Mean Skeletal Muscle Index Research Articles

Change of skeletal muscle mass in cirrhotic patients with hypersplenism after partial splenic artery embolization

PurposePartial splenic artery embolization (PSAE) is an effective procedure for cirrhotic patients with hypersplenism. The aim of our study is to evaluate the effect of PSAE on skeletal muscle, and to identify the predictor for an improvement in skeletal muscle index (SMI) in cirrhotic patients with hypersplenism after PSAE. Materials and Methods466 cirrhotic patients with hypersplenism underwent PASE between Dec 2013 and Mar 2022. Medical records and CT images of enrolled patients were analyzed. Results105 cirrhotic patients with hypersplenism were enrolled. Sarcopenia was observed in 60.00 % (63/105) of these patients, 68.25 % (43/63) of male patients, and 31.75 % (20/63) of female patients. In cirrhotic patients, no significant change in the mean SMI at the third lumbar vertebra (L3) level after PSAE. In patients with sarcopenia, the L3 SMI increased from 36.77 cm2/m2 (baseline) to 43.38 cm2/m2 (P < 0.01), the L3 subcutaneous fat area (SFA) increased from 79.16 cm2 (baseline) to 103.52 cm2 (P < 0.01) at 12-month follow-up after PSAE. In patients without sarcopenia, the L3 SMI decreased from 58.38 cm2/m2 (baseline) to 49.44 cm2/m2 (P < 0.05), the L3 SFA increased from 89.63 cm2 (baseline) to 94.77 cm2 (P > 0.05) at 12-month follow-up after PSAE. Univariate and multivariate analysis demonstrated splenic infarction rate (OR: 0.01, P = 0.0032) and SMI (OR: 0.84, P < 0.001) were independent predictors for an improvement in skeletal muscle in patients with sarcopenia. ConclusionsIn cirrhotic patients with sarcopenia, an improvement in skeletal muscle and fat mass was observed after PSAE; splenic infarction rate and the L3 SMI before PSAE predicted an improvement in skeletal muscle index in patients with sarcopenia after PSAE.

Frequency of weight and body composition increases in advanced non-small cell lung cancer patients during first line therapy.

The primary objective of this study was to assess the frequency of body composition increases and their relationships to changes in body weight in two cohorts of real world, treatment-naïve, advanced non-small cell lung cancer (NSCLC) patients. One cohort received the current standard of care (CSOC), which consisted of immunotherapy and newer chemotherapy regimens, and the other cohort was treated with the former standard of care (FSOC), consisting only of older platinum-containing regimens. CSOC (n=106) and FSOC (n=88) cohorts of advanced NSCLC patients were included in this study. Weights were collected at each clinical visit, and body composition analysis from routine chest computed tomography via automated segmentation software assessed at baseline and at 6 and 12weeks. Standard statistical methods were used to calculate relationships between changes in weight and in body composition. The CSOC cohort contained 106 stage IV NSCLC patients treated between 16/12/2014 and 22/10/2020 while the FSOC cohort contained 88 stage III/IV NSCLC patients treated between 16/6/2006 and 18/11/2014. While each cohort exhibited decreases in median weight, body mass index (BMI), mean skeletal muscle index (SMI) and subcutaneous adipose tissue index (SATI) at the 6 and 12week time points, a subset of patients experienced increases in these parameters. Using a threshold of ≥2.5% increase for weight, BMI, SMI, and SATI at the 12week time point, both cohorts showed similar (20.5% and 27.3%) increases in these parameters. With a cut point of ≥5% increase at 12weeks follow-up, 8.0% to 25.0% of the patients gained ≥5% in weight, BMI, SMI and SATI. Comparing these results in each cohort showed no significant differences. Pearson coefficients for weight change related to changes in SMI and SATI at 6 and 12weeks ranged from 0.31 to 0.58 with all P values <0.02. Pearson coefficients for weight change at 12weeks related to changes in VATI and IMATI ranged from 0.26 to 0.47 with all P values <0.05. Comparison of Pearson coefficients for each cohort showed no significant differences. Although decreases in median weight, BMI, SMI and SATI were observed in both cohorts, similar percentage of patients in each cohort experienced increases in these parameters. These findings, plus the positive correlations between longitudinal measurements of weight, muscle mass and adipose tissue, indicate that weight gain in these patients involves increases in both muscle mass and adipose tissue. Upon validation, these findings could have implications for clinical trial design and for translational research in cancer cachexia.

Feasibility and safety of exercise during chemotherapy in people with gastrointestinal cancers: a pilot study

