CT images used to calculate the skeletal muscle index (SMI) at the third lumbar vertebra level were obtained before the LVAD implantation procedures. Patients were classified as having muscle wasting if their SMI fell into the lowest gender‐based tertile. The median SMI for the study patients was 37.6 cm2/m2. The SMI cut‐off values for the lowest tertiles were 36.7 cm2/m2 for men and 28.2 cm2/m2 for women, resulting in 26 patients (33.3%) with muscle wasting in this study. During the mean follow‐up of 738 ± 379 days, there were 10 deaths (12.8% mortality). Seven of the 26 patients with muscle wasting (26.9%) died, and 3 of the 52 patients without muscle wasting (5.8%) died. The times to all‐cause mortality were significantly different between patients with and without muscle wasting (P = 0.0094). Muscle wasting was found to be associated with mortality in univariate and multivariate Cox analyses (hazard ratio: 4.32; 95% CI: 1.19–20.2).ConclusionsPreoperative muscle wasting was associated with a higher mortality in patients with LVAD. Assessment of the abdominal skeletal muscle area on CT prior to LVAD implantation can help predict mortality.

Analysis of computer tomographic image: skeleto-muscle index as a criterion of sarcopenia in patients with patients with patients

Aim of the study. The study of the possibility and informativeness of the detection of sarcopenia in a patient with pancreatic cancer (PC) by post-processing obtained using computed tomography (CT) images. Materials and methods. A total of 108 patients with obstructive jaundice syndrome (probably of tumor etiology, and later diagnosed with pancreas cancer) were studied using the «Activion 16» spiral tomograph (Toshiba Medical Systems Corporation) according to a common protocol. The control group consisted of 60 patients aged from 22 to 74 years. We determined sarcopenia criteria on CT images: musculoskeletal L3 index (MSI) as the ratio of the area indicator of skeletal muscle in the body to the level L3 square growth patient. The somatotype index (SI) was determined by the formula: SI = BL x 100 / TSCH, where BL is the body length, TSCH is the transverse size of the chest, measurement in centimeters. Results. Based on media values at the L3 level, sarcopenia was generally detected in 85.18 % of patients with pancreas cancer. Sarcopenia was observed in 100 % of patients with a dolichomorphic type, in 87.8 % of patients with a mesomorphic type, and in 65.5 % of patients with a brachiomorphic type of somatotype. Sarcopenia based on SMI at the L3 level is set in 85.2 % of patients with pancreas cancer: 47.8±4.3 cm² / m² for men, 36.2±4.1 cm² / m² for women, 58.4±3 6 cm² / m² and 44.2±3.5 cm² / m² for conditionally healthy men and women, respectively (p<0.01). The reliable differences of SMI according to gender were established in conditionally healthy men and women suffering from pancreatic cancer with inaccurate differences in BMI. In patients, the statistically significant difference of SMI (p = 0.001), corresponds to the various distribution of fatty mass in the body structure, was accompanied by statistical misleading differences in BMI. Findings. CT as a standard method of diagnosis of pancreatic cancer and inflammatory diseases of the pancreas by calculating the SMI allows evaluating the degree of sarcopenia. SMI is more informative and personalized indicators to assess body composition than the standard used BMI as CT allows differentiation of muscle and fat components in the composition of the human body and to quantify

Normative Data for Lean Mass Using FNIH Criteria in an Australian Setting

Recommendations from the FNIH Sarcopenia Project are that appendicular lean mass (ALM, kg) adjusted for body mass index (BMI, kg/m2) be used for identifying low lean mass, with ALM/BMI cutpoints of < 0.789m2 for men and < 0.512m2 for women. We report normative ALM/BMI values for Australian adults, and compare the performance of cutpoints derived from reference values for this population with FNIH values for identifying low lean mass. Body composition was measured by DXA (Lunar) for 1411 men and 960 women, aged 20-93 years, from the Geelong Osteoporosis Study, a population-based study in Australia. Sex-stratified means and standard deviations for DXA-derived ALM/BMI were generated for each age-decade, and cutpoints equivalent to T-scores of - 2.0 were derived using reference data for 374 men and 308 women aged 20-39years. Mean ALM/BMI values were greater for men than women, and decreased with age in both sexes. Cutpoints for ALM/BMI corresponding to T-scores of - 2.0 were 0.827m2 for men and 0.518m2 for women. For individuals aged 65+ years, cross-classification of low lean mass according to FNIH criteria (ALM/BMI < 0.789m2 men and < 0.512m2 women) in comparison with our cutpoints for ALM/BMI showed overall agreement of 94.6% for men and 99.0% for women (κ 0.73 and 0.89, respectively). We report good agreement for low ALM indexed to BMI, particularly for women, between classifications based on recommendations from the FNIH Sarcopenia Project for identifying clinically significant weakness, with low values identified within our population distribution of ALM/BMI.

