A critical evaluation of body composition modalities used to assess adipose and skeletal muscle tissue in cancer

2012 ◽  
Vol 37 (5) ◽  
pp. 811-821 ◽  
Author(s):  
Katie M. Di Sebastiano ◽  
Marina Mourtzakis
Keyword(s):  
Skeletal Muscle ◽  
Body Composition ◽  
Adipose Tissue ◽  
Cancer Patients ◽  
Tissue Loss ◽  
Metabolic Complications ◽  
Increased Risk ◽  
Body Composition Change ◽  
Patients Experience ◽  
Risk Of Cancer

The majority of cancer patients experience some form of body composition change during the disease trajectory. For example, breast cancer patients undergoing chemotherapy and prostate cancer patients undergoing androgen deprivation therapy gain fat and lose skeletal muscle, which are associated with increased risk of cancer recurrence and clinical comorbidities. In contrast, advanced cancer patients, such as lung and colorectal cancer patients, experience symptoms of cancer cachexia (accelerated loss of skeletal muscle with or without adipose tissue loss), which are associated with decreased treatment response and poorer survival rates in advanced cancers. The heterogeneity of body composition features and their diverse implications across different cancer populations supports the need for accurate quantification of muscle and adipose tissue. Use of appropriate body composition modalities will facilitate an understanding of the complex relationship between body composition characteristics and clinical outcomes. This will ultimately support the development and evaluation of future therapeutic interventions that aim to counter muscle loss and fat gain in cancer populations. Despite the various metabolic complications that may confound the accurate body composition measurement in cancer patients (i.e., dehydration may confound lean tissue measurement), there are no guidelines for selecting the most appropriate modalities to make these measurements. In this review we outline specific considerations for choosing the most optimal approaches of lean and adipose tissue measurements among different cancer populations. Anthropometric measures, bioelectrical impedance analysis, air displacement plethysmography, dual-energy X-ray absorptiometry, computed tomography, and magnetic resonance imaging will be discussed.

Weight, skeletal muscle mass, and adipose tissue loss during lung cancer patients' treatment.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e20627-e20627
Author(s):  
Stéphanie Chemama ◽  
Sami Antoun ◽  
Julien Hadoux ◽  
Benjamin Besse ◽  
David Planchard ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Skeletal Muscle ◽  
Adipose Tissue ◽  
Cancer Patients ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Tissue Loss ◽  
Lung Cancer Patients

scholarly journals Body Composition Predicts Survival in Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) Recipients

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2113-2113
Author(s):  
Asmita Mishra ◽  
Binglin Yue ◽  
Martine Extermann ◽  
Claudio Anasetti ◽  
Heather Jim ◽  
...  
Keyword(s):  
Physical Activity ◽  
Skeletal Muscle ◽  
Body Composition ◽  
Adipose Tissue ◽  
Cancer Patients ◽  
Unrelated Donor ◽  
Cross Sectional ◽  
Hematopoietic Stem ◽  
Patient Reported ◽  
Baseline Characteristics