PurposeSarcopenia is a poor prognostic factor in cancer patients, and exercise is one of the treatments to improve sarcopenia. However, there is currently insufficient evidence on whether exercise can improve sarcopenia in patients with advanced cancers. This study examined the feasibility of exercise in advanced gastrointestinal (GI) cancer patients treated with palliative chemotherapy.MethodsBetween 2020 and 2021, 30 patients were enrolled in a resistance and aerobic exercise program for six weeks. The exercise intervention program (EIP) consisted of low, moderate, and high intensity levels. Patients were asked to select the intensity level according to their ability. The primary endpoint was the feasibility of the EIP measured by compliance during the six weeks. A compliance of over 50% was considered acceptable. The secondary endpoints were changes in weight and muscle mass, safety, quality of life (QoL) and overall survival (OS).ResultsThe median age of the study’s participants was 60 (30–77). The total compliance to the EIP was 63.3% (19/30 patients). Sixteen (53.3%) patients had a compliance of over 80%. The attrition rate was 30.0% (9/30). The mean exercise time was 41.4 min, and the aerobic exercise was 92.3% and the resistant exercise was 73.7%, and both exercise was 66.5%. Most patients performed the moderate intensity level exercises at home or near their home. The mean skeletal muscle index (SMI) was 43.5 cm2/m2 pre-chemotherapy and 42.2 cm2/m2 after six weeks of chemotherapy, with a decrease of -1.2 ± 2.8 cm2/m2 (-3.0%) (p = 0.030). In the poor compliance group, the mean SMI decrease was -2.8 ± 3.0 cm2/m2 which was significantly different (p = 0.033); however, in the good compliance group, the mean SMI decrease was -0.5 ± 2.5 cm2/m2 which was maintained over the six weeks (p = 0.337). The good compliance group had a significantly longer median OS compared with the poor compliance group (25.3 months vs. 7.9 months, HR = 0.306, 95% CI = 0.120–0.784, p = 0.014). The QoL showed a better score for insomnia (p = 0.042). There were no serious adverse events.ConclusionsThe EIP during palliative chemotherapy in advanced GI cancer patients showed good compliance. In the good compliance group, muscle mass and physical functions were maintained for six weeks. The EIP was safe, and the QoL was maintained. Based on this study, further research in exercise intervention in advanced cancer patients is needed.Clinical trial registrationThe clinical trial registration number is KCT 0005615 (CRIS, https://cris.nih.go.kr/cris/en/); registration date, 23rd Nov 2020.

Significance of skeletal muscle index-to-body mass index ratio as a predictor of post-surgical bleeding after mastectomy in patients with breast cancer.

Post-surgical bleeding is a major complication of mastectomy in patients with breast cancer. However, the risk factors for post-surgical bleeding have not been well studied. Although obesity or reduced skeletal muscle mass is an indicator of cancer surgery complications, its impact on post-surgical bleeding after mastectomy remains unknown. In total, 563 patients with breast cancer who underwent mastectomy were included in this study. We evaluated the preoperative body mass index (BMI), skeletal muscle index (SMI), and SMI-to-BMI ratio and analyzed the association between these values and the incidence of post-surgical bleeding. Post-surgical bleeding occurred in 33 (5.6%) patients. Mean BMI was significantly higher in the bleeding group (26.3 ± 4.7) than in the no-bleeding group (23.0 ± 4.1) (p < 0.001), whereas mean SMI was lower in the former group (45.0 ± 8.5) than in the latter group (48.0 ± 8.5) (p = 0.08). The bleeding group had significantly lower SMI-to-BMI ratio (1.71 ± 0.16) than the no-bleeding group (2.10 ± 0.23) (p < 0.001). Among these three parameters, SMI-to-BMI ratio had the highest area under the curve value in their receiver operating characteristic curves (0.73 for BMI, 0.59 for SMI, 0.92 for SMI-to-BMI ratio). Furthermore, on multivariate analysis, SMI-to-BMI ratio was an independent risk factor for post-surgical bleeding (hazard ratio, 38.4; 95% confidence interval, 13.9-136.2; p < 0.001). SMI-to-BMI ratio is a superior predictive factor of post-surgical bleeding after mastectomy to either BMI or SMI alone.

Sarcopenia in Patients With Rectal Adenocarcinoma: An Opportunity for Preoperative Rehabilitation.

Sarcopenia, defined as low skeletal muscle mass, affects up to 60% of rectal adenocarcinoma patients receiving neoadjuvant chemoradiation (NACRT), with negative impact on patient outcomes. Identifying modifiable risk factors may decrease morbidity and mortality. A retrospective review of rectal cancer patients from a single academic center from 2006 to 2020 was performed. Sixty-nine patients with pre- and post-NACRT CT imaging were included. Skeletal muscle index (SMI) was calculated as total L3 skeletal muscle divided by height squared. Sarcopenia thresholds were 52.4cm2/m2 for men and 38.5cm2/m2 for women. Student T-test, chi-square test, multivariable regression, and multivariable Cox hazard analysis were performed. 62.3% of patients lost SMI from pre- to post-NACRT imaging, with a mean change of -7.8% (±19.9%). Eleven (15.9%) patients were sarcopenic at presentation, increasing to 20 (29.0%) following NACRT. Mean SMI decreased from 49.0cm2/m2 (95% CI: 42.0cm2/m2-56.0cm2/m2) to 38.2cm2/m2 (95% CI: 33.6cm2/m2-42.9cm2/m2) (P = .003). Pre-NACRT sarcopenia correlated with post-NACRT sarcopenia (OR 20.6, P = .002). Percent decrease in SMI was associated with a 5% increased mortality risk. The presence of sarcopenia at diagnosis and its association with post-NACRT sarcopenia suggests an opportunity for a high-impact intervention.

Prognostic value of sarcopenia in patients with lung cancer treated with epidermal growth factor receptor tyrosine kinase inhibitors or immune checkpoint inhibitors.

