Cancer‐Associated Malnutrition and CT‐Defined Sarcopenia and Myosteatosis Are Endemic in Overweight and Obese Patients

Abstract

Background Overweight/obese patients’ large fat mass can mask the loss of skeletal muscle, which is associated with mortality in the oncology setting. We investigated the prevalence of computed tomography (CT)‐defined sarcopenia and myosteatosis across different levels of nutrition risk assessed by the Patient‐Generated Subjective Global Assessment Short Form (PG‐SGA SF). We also evaluated whether the PG‐SGA SF, sarcopenia, and myosteatosis were prognostic of overall survival. Methods This was a prospective, observational study. Consecutive patients with body mass index ≥25.0 kg/m2 with newly diagnosed head and neck cancer (any stage) or lung and gastrointestinal tract cancer (locally recurrent or metastatic) were screened at presentation to oncology clinics. Nutrition risk was assigned based on PG‐SGA SF triage recommendations. Based on CT, patients were classified with sarcopenia and/or myosteatosis using published cutoffs. Survival analyses were conducted. Results Patients (n=1157) were 63.6 ± 11.4 years, 64% male, and 61% had stage IV disease. Sarcopenia and myosteatosis were prevalent across PG‐SGA SF nutrition risk categories (scores 0–1 [no risk; 36% sarcopenic; 44% myosteatotic], scores 2–3 [37%; 37%], scores 4–8 [40%; 41%], and scores ≥9 [high risk; 50%; 49%]). In multivariable survival analysis, PG‐SGA SF scores ≥9 (hazard ratio [HR] 2.08, 95% confidence interval [CI] 1.66‐2.60, P<0.001), sarcopenia (HR 1.25, 95% CI 1.06‐1.46, P=0.006), and myosteatosis (HR 1.25, 95% CI 1.07‐1.46, P<0.001) independently predicted reduced survival. Conclusion CT‐defined sarcopenia and myosteatosis are prevalent across different levels of nutrition risk in overweight/obese patients with cancer. Assessment of skeletal muscle using CT adds prognostic value to the PG‐SGA SF.

Sarcopenia and myosteatosis in patients undergoing curative radiotherapy for head and neck cancer: Impact on survival, treatment completion, hospital admission and cost

“…The prevalence of sarcopenia and myosteatosis in patients who were obese was 17% and 25%, respectively. These findings are consistent with the current literature where sarcopenia is a demonstrated poor prognostic factor regardless of overall BMI or nutritional status ( 2,4 ) . Efforts to understand the magnitude, clinical importance and mechanisms of sarcopenia and myosteatosis are needed to inform a more personalised approach with respect to mitigating the body composition changes associated with HNC treatment ( 17,26,40 ) .…”

“…An early change in muscle architecture, myosteatosis, occurs prior to a decline in strength and function, as well as prior to metabolic derangements associated with obesity and diabetes, and thus warrants further attention ( 37,38 ) . A metabolically active element of muscle, intermuscular adipose, secretes inflammatory cytokines contributing to systemic inflammation, a decline in muscle cell proliferation, and differentiation and muscle catabolism ( 38 ) , As such, an association with increased morbidity and mortality is therefore unsurprising; however, attempts to understand the causal mechanisms and optimal therapeutic strategies with respect to myosteatosis are ongoing ( 2 ) . Our findings are consistent with a systematic review ( 16 ) showing an independent association between sarcopenia and reduced OS in patients undergoing radiotherapy for HNC ( 17–20,23,26 ) with post‐treatment sarcopenia also being a powerful predictor of reduced OS ( 17,26 ) .…”

“…Sarcopenia and myosteatosis are prevalent in patients with cancer and are recognised poor prognostic factors regardless of weight or nutritional status ( 1,2 ) . Sarcopenia, defined as low muscle mass relative to healthy individuals, is associated with impaired metabolism, functional capacity and disability ( 3 ) , greater length of hospital stay and reduced survival ( 4 ) .…”

Muscle loss during primary debulking surgery and chemotherapy predicts poor survival in advanced‐stage ovarian cancer

“…As body composition varies greatly between regions, ethnicities, and cancer types, we defined our own cut‐off values for defining sarcopenia, myosteatosis, and low TATI on the basis of previous studies with similar population sizes . Cut‐off values were set at the lowest tertile for SMI and SMD and at the highest tertile for TATI.…”

Sarcopenia, physical frailty, undernutrition and obesity cooccurrence among Portuguese community-dwelling older adults: results from Nutrition UP 65 cross-sectional study

“…6 In fact, in a study with overweight and obese cancer patients, sarcopenia was prevalent across different levels of nutrition risk. 7 In addition, the double burden of malnutrition was characterised by World Health Organization (WHO) as the coexistence of undernutrition along with overweight and obesity, namely, within individuals, but it needs to be further explored.…”