A16938 factors influencing left ventricular mass in hypertensive patients

Objectives: LVH is a marker of cardiovascular risk. it is a reflection of target organ damage in hypertensive patients. our goal is to describe the left ventricular mass, and studying the influencing factors Methods: retrospective study of patients’ records for hypertension during the month of February 2018. all patients underwent cardiac ultrasound with left ventricular mass estimation. Left Ventricular Hypertrophy is considered if Left Ventricular Mass > 95 mg / m2 in women and > 113 g / m2 in men Results: 22 patients included in our series. it's about 10 women and 12 men. the average age is estimated at 60 years old. LVH is observed in 5 patients (02 women and 03 men), among them three diabetics. 3 out of 5 patients were in the age group between 50 and 60 years old. 40 % of patients with LVH have a duration of progression between 5 and 10 years, 20 % diagnosed recently, a patient < 5 years of evolution and 1 other > 10 years. Conclusion: in our series the LVH preferentially touches the subjects in the fivetiess. it can be observed at any moment of evolution, even at the time of diagnosis. the frequency peak is observed between 5 and 10 years of evolution. the man is more affected as well as the diabetic.

Poor performance of psoas muscle index for identification of patients with higher waitlist mortality risk in cirrhosis

BackgroundSarcopenia, characterized by low muscle mass, associates with mortality in patients with cirrhosis. Skeletal muscle area in a single computed tomography image at the level of the third lumbar vertebrate (L3) is a valid representative of whole body muscle mass. Controversy remains regarding applicability of psoas muscle to identify patients at greater risk of mortality. We aimed to determine psoas muscle index (PMI) association with skeletal muscle index (SMI) and to evaluate the capacity of PMI to predict liver transplant waitlist mortality.MethodsWe evaluated listed adult patients with cirrhosis from 2012 to 2013 at four North American liver transplant centres. From L3 computed tomography images within 3 months of listing, we determined SMI and PMI expressed by cm2/m2. Low SMI was defined as SMI <39 cm2/m2 in women and <50 cm2/m2 in men as published by us earlier. Cut‐offs for PMI to predict mortality were established using a receiver‐operating characteristic analysis. Mortality predictors were determined using competing‐risk analysis with reported results as subdistribution hazard ratios (sHRs).ResultsOf 353 waitlist candidates, 68% were men, mean age 56 ± 9 years, and Model for End‐stage Liver Disease of 16 ± 8 points. Low SMI was present more frequently in men than women (51 vs. 36%, P = 0.02). Moderately strong correlation between SMI and PMI was observed (r > 0.7, P < 0.001). Low PMI (males < 5.1 cm2/m2; females < 4.3 cm2/m2) yielded poor and moderate concordance with low SMI in men and women, respectively (Kappa coefficient 0.31 and 0.63). SMI (39 ± 9 vs. 43 ± 7 cm2/m2; P = 0.009) and PMI (4.4 ± 1.3 vs. 5.2 ± 1.1 cm2/m2; P = 0.001) were lower in women who died and/or were delisted (compared with non‐deceased patients) whereas men who died and/or were delisted had only lower SMI (47 ± 7 vs. 51 ± 9 cm2/m2; P = 0.003), but not PMI compared with non‐deceased patients. In women, both SMI (sHR 0.94, P = 0.048) and PMI (sHR 0.58, P = 0.002) were predictors of mortality, while in men, SMI was significant (sHR 0.95, P = 0.001) and PMI showed a trend to be (sHR 0.85, P = 0.09) associated with mortality. Overall, 104 patients (29%) were misclassified between SMI and PMI categories. Using PMI cut‐offs, 66% and 28% of low SMI men and women, who have a higher risk of mortality, were incorrectly classified as low risk.ConclusionsSkeletal muscle index is a more complete and robust measurement than PMI, especially in men with cirrhosis. Low PMI identifies an incomplete subset of patients at increased risk of mortality indicated by low SMI. Given the poor performance of PMI, SMI should not be substituted by PMI.

Clinical usefulness of psoas muscle thickness for the diagnosis of sarcopenia in patients with liver cirrhosis.