It remains controversial whether sarcopenia has any significant impact on the efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) or immune checkpoint inhibitors (ICIs) in patients with advanced non-small cell lung cancer (NSCLC). Therefore, in this study, we aimed to assess the association between sarcopenia and clinical outcomes in patients with advanced NSCLC receiving EGFR-TKIs or ICIs as a first-line therapy. We retrospectively enrolled 131 patients with advanced NSCLC treated with first-line EGFR-TKIs or ICIs between 1 March 2019 and 31 March 2021. To estimate sarcopenia, we calculated skeletal muscle index (SMI) as the ratio of skeletal muscle area (cm2) to height squared (m2). Associations between sarcopenia and overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan-Meier method and log-rank tests, respectively. A Cox proportional hazards regression model was used to assess the factors associated with OS and PFS. The Student's t-test or Mann-Whitney U test was used to compare the SMI between patients with or without objective response and disease control. The chi-squared test was used to compare adverse events (AEs) between patients with and without sarcopenia. Among the 131 patients, 35 (26.7%) were diagnosed with sarcopenia. Sarcopenia was an independent predictor of poor OS and PFS (p < 0.05) overall and in the EGFR-TKI- and ICI-treated cohorts. Among all patients, those with sarcopenia showed significantly shorter OS and PFS than those without sarcopenia (median OS and PFS: 13.0 vs. 26.0 months and 6.4 vs. 15.1 months; both p < 0.001). These associations were consistent across the subtypes of most clinical characteristics. Statistically significant differences between the objective response (OR) and non-OR groups were also observed in the mean SMI (OR group, 43.89 ± 7.55 vs. non-OR group, 38.84 ± 7.11 cm2/m2; p < 0.001). In addition, we observed similar results with disease control (DC) and non-DC groups (DC group, 42.46 ± 7.64 vs. non-DCR group, 33.74 ± 4.31 cm2/m2; p < 0.001). The AEs did not differ significantly between the sarcopenia and non-sarcopenia groups. Sarcopenia before treatment might be a significant predictor of poor clinical outcomes (shorter OS and PFS, fewer ORs, less DC) in patients with advanced NSCLC treated with EGFR-TKIs or ICIs as the first-line therapy.

Prognostic Value of Sarcopenia and Metabolic Parameters of 18F-FDG-PET/CT in Patients with Advanced Gastroesophageal Cancer.

We investigated the prognostic value of sarcopenia measurements and metabolic parameters of primary tumors derived from 18F-FDG-PET/CT among patients with primary, metastatic esophageal and gastroesophageal cancer. A total of 128 patients (26 females; 102 males; mean age 63.5 ± 11.7 years; age range: 29-91 years) with advanced metastatic gastroesophageal cancer who underwent 18F-FDG-PET/CT as part of their initial staging between November 2008 and December 2019 were included. Mean and maximum standardized uptake value (SUV) and SUV normalized by lean body mass (SUL) were measured. Skeletal muscle index (SMI) was measured at the level of L3 on the CT component of the 18F-FDG-PET/CT. Sarcopenia was defined as SMI < 34.4 cm2/m2 in women and <45.4 cm2/m2 in men. A total of 60/128 patients (47%) had sarcopenia on baseline 18F-FDG-PET/CT. Mean SMI in patients with sarcopenia was 29.7 cm2/m2 in females and 37.5 cm2/m2 in males. In a univariable analysis, ECOG (<0.001), bone metastases (p = 0.028), SMI (p = 0.0075) and dichotomized sarcopenia score (p = 0.033) were significant prognostic factors for overall survival (OS) and progression-free survival (PFS). Age was a poor prognostic factor for OS (p = 0.017). Standard metabolic parameters were not statistically significant in the univariable analysis and thus were not evaluated further. In a multivariable analysis, ECOG (p < 0.001) and bone metastases (p = 0.019) remained significant poor prognostic factors for OS and PFS. The final model demonstrated improved OS and PFS prognostication when combining clinical parameters with imaging-derived sarcopenia measurements but not metabolic tumor parameters. In summary, the combination of clinical parameters and sarcopenia status, but not standard metabolic values from 18F-FDG-PET/CT, may improve survival prognostication in patients with advanced, metastatic gastroesophageal cancer.

Association of Thoracic Skeletal Muscle Index with Clinical Outcome and Response to Nutritional Interventions in Patients at Risk of Malnutrition-Secondary Analysis of a Randomized Trial.

Measurement of skeletal muscle index (SMI) in computed tomography has been suggested to improve the objective assessment of muscle mass. While most studies have focused on lumbar vertebrae, we examine the association of SMI at the thoracic level with nutritional and clinical outcomes and response to nutritional intervention. We conducted a secondary analysis of EFFORT, a Swiss-wide, multicenter, randomized trial. We investigated the association of low SMI at the 12th thoracic vertebra (T12) with adverse outcome within 30 days after hospital admission (primary endpoint). 663 of 2028 patients from the EFFORT trial had available CT scans for T12, and 519 among them also had available L3 scans. Mean SMI at T12 was 22.4 ± 5.8 cm2/m2 and 19.6 ± 5.5 cm2/m2 in male and female patients, respectively, and correlated well with nutritional parameters, including nutritional risk based on NRS 2002 (adjusted coefficient -0.63, 95%CI -1.25 to -0.01, p = 0.047), BMI (adjusted coefficient 0.74, 95%CI 0.66 to 0.82, p < 0.001) and handgrip strength (adjusted coefficient 0.15, 95%CI 0.11 to 0.2, p < 0.001). In multivariate regression analyses, low SMI was not a significant predictor for either clinical outcome or for treatment response. Results for SMI measured at L3 were similar, with only little prognostic value. Within medical patients at risk for malnutrition, SMI at thoracic vertebra provided low prognostic information regarding clinical outcomes and nutritional treatment response.

