Sarcopenia in aging, obesity, and cancer

Abstract

Sarcopenia, defined as loss of muscle mass, strength and physical performance, is a hallmark of aging and is invariably associated with perturbation of amino acid metabolism, increased muscle protein catabolism relative to anabolism, and loss of muscle fibers. Sarcopenia may be associated with general loss of body mass, or it may also occur along with obesity [sarcopenic obesity (SO)]. Although sarcopenia is associated with multiple comorbidities in older adults, its effects may even be more severe in patients with malignant disease where it has been shown to contribute to poor surgical outcomes, increased chemotherapy toxicity associated with both cytotoxic and targeted agents, as well as adversely impacting survival. While development of sarcopenia is a common age-related phenomenon, the associated catabolic processes appear to be promoted by physical inactivity, inadequate nutrition, and systemic low-grade inflammation, as well as intrinsic muscle and molecular changes, including mitochondrial dysfunction and impaired muscle stem cell regenerative capacity. Increased physical activity and adequate protein intake can reduce incidence and severity of sarcopenia in cancer patients, but many older cancer patients do not meet physical activity and nutrition recommendations, and cancer treatment can make it more difficult to make favorable lifestyle changes. Sarcopenia is discussed in terms of its adverse clinical consequences in older subjects and particularly, in older patients with cancer. Contributions of lifestyle, molecular, and cellular factors are likewise reviewed with suggestions for interventions to improve sarcopenia and its comorbid sequalae.

Different Impact of Definitions of Sarcopenia in Defining Frailty Status in a Population of Older Women with Early Breast Cancer

“…Sarcopenia can be defined as a pathological loss of skeletal muscle mass characterized by essential structural changes in muscle quality, which occurs in older adults and shows functional impairment and/or strength reduction [ 55 ]. Aging is related to a decline in muscle mass and strength [ 56 ] but only when this decline becomes pathological (sarcopenia) does this process lead to adverse health outcomes [ 57 ].…”

The Role of Sarcopenic Obesity in Cancer and Cardiovascular Disease: A Synthesis of the Evidence on Pathophysiological Aspects and Clinical Implications

“…Sarcopenic obesity is more common in older adults (≥50 years old) [ 109 ], and the prevalence in individuals with cancer can vary substantially between 1% and 41.7%, as shown in Table 3 . This range of prevalence in several studies can be related to the different criteria used for the diagnosis of sarcopenic obesity, to the various types of cancer and their staging, aspects that limit understanding the panorama of occurrence and reveals the need for more research with other types of cancer not yet investigated.…”

“…It has been stated that sarcopenic obesity adversely impacts treatment tolerance, long-term expectations and is an important indicator of adverse outcomes and a prognostic factor for complications in cancer patients [ 109 ]. In the present study, we concluded that there is still a very limited number of studies evaluating the impacts of sarcopenic obesity on several clinical and treatment variables of different types of cancer.…”

“…Sarcopenic obesity is an important prognostic factor for survival in cancer patients [ 109 ]. We found 12 studies that assessed the potential impact of sarcopenic obesity on cancer patient’s survival.…”

Food, Nutrition, Physical Activity and Microbiota: Which Impact on Lung Cancer?

“…An adequate protein intake can reduce the incidence and severity of sarcopenia in cancer patients [ 56 ]. It has been demonstrated that a dietary program with energy and protein rich meals and snacks can improve muscle strength and performance status of lung cancer patients [ 57 , 58 ].…”