Abstract Background: Innovative means to risk-stratify HSCT patients are needed. Previous studies in cancer patients suggest association between body composition and survival. However, this has not been previously described is allogeneic HSCT recipients. Furthermore, the correlation of body composition with pre- and post-HSCT physical activity in cancer patients remains undefined. We postulated that body composition prior to HSCT is associated with post-HSCT outcomes. Methods: Patients who had completed pre-HSCT physical function assessment as part of ongoing prospective clinical trial were identified. Analysis of self-reported and measured physical activity and their association with outcomes after transplantation is currently ongoing. Regional CT at the 4th thoracic vertebra (T4) was obtained for post-hoc analysis of body composition within this cohort. Using Slice-O-Matic software V4.3 (Tomovision, Magog, Quebec, Canada), both adipose and muscle tissue were quantified to obtain the respective cross sectional area (cm2). Fat and skeletal muscle were identified and quantified within the following CT Hounsfield unit thresholds: -29 to +150 for skeletal muscle and -190 to -30 for adipose tissue. Tissue boundaries were manually corrected as necessary. Cross sectional areas were subsequently normalized for stature (height2) to obtain a tissue index for both fat and muscle (cm2/m2). For this analysis, fat index (FI) and muscle index (MI) were divided into quartiles (group 0: ≤25%, group 1: 26-50%, group 2: 51=75%, group 3: ≥75%). Statistical significance was defined as p < 0.05 and all analyses were done on SAS 9.3. Results: All patients (n=50) enrolled on the pre-HSCT functionality trial between 02/2014 and 02/2015 were identified for this analysis. 3 patients were excluded for analysis: 2 subjects ultimately did not proceed to HSCT and 1 subject had a CT scan that was not evaluable. Thus, 47 subjects had evaluable data; baseline characteristics are summarized (Table 1). Median follow-up for survivors is 298 days (interquartile range (IQR): 272-368 days). Overall survival (OS) significantly differs between FI strata (log rank p value =0.0013) (Figure 1). MI is not associated with OS (p=NS). FI is inversely correlated with distance walked during 6-minute walk test pre-HSCT (r = -0.33, p = 0.027). FI and MI are not significantly associated with self-reported physical activity using the International Physical Activity Questionnaire (IPAQ) post-HSCT (day 1, 30, 90), or patient-reported quality of life (QOL). Conclusions: These data provide the first evidence supporting an association between CT-defined cross sectional adipose tissue index and survival following HSCT. This non-invasive, routinely employed imaging modality may provide a new avenue for enhanced risk-assessment for HSCT patients. Subsequent studies will examine this effect in larger populations, with specific attention to other established prognostic variables. Table 1. Baseline Characteristics Variables N (%) Age, yrs (median, range) 60 (24-75) Gender, male 30 (63.8%) KPS ≥90 42 (89.3%) HCT-CI≥3 29 (61.7) Diagnosis § AML § ALL § CLL § CML § MDS § HD § MM § MPS § NHL 12 (25.5%) 5 (10.6%) 3 (6.4%) 2 (4.3%) 9 (19.1%) 2 (4.3%) 3 (6.4%) 2 (4.3%) 9 (19.1%) Conditioning Intensity, Myeloablative 24 (51.1%) Armand Disease Risk at HSCT § Low § Intermediate § High/Very High 2 (4.3%) 26 (55.3%) 19 (40.4%) Donor Type § Matched Related Donor § Matched Unrelated Donor § Mismatched Unrelated Donor § Double Umbilical Cord Blood 13 (27.7%) 27 (57.4%) 6 (12.8%) 1 (2.1%) Disclosures No relevant conflicts of interest to declare.

Body composition and association with treatment toxicity in patients with advanced renal cell carcinoma receiving targeted agents.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15608-e15608
Author(s):  
Kelly McCabe ◽  
Vicky Goh ◽  
Anup Vinayan ◽  
Ann Petruckevitch ◽  
Paul D. Nathan
Keyword(s):  
Skeletal Muscle ◽  
Body Composition ◽  
Adipose Tissue ◽  
Weight Change ◽  
Mtor Inhibitors ◽  
Targeted Agents ◽  
Muscle Area ◽  
Skeletal Muscle Index ◽  
Treatment Toxicity ◽  
Increased Risk

e15608 Background: Treatment toxicity may be influenced by heterogeneity in body composition. Muscle wasting in mRCC patients treated with sorafenib is associated with increased risk of toxicity (Antoun et al, 2010). We used CT analysis to investigate changes in adipose tissue and skeletal muscle in a large cohort of mRCC patients treated with a number of targeted agents and determined whether body composition was associated with treatment toxicity. Methods: A retrospective analysis of between 2-7 sequential CT scans of 112 mRCC patients was conducted. Each patient received between 1-4 courses of therapy. In total 191 treatment episodes within this population were included; 113 courses of VEGF TKIs, 22 courses of mTOR inhibitors, 36 courses of immunotherapy and 20 episodes where no treatment was given. A validated method, using L3 as a lumbar vertebral landmark, was used to measure lumbar skeletal muscle area (cm3) and adipose tissue volume (cm3). Appendicular Skeletal Muscle Index (ASMI) was calculated to determine prevalence of sarcopenia within the cohort; sarcopenia was defined as ASMI <7.26kg/m2 for males and <5.45kg/m2for females. Toxicity was assessed by Common Toxicity Criteria (CTC) scores documented in medical records. The cohort was divided into body mass index (BMI) quartiles. Results: Of the 112 participants, 74.1% of the group had a BMI >25 at their first scan. Mean weight change between first and last scan was -3.89kg (SD: ±9.09). 20.5% of the cohort were sarcopenic at baseline, increasing to 38.4% at final scan. Sarcopenia was independent of weight change and was associated with increased frequency of severe (CTC grade > 2) treatment toxicity (Pearson Chi Square Value: 12.82; p= 0.001). This effect persisted after adjusting for BMI quartile (odds ratio = 5.04; p=0.004). Changes in bone composition and correlation of body composition with clinical outcome will also be reported. Conclusions: Sarcopenia is common in mRCC patients and is associated with a significantly increased risk of severe treatment toxicity when receiving targeted agents. Sarcopenia was seen across all BMI quartiles and was not associated with weight change.