Correlation of skeletal muscle depletion with acute toxicities for cervical cancer patients undergoing concurrent chemoradiation: A prospective study.

Pelvic radiation with concurrent chemotherapy is associated with toxicities that worsen the cachectic state of the patient. : The aim of this study is to quantify skeletal muscle changes on computed tomography (CT) images helps in assessing the same which could be correlated with the toxicities. The study design was s prospective study. Forty-one patients were treated with chemoradiation followed by brachytherapy (BT) for cervical cancer. Preexternal beam and preBT CT scans were used to assess skeletal muscle index (SMI). The changes in the SMI were correlated with enteritis, dyselectrolytemia, and hematological toxicities. Paired t-test was used to compare pre- and post-treatment SMI. Chi-square test would be used to study the association between toxicity and SMI change. The mean SMI was 57.41 cm2/m2 (42.5-73) in the preexternal beam radiotherapy (EBRT) scans and 54.5 cm2/m2 (40.9-71.07) in the post-EBRT scans. Twenty-two patients (53.7%), 14 patients (34.1%), and five patients (12.2%) belonged to <5%, 5%-10%, and >10% loss in SMI groups, respectively. Grade III enteritis was seen in 31.7% of the patients, hyponatremia in 26.8% of the patients in the 4th week, and leukopenia and neutropenia were seen in 26.8% of cases in the 5th week. Enteritis correlated significantly with the change in SMI (P = 0.047). Patients with cancer cachexia are at higher risk for radiation enteritis during chemoradiation for cervical cancer.

Does neoadjuvant chemotherapy regimen affect sarcopenia status in patients with breast cancer?

BackgroundLow muscle mass, or sarcopenia, predicts poorer treatment outcomes in breast cancer. Neoadjuvant chemotherapy is the main treatment to improve surgical outcomes for breast cancer, yet few studies have assessed the relationships between different chemotherapy regimens and sarcopenia. This study compared body composition change between two neoadjuvant chemotherapy regimens: AC-T (anthracyclines and cyclophosphamide followed by a taxane) and TCHP (docetaxel, carboplatin, trastuzumab, and pertuzumab). MethodsThis study included 298 patients with breast cancer who received neoadjuvant chemotherapy between 2017 and 2020 at one university hospital. Body composition was assessed by computed tomography. Multiple linear regression was performed to examine predictors of SMI change. ResultsPatients receiving TCHP showed a significant mean skeletal muscle index (SMI) decrease of 1.6 cm2/m2 (SD = 3.5, p < .001); patients receiving AC-T showed no significant change in mean SMI. The TCHP group also showed significantly decreased visceral and subcutaneous fat mass, while the AC-T group showed increases in both. The TCHP group had significantly more patients with newly diagnosed sarcopenia after neoadjuvant chemotherapy than the AC-T group (12% vs 1%, respectively). Chemotherapy regimen was the only significant predictor of muscle mass loss, and the TCHP group's mean SMI decrease was 3.124 greater than that of the AC-T group (p = .015). ConclusionsPatients receiving TCHP have a higher risk of muscle mass loss than those receiving AC-T. Considering the severe SMI decline observed in the TCHP group, further prospective studies are called for to examine treatment-induced sarcopenia and its relationship to body composition.

Sarcopenia Was a Poor Prognostic Predictor for Patients With Advanced Lung Cancer Treated With Immune Checkpoint Inhibitors.

BackgroundIt remains not well known whether skeletal muscle mass (SMM) loss has any impact on the effectiveness of immune checkpoint inhibitors (ICIs) in patients with advanced lung cancer. We aimed to evaluate the association between SMM and clinical outcome of patients with advanced lung cancer receiving ICIs as first line or second line.Materials and MethodsFrom March 1st, 2019 to March 31st, 2021 at our hospital, 34 patients with advanced lung cancer treated with first-line or second-line ICIs were enrolled retrospectively. The estimation of skeletal muscle index (SMI) for sarcopenia was assessed at the level of the third lumbar vertebra (L3) on computed tomography (CT) images obtained within 4 weeks before initiation of ICIs treatment. The impact of sarcopenia (low SMI) on progression free survival (PFS) was analyzed using Kaplan-Meier method and log-rank tests. The effect of various variables on PFS was evaluated using Cox proportional hazards regression model with univariate and multivariate analysis. The impact on treatment response including objective response rate (ORR) and disease control rate (DCR) and immunotherapy related adverse events (irAEs) between patients with and without sarcopenia was compared by the chi-squared test. The comparison of SMI value between patients with objective response (OR), disease control (DC) and those without OR and DC was used student t-test or Mann-Whitney U test.ResultsBoth in univariate and multivariate analysis, sarcopenia and treatment lines were the predictive factors for PFS (p < 0.05). Patients with sarcopenia had significantly shorter PFS than that of non-sarcopenic ones [6.57 vs. 16.2 months, hazard ratios (HR) = 2.947 and 3.542, and 95% confidence interval (CI): 1.123–13.183 and 1.11–11.308, p = 0.022 and 0.033]. No significant difference in ORR and irAEs was found. Patients with sarcopenia had lower DCR than those without sarcopenia. The mean SMI value of DCR group and non-DCR group was 32.94 ± 5.49 and 44.77 ± 9.06 cm2/m2, respectively (p = 0.008).ConclusionSarcopenia before immunotherapy might be a significant predictor for poor prognosis including shorter PFS and lower DCR in patients with advanced lung cancer treated with ICIs as first line or second line.

Associations between body composition measurements (BCM) and phase 1 (P1) oncology clinical trial outcomes.

e18648 Background: Cancer-related malnutrition and cachexia can lead to body composition changes. BCM can be assessed at the third lumbar (L3) vertebra by CT, which is available as part of pre-trial evaluation. We previously found that malnutrition and low psoas muscle area (PMA) are associated with adverse P1 outcomes including higher rates of ≥ Grade 3 toxicity (G3T). Here we evaluate the relationships between comprehensive cross-sectional muscle and adipose tissue BCM at L3 on P1 outcomes. Methods: Baseline CT scans for 82 patients (pts) were reviewed and images at the level of L3 were identified by 3 independent reviewers. A CT L3 image selected by at least 2 reviewers underwent analysis by Slice-O-Matic software (Tomovision, Canada) to generate BCM including: skeletal muscle area (SMA), skeletal muscle radiodensity (SMD), and adipose tissue area [intermuscular (IMAT), visceral (VAT), subcutaneous (SAT), and total adipose (TAT)] in cm2. SMA was normalized by height (m2), yielding cross-sectional skeletal muscle index (SMI). We stratified pts by having a SMI, SMD, IMAT, VAT, SAT, and TAT above or below the median value. We evaluated for associations between BCM and the following outcomes: rates of ≥ G3T, frequency of dose reductions/interruptions, hospitalizations, tumor response, disease control, duration on study (DOS), and overall survival (OS). Chi-square analysis was used to determine statistical significance between groups. Kaplan-Meier curves were used to compare DOS and OS. A multivariable analysis (MVA) was conducted via logistic regression to evaluate the association between SMI, VAT, PMA and ≥ G3T controlling for age and gender. Results: 82 P1 pts were included (38 M, 45 F), with a median age of 60 (range 28-85). The most common disease site was gastrointestinal (33%). Mean SMI was 44.78 cm2/m2 (range 25.70-79.89). Higher SMI was associated with a reduced risk of ≥ G3T (36.6% vs 58.5%; p = 0.047) and a trend towards improved OS (p = 0.07). There was no association between SMD, IMAT, SAT, or TAT and toxicity, however, higher VAT was associated with reduced risk of ≥ G3T (31.7% vs 63.4%, p = 0.004), and improved response to therapy (p = 0.001). A MVA controlling for age and gender showed that reduced SMI (AUC 0.7072), increased VAT (AUC 0.7597), and reduced PMA (AUC 0.757) were similar in their ability to predict ≥ G3T. Conclusions: P1 trials are designed to determine the safety and tolerability of investigational agents. In this population of P1 pts, BCM including higher baseline CT L3 SMI and VAT were associated with a reduced risk of ≥ G3T. BCM were also tied to efficacy as high VAT was associated with improved tumor response while a trend towards improved OS was noted for pts with higher baseline SMI. Future research should examine the value of integrating CT-based BCM into dose-selection algorithms when evaluating safety in P1 trials to minimize treatment-related toxicity and optimize therapeutic benefit.

Body Composition Differences Between Excess Weight Loss ≥ 50% and < 50% at 12 Months Following Bariatric Surgery.

BackgroundThe relationship between weight loss and body composition is undefined after bariatric surgery. The objective of this study was to compare body composition changes in patients with excess weight loss ≥ 50% (EWL ≥ 50) and < 50% at 12 months post-operatively (EWL < 50).MethodsA prospective cohort study was completed on patients undergoing bariatric surgery at two tertiary hospitals between 2017 and 2021. Body composition was measured with dual-energy X-ray absorptiometry immediately before surgery, and at 1, 6, and 12 months post-operatively. Body mass index (BMI), fat mass (FM), lean body mass (LBM), and skeletal muscle index (SMI) trajectories were analysed between patients with EWL ≥ 50% and EWL < 50%.ResultsThirty-seven patients were included in this series (EWL ≥ 50% n = 25, EWL < 50% n = 12), comprising of both primary and revisional bariatric surgery cases, undergoing a sleeve gastrectomy (62.2%), Roux-en-Y gastric bypass (32.4%), or one anastomosis gastric bypass (5.4%). The EWL ≥ 50% group demonstrated a more optimal mean FM-to-LBM loss ratio than the EWL < 50% group. EWL ≥ 50% patients lost 2.0 kg more FM than EWL < 50% patients for each 1 kg of LBM lost. EWL ≥ 50% was also associated with an increase in mean SMI% over 12 months (5.5 vs. 2.4%; p < 0.0009). Across the whole cohort, the first month after surgery accounted for 67.4% of the total LBM reduction that occurred during the 12-month post-operative period.ConclusionThis data suggests EWL ≥ 50% is associated with a more optimal body composition outcome than EWL < 50%. LBM reduction occurs predominantly in the early post-operative period.Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s11695-022-06128-3.

Hand-grip strength as a screening tool for sarcopenia in males with decompensated cirrhosis.

Skeletal muscle index (SMI), the gold standard for sarcopenia, cannot measure muscle strength and requires specialized software and training. Hand-grip strength (HGS) measurement is cheap, requires minimal training and directly reflects muscle strength. We assessed the performance of HGS as a screening tool for sarcopenia in male patients with decompensated cirrhosis (DC). Consecutive male DC patients (n=155) were enrolled. Baseline liver functions, etiologic work-up and anthropometric measurements were done. SMI was determined from computed tomography (CT) images at L3 level using ImageJ software. Sarcopenia was diagnosed using SMI cut-off <42 cm2/m2 as suggested by the Indian National Association for Study of the Liver. HGS was assessed using a hand-grip dynamometer. Diagnostic performance of HGS for discriminating sarcopenia was described using receiver operating characteristic (ROC) analysis. Diagnostic performance of different HGS cut-offs was assessed. Findings were internally validated using bootstrapping. Mean HGS and SMI were 25.73 ± 5.94 kg and 47.72 ± 8.71 cm2/m2, respectively. HGS showed modest correlation with SMI (tau: 0.31, p <0.001). Sarcopenia was seen in 41 (26.5%) patients. Age and HGS were independent predictors of sarcopenia on multivariate analysis. Area under the ROC curve (AUROC) of HGS for detecting sarcopenia was 0.73 (p<0.001). Optimal cut-off for using HGS as a screening tool was ≤31 kg (sensitivity: 37/41 [90.2%]; specificity: 29/114 [25.4%]; positive predictive value [PPV]: 37/122 [30.3%]; and negative predictive value [NPV]: 29/33 [87.9%]). Prevalence of sarcopenia in Indian male patients with DC is 26.5%. HGS is an independent predictor of sarcopenia and can be used as a screening tool to stratify the need for confirmatory CT-based assessment of sarcopenia.

Prognostic Significance of Preoperative Sarcopenia in Patients With Gastric Cancer Liver Metastases Receiving Hepatectomy.

BackgroundThe present work focused on assessing the role of computed tomography (CT)-determined sarcopenia in the prognosis of patients with gastric cancer liver metastases (GCLM) receiving hepatectomy.MethodsWe analyzed data collected from GCLM cases that underwent hepatectomy between March 2011 and July 2017. The third lumbar vertebra (L3) level skeletal muscle index (SMI) was analyzed by abdominal CT to determine the sarcopenia before surgery. The thresholds for CT-based sarcopenia of sex-specific L3 SMI were ≤ 34.9 cm2/m2 and ≤ 40.8 cm2/m2 for female and male, separately We determined overall survival (OS) and recurrence-free survival (RFS)by univariate and multivariate analyses.ResultsThe cohort enrolled altogether 114 patients with GCLM receiving hepatectomy (average age: 62.6 years, male: 79.8%), and 58 (50.8%) patients had sarcopenia. The mean SMI was 34.2 in patients with sarcopenia compared to 42.7 in patients without sarcopenia (p < 0.001). The 1-, 3-, and 5-year OS rates in patients with GCLM after hepatectomy were 78.1, 43.7, and 34.3%, respectively. The 1-, 3-, and 5-year RFS rates in patients were 49.8, 33.6, and 29.3%, respectively. Sarcopenia was related to an advanced age (≥65.0 years) (p = 0.009), reduced BMI (<18.5 kg/m2) (p < 0.001) and number of liver metastases (>1) (p = 0.025). Sarcopenia had a significant associated with the patterns of recurrence (p < 0.001). In addition, patients with sarcopenia had a significant difference in number of liver metastases in comparison with those without sarcopenia (p = 0.025). We discovered from multivariate analysis that sarcopenia independently predicted RFS [hazard ratio (HR) = 1.76; 95% confidence interval (CI)= 1.18–2.35, p = 0.007]. Nevertheless, sarcopenia was not the prognostic factors that independently predicted OS (HR = 1.62; 95% CI = 0.57–2.73; p = 0.330).ConclusionsIn conclusion, we showed that CT-determined sarcopenia was the facile and effective prognostic factor for RFS inpatients with GCLM after hepatectomy. Patients with sarcopenia are associated with an increased tumor recurrence risk, and thereby customized treatment should be applied.

Sarcopenia and risk of infection in adult heart transplant recipients in Japan.