Background/AimsThe most widely used method for diagnosing sarcopenia is the skeletal muscle index (SMI). Several studies have suggested that psoas muscle thickness per height (PMTH) is also effective for detecting sarcopenia and predicting prognosis in patients with cirrhosis. The aim of this study was to evaluate the optimal cutoff values of PMTH for detecting sarcopenia in cirrhotic patients.MethodsAll cirrhotic patients who underwent abdominal computed tomography (CT) scan including L3 and umbilical levels for measuring SMI and transverse psoas muscle thickness, respectively, were included. Two definitions of sarcopenia were used: (1) sex-specific cutoffs of SMI (≤52.4 cm2 /m2 in men and ≤38.5 cm2 /m2 in women) for SMI-sarcopenia and (2) cutoff of PMTH (<16.8 mm/m) for PMTH-sarcopenia.ResultsSix hundred fifty-three patients were included. The average age was 53.6 ± 10.2 years, and 499 patients (76.4%) were men. PMTH correlated well with SMI in both men and women (P<0.001). Two hundred forty-one (36.9%) patients met the criteria for SMI-sarcopenia. The best PMTH cutoff values for predicting SMI-sarcopenia were 17.3 mm/m in men and 10.4 mm/m in women, and these were defined as sex-specific cutoffs of PMTH (SsPMTH). The previously published cutoff of PMTH was defined as sex-nonspecific cutoff of PMTH (SnPMTH). Two hundred thirty (35.2%) patients were diagnosed with SsPMTH-sarcopenia, and 280 (44.4%) patients were diagnosed with SnPMTH-sarcopenia. On a multivariate Cox regression analysis, SsPMTH-sarcopenia (hazard ratio [HR], 1.944; 95% confidence interval [CI], 1.144–3.304; P=0.014) was significantly associated with mortality, while SnPMTH-sarcopenia was not (HR, 1.446; 95% CI, 0.861–2.431; P=0.164).ConclusionsPMTH was well correlated with SMI in cirrhotic patients. SsPMTH-sarcopenia was an independent predictor of mortality in these patients and more accurately predicted mortality compared to SnPMTH-sarcopenia.

Anthropometric characteristics of top-class Olympic race walkers

Typical training programmes in elite race walkers involve high training volumes at low and moderate intensities, which have been reported to induce functional and structural adaptations at an anthropometric level. Since anthropometrical variables are closely related to movement efficiency and performance in endurance events, the aim of this study was to describe the anthropometric profile of world-class race walkers. Twenty-nine world-class race walkers (21 men and 8 women) participated in this study. Anthropometric characteristics, including height, body mass, eight skinfolds, five girths and four bone breadths were measured. Body composition, somatotype, somatotype dispersion mean, somatotype attitudinal mean and height to weight ratio, as well as skinfolds extremity to trunk ratio were also calculated. Mean height, body mass and body mass index were 177.1±7.1 cm, 66.4±5.8 kg, and 21.2±1.3 kg·m2 for men and 165.6±4.5 cm, 53.6±3.7 kg, and 19.6±1.6 kg· m2 for women, respectively. Women presented greater body fat content (6.7±0.6 vs. 12.2±0.8%; very large effect), less muscle mass (65.6±4.6 vs. 61.6±2.6 kg; large effect), and were more endomorphic (large effect) than men. Men specialists in 20-km showed greater muscle mass (66.7±4.9 vs. 64.4±4.3 kg; moderate effect), and slightly higher skinfolds, girths, body fat content and were more mesomorphic than 50-km specialists (moderate effect). The present study expands the limited knowledge on the anthropometric characteristics and somatotype elements of elite top-class race walkers. The characterisation of the morphology of elite race walkers provides coaches a reference values to control the training development of the race walker, as well as providing reference values to improve talent identification.

Pretreatment subcutaneous adipose tissue predicts the outcomes of patients with head and neck cancer receiving definitive radiation and chemoradiation in Taiwan.

We aimed to determine whether body composition assessment before treatment can predict outcomes in patients with head and neck cancer (HNC). All 881 patients with locoregional head and neck cancer treated with curative intent radiotherapy (RT) between 2005 and 2012 were retrospectively investigated. Body composition was analyzed via pre‐RT planning computed tomography (CT) images. Subcutaneous adipose tissue (SAT) and skeletal muscle (SM) indices were measured cross‐sectionally at the level of the third thoracic vertebra. Overall survival (OS), locoregional control (LRC), and distant metastasis‐free survival (MFS) were analyzed by body composition index and body mass index (BMI). Survivors were followed up for a median of 4.68 years. The SAT indices in female patients were significantly higher than those in males (P < 0.001). The median SAT and muscle indices were 18.6 and 34.3 cm2/m2 for women and 6.19 and 51.74 cm2/m2 for men, respectively. The 5‐ and 10‐year MFS, LRC, and OS rates were 83% and 82.1%, 73.4% and 71.4%, and 66.4 and 57.6%, respectively. Higher pretreatment SAT index was associated with MFS (hazard ratio [HR]: 0.65; P = 0.015), LRC (HR: 0.758; P = 0.047), and OS (HR: 0.604; P < 0.001). Higher pretreatment BMI was associated with MFS (HR: 0.642; P = 0.031) and OS (HR: 0.615; P < 0.001). The pretreatment SM index had no significant effect on MFS, LRC, and OS. Multivariate analysis revealed that T‐stage, N‐stage, lesion sites, age, and RT treatment days are independent factors associated with OS; T‐stage, N‐stage, and lesion sites are independent factors associated with MFS; and N‐stage, smoking history, and betel quid chewing history are independent factors associated with LRC. A higher CT‐assessed SAT index predicts superior MSF, LCR, and OS in patients with curative HNC, whereas SM does not predict survival or locoregional control.