P237 The impact of body composition change on neo-adjuvant chemotherapy for breast cancer patients

The Breast ◽  
2015 ◽  
Vol 24 ◽  
pp. S106-S107
Author(s):  
T. Iwase ◽  
T. Sangai ◽  
E. Ishigami ◽  
J. Sakakibara ◽  
K. Fujisaki ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Body Composition ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Composition Change ◽  
Breast Cancer Patients ◽  
Body Composition Change ◽  
Neo Adjuvant Chemotherapy ◽  
The Impact

scholarly journals Preventing Venous Thromboembolism in Ambulatory Patients with Cancer: A Narrative Review

Cancers ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 612 ◽  
Author(s):  
Anne Rossel ◽  
Helia Robert-Ebadi ◽  
Christophe Marti
Keyword(s):  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Absolute Risk ◽  
Narrative Review ◽  
Relative Reduction ◽  
Number Needed To Treat ◽  
Chemotherapeutic Regimen ◽  
Patients With Cancer ◽  
Increased Risk ◽  
Risk Of Cancer

Venous thromboembolism (VTE) is frequent among patients with cancer. Ambulatory cancer patients starting chemotherapy have a 5% to 10% risk of cancer associated thrombosis (CAT) within the first year after cancer diagnosis. This risk may vary according to patient characteristics, cancer location, cancer stage, or the type of chemotherapeutic regimen. Landmark studies evaluating thrombophrophylaxis with low molecular weight heparin (LMWH) for ambulatory cancer patients have shown a relative reduction in the rate of symptomatic VTE of about one half. However, the absolute risk reduction is modest among unselected patients given a rather low risk of events resulting in a number needed to treat (NNT) of 40 to 50. Moreover, this modest benefit is mitigated by a trend towards an increased risk of bleeding, and the economic and patient burden due to daily injections of LMWH. For these reasons, routine thromboprophylaxis is not recommended by expert societies. Advances in VTE risk stratification among cancer patients, and growing evidence regarding efficacy and safety of direct oral anticoagulants (DOACs) for the treatment and prevention of CAT have led to reconsider the paradigms of this risk–benefit assessment. This narrative review aims to summarize the recent evidence provided by randomized trials comparing DOACs to placebo in ambulatory cancer patients and its impact on expert recommendations and clinical practice.

scholarly journals MECHANISMS IN ENDOCRINOLOGY: Skeletal muscle lipotoxicity in insulin resistance and type 2 diabetes: a causal mechanism or an innocent bystander?

2017 ◽  
Vol 176 (2) ◽  
pp. R67-R78 ◽  
Author(s):  
Charlotte Brøns ◽  
Louise Groth Grunnet
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Skeletal Muscle ◽  
Adipose Tissue ◽  
Cellular Localization ◽  
Future Research ◽  
Causal Mechanism ◽  
Increased Risk ◽  
Adipose Tissue Expandability