AimsHeart transplantation (HT) is an effective therapeutic option for end‐stage heart failure. Infection is a major cause of morbidity and mortality after HT. Sarcopenia, defined as the loss of muscle mass and strength, is a common comorbidity in HT candidates with end‐stage heart failure. However, the effects of sarcopenia on the occurrence of post‐HT infections are not well understood. Therefore, we explored the association between the skeletal muscle mass and post‐transplant infections in adult HT recipients.Methods and resultsWe retrospectively examined the records of 135 patients who underwent HT between August 2007 and November 2019 at our institution. Pre‐transplant computed tomography was used to calculate the skeletal muscle index (SMI) at the level of the third lumbar vertebra. Muscle wasting was defined as the SMI of the lowest sex‐based tertiles. The primary endpoint was infections within 6 months of HT. The study included 109 patients (80 men, mean age: 41.6 ± 12.0 years): 37 patients in the muscle wasting group and 72 patients in the non‐muscle wasting group. The mean SMI values in the muscle wasting and non‐muscle wasting groups were 29.9 ± 4.8 cm2/m2 and 40.7 ± 6.7 cm2/m2, respectively. Prior to HT, 108 (99.1%) patients were on left ventricular assist device support, and during that support, the rate of late right heart failure was significantly higher in the muscle wasting group than non‐muscle wasting group (P = 0.012). Sixteen infections occurred within 6 months of HT. The most common infection sites included the respiratory tract (n = 5) and the upper gastrointestinal tract (n = 5), followed by the urinary tract (n = 4). Overall, 10 patients experienced infections in the muscle wasting group (27.0%) and 6 in the non‐muscle wasting group (8.3%) (P = 0.009). Two patients in the muscle wasting group required intensive care unit admission, compared to none in the non‐muscle wasting group. Low skeletal muscle mass was associated with infections in the univariate and multivariate logistic regression models (hazard ratio: 3.68, 95% confidence interval: 1.19–11.3; P = 0.023). However, the duration of all‐cause mortality within 3 years did not differ between the groups (P = 0.56).ConclusionsLow skeletal muscle mass is a predictor of post‐HT infections within 6 months of HT.

The Analysis of Surgical Outcomes in Operable Gastric Cancer Patients Presenting With or Without Sarcopenia.

We aimed to identify the patients with increased risk of post-operative complications using pre-operative sarcopenia as an indicator of adverse outcome in gastric cancer patients undergoing resection. This study was a prospective observational cohort study including patients with adenocarcinoma of stomach, undergoing gastric resection with curative intent. All the patient underwent pre-operative evaluation of sarcopenia including skeletal muscle index (SMI) measurements and hand grip strength (HGS) analysis. The post-operative parameters assessed were the time to initiate enteral feeding, the time to pass first flatus, post-operative complications, post-operative hospital stay, and histopathological staging of the resected specimen. All these parameters were compared between the sarcopenia and non-sarcopenia arms to obtain the final results. The total number of patients enrolled was 72 (46 male, 26 female). The mean SMI of the study cohort was 47.1 cm2/m2 and the mean HGS was 29.35kg. Thirty-six patients (24 male, 12 female) were sarcopenic pre-operatively. Sixty-two patients underwent subtotal gastrectomy with D2 lymphadenectomy, and 10 patients underwent total gastrectomy with D2 lymphadenectomy. The median time to pass flatus was 4days, the median time to initiation of enteral feeding was 4days, and the median post-operative hospital stay was 12days. Majority of the study patients had a pT3N1-2 disease. Sarcopenia was significantly associated with worsening ECOG performance status (p = 0.001), delay in passage of first flatus post-operatively (p = 0.017), higher post-operative complications (p = 0.012), higher T stage (p = 0.040), and higher N stage (p = 0.001). But there was no significant association between sarcopenia and time to initiation of enteral feeding and post-operative hospital stay. Sarcopenia is an independent prognostic factor for adverse short-term post-operative outcomes in patients undergoing curative intent resection of gastric cancer.

O-B05 Does rapid or gradual weight loss following bariatric surgery affect lean body mass depreciation?

Abstract Background Controversy exists regarding the influence of the rate of weight loss on long-term body composition. The objective of this study was to compare body composition changes in patients with successful and unsuccessful weight loss 12 months after bariatric surgery. Methods A prospective analysis was completed on patients undergoing bariatric surgery at St Vincent’s Hospital Melbourne between 2017 and 2021. Body composition was measured with dual-energy X-ray absorptiometry immediately before surgery, and at 12 months post-operatively. Fat mass (FM), lean body mass (LBM) and skeletal muscle index (SMI) trajectories were analysed between patients, with either successful weight loss (SWL) or unsuccessful weight loss (USWL) stratified based on an excess weight loss (EWL) threshold of ≥ 50%. Results Thirty-seven patients were included in this series (SWL n = 25, USWL n = 12). Compared to those with USWL, SWL demonstrated a greater mean loss in BMI (12.3 vs 7.3 kg/m2; p &amp;lt; 0.001) and weight (34.4 vs 20.3 kg; p &amp;lt; 0.001). SWL demonstrated a significantly greater reduction in tissue fat% than USWL, with patients losing 7.3% more tissue fat on average. SWL was associated with an improved mean SMI% when compared with USWL (5.5 vs. 2.42%; p &amp;lt; 0.0009). However, the difference in FM:LBM loss ratio between the two groups did not demonstrate statistical significance (7.07 vs 4.62, p = 0.2519). Conclusions This data suggests that SWL is associated with a more optimal body composition outcome than USWL, which is at least partly due to a relative skeletal muscle-sparing effect in this group. Further research is warranted in understanding the implications of these changes on resting energy expenditure and the risk of weight regain.

Higher Skeletal Muscle Index Is Associated with Improved Overall Survival in Older Patients with Sarcopenia Undergoing Allogeneic Stem Cell Transplant

Introduction: Allogeneic stem cell transplantation (allo-SCT) can be curative for patients with hematologic malignancies. Despite optimization of supportive measures, the risk of non-relapse mortality is a particularly important consideration in older individuals. Sarcopenia, defined as low skeletal muscle mass, has been shown to be associated with decreased overall survival in cancer patients and may identify individuals at higher risk of treatment-related complications.Methods: Using Mayo Clinic Arizona's hematopoietic stem cell transplantation database, patients aged 60 years or older who underwent allo-SCT between 2008 and 2018 were identified. Patients who underwent abdominal computed tomography (CT) at our institution within 90 days prior to their transplant date were included in the study. The skeletal muscle area (SMA) was obtained using a fully automated algorithm for segmenting abdominal CT images to quantify body composition based on a deep learning approach (Weston et al., Radiology, 2019). The skeletal muscle index (SMI) was then calculated using the SMA and the subject's height at the time the CT was obtained. Sarcopenia was defined based on previously described consensus (Cruz-Jentoft et al., Age Ageing, 2010; Magudia et al., Radiology, 2021). T-tests and Fisher's exact tests compared patient characteristics between groups, where appropriate. Kaplan-Meier methods were used to construct survival times. Log-rank tests compared survival distributions and Cox proportional hazards models estimated hazard ratios.Results: A total of 79 patients met inclusion criteria (Table 1). Of these, 50 (63%, n=50/79) had sarcopenia, and 29 (37%, n=29/79) had normal skeletal muscle mass. Among the sarcopenia group, 43 (86%, n=43/50) had SMI measurements. No differences were seen between groups in age at transplant, sex, Karnofsky performance scale, disease risk index, or conditioning regimen intent.There was no statistically significant difference in overall survival between those with sarcopenia and those with normal skeletal muscle mass (log-rank p=0.18). Median survival was 3.3 years (95% CI: 0.8, not estimable (NE)) for those with sarcopenia and 3.6 years (95% CI: 1.3, NE) for those with normal skeletal muscle mass. Given the infrequency of events, the upper bounds of the median survival confidence intervals were not estimable. The unadjusted hazard ratio (HR) for sarcopenia versus normal skeletal muscle mass was 1.65 (95% CI: 0.79, 3.47; p=0.18).Males had a higher mean SMI than females, as expected (50.4 versus 37.5, p<0.001; mean difference 13.0, 95% CI: 8.9, 17.1). Without considering sex, higher or lower SMI was not associated with survival time in a Cox model in those with sarcopenia (HR: 0.97, 95% CI: 0.92, 1.03; p=0.32). Sex alone was also not associated with any survival benefit among these 43 patients. After adjusting for the difference seen in SMI between sexes, on average, those with higher SMI were associated with a survival benefit (HR: 0.92, 95% CI: 0.84, 0.99; p=0.039). This amounts to roughly an 8% reduction in hazard rate as SMI increased.Conclusions: The presence of sarcopenia alone was not associated with overall survival in patients 60 years and older undergoing allo-SCT for hematologic malignancy. Rating sarcopenia severity using SMI may assist in identifying high risk individuals with sarcopenia as lower sarcopenia severity was associated with improved overall survival. Further studies are warranted to explore the possible impacts of interventions directed at improving skeletal muscle mass on transplant-related outcomes. [Display omitted] DisclosuresGaulin: DeciBio: Honoraria; Olson Research Group: Honoraria. Jain: CareDx: Other: for advisory board participation; CTI Biopharma: Research Funding; Syneos Health: Research Funding; Bristol Myers Squibb: Other: for advisory board participation; Targeted Healthcare Communications: Consultancy. Palmer: PharmaEssentia: Research Funding; Incyte: Research Funding; Sierra Oncology: Consultancy, Research Funding; CTI BioPharma: Consultancy, Research Funding; Protagonist: Consultancy, Research Funding.

The improvement in body composition including subcutaneous and visceral fat reduces ammonia and hepatic encephalopathy after transjugular intrahepatic portosystemic shunt.

BackgroundSarcopenia and myosteatosis have been associated to a poor prognosis of cirrhosis and to a higher incidence of hepatic encephalopathy (HE). The prognostic implications of visceral and subcutaneous adiposity are less known.AimTo evaluate the modifications of visceral and subcutaneous adipose tissue after TIPS and to investigate their relationships with the modification of muscle mass and with the incidence of post‐TIPS HE.Patients and Methods35 cirrhotic patients submitted to TIPS were retrospectively studied. The modification of skeletal muscle index (SMI), muscle attenuation (myosteatosis), subcutaneous adipose tissue index (SATI), visceral adipose tissue index (VATI), assessed by CT‐scan and plasma ammonia were evaluated before and after a mean follow‐up of 19 ± 15 months after TIPS. The number of episodes of overt HE was also recorded.ResultsDuring the follow‐up, the mean SMI and muscle attenuation increased significantly; SATI significantly increased while VATI significantly decreased, although not uniformly in all patients. By comparing the patients with or without improvement in their nutritional status after TIPS, MELD remained stable while the number of episodes of overt HE was significantly lower in the patients with improved SMI and in the patients with improved SATI. Finally, inverse correlation was observed between the variation of ammonia and SATI (r = −.40; P < .05).ConclusionIn addition to muscle mass, adipose tissue is modified after TIPS. The improvement of subcutaneous adipose tissue as well as of sarcopenia and myosteatosis is associated to the amelioration of cognitive impairment independently of liver function. The correlation between adipose tissue and ammonia modification may suggest an active role of the adipose tissue in the inter‐organ ammonia trafficking.