Dysfunctional adipose tissue is associated with an increased risk of developing type 2 diabetes (T2D). One characteristic of a dysfunctional adipose tissue is the reduced expandability of the subcutaneous adipose tissue leading to ectopic storage of fat in organs and/or tissues involved in the pathogenesis of T2D that can cause lipotoxicity. Accumulation of lipids in the skeletal muscle is associated with insulin resistance, but the majority of previous studies do not prove any causality. Most studies agree that it is not the intramuscular lipids per se that causes insulin resistance, but rather lipid intermediates such as diacylglycerols, fatty acyl-CoAs and ceramides and that it is the localization, composition and turnover of these intermediates that play an important role in the development of insulin resistance and T2D. Adipose tissue is a more active tissue than previously thought, and future research should thus aim at examining the exact role of lipid composition, cellular localization and the dynamics of lipid turnover on the development of insulin resistance. In addition, ectopic storage of fat has differential impact on various organs in different phenotypes at risk of developing T2D; thus, understanding how adipogenesis is regulated, the interference with metabolic outcomes and what determines the capacity of adipose tissue expandability in distinct population groups is necessary. This study is a review of the current literature on the adipose tissue expandability hypothesis and how the following ectopic lipid accumulation as a consequence of a limited adipose tissue expandability may be associated with insulin resistance in muscle and liver.

Results of a Diet/Exercise Feasibility Trial to Prevent Adverse Body Composition Change in Breast Cancer Patients on Adjuvant Chemotherapy

2008 ◽  
Vol 8 (1) ◽  
pp. 70-79 ◽  
Author(s):  
Wendy Demark-Wahnefried ◽  
L. Douglas Case ◽  
Kimberly Blackwell ◽  
P. Kelly Marcom ◽  
William Kraus ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Body Composition ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Feasibility Trial ◽  
Composition Change ◽  
Breast Cancer Patients ◽  
Body Composition Change

scholarly journals Impact of Preoperative Low Prognostic Nutritional Index and High Intramuscular Adipose Tissue Content on Outcomes of Patients with Oral Squamous Cell Carcinoma

Cancers ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3167
Author(s):  
Takuya Yoshimura ◽  
Hajime Suzuki ◽  
Hirotaka Takayama ◽  
Shotaro Higashi ◽  
Yuka Hirano ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Squamous Cell Carcinoma ◽  
Body Composition ◽  
Adipose Tissue ◽  
Oral Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Prognostic Nutritional Index ◽  
Muscle Quality ◽  
Nutritional Index

The impact of preoperative malnutrition and sarcopenia on survival in oral squamous cell carcinoma (OSCC) patients remains controversial. We investigated the effects of the preoperative nutritional status and abnormalities in body composition on the mortality of OSCC patients. A retrospective study involving 103 patients with OSCC was conducted. Disease-specific survival (DSS) according to the preoperative psoas muscle mass index (PMI) and intramuscular adipose tissue content (IMAC) was evaluated. Univariate and multivariate analyses were performed to determine the predictive performance of the covariates with respect to DSS. The DSS rate in patients with high IMAC and low PMI was significantly lower than that in controls. Multivariate analysis revealed that a low preoperative Prognostic Nutritional Index (PNI) and high IMAC were independent risk factors. We demonstrated that preoperative malnutrition and abnormal body composition, such as preoperative skeletal muscle quality, are associated with DSS in OSCC patients. Our study suggests that the evaluation of preoperative malnutrition and skeletal muscle quality would be useful for predicting mortality in patients with OSCC.

PS02.249: VARIATION IN BODY COMPOSITION IN ESOPHAGEAL CANCER PATIENTS RECEIVING SUPPLEMENTARY JEJUNOSTOMY FEEDING DURING NEOADJUVANT CHEMORADIOTHERAPY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 194-194
Author(s):  
Piers R Boshier ◽  
M F J Seesing ◽  
Vickie E Baracos ◽  
Donald E Low
Keyword(s):  
Esophageal Cancer ◽  
Body Composition ◽  
Cancer Patients ◽  
Neoadjuvant Chemoradiotherapy ◽  
The Body ◽  
Tissue Loss ◽  
Tube Placement ◽  
Average Weight ◽  
Term Survival ◽  
Jejunostomy Feeding

Abstract Background Cancer of the esophagus has one of the highest known associations with cancer–related malnutrition. The aim of the current study was to investigate variation in the body composition of esophageal cancer patients receiving supplementary jejunostomy feeding during neoadjuvant chemoradiotherapy (nCRT) and to assess its correlation with outcomes. Methods Retrospective review of esophageal cancer patient's receiving jejunal feeding during nCRT. Patients selected for jejunal feeding tube placement were considered at high nutritional risk according to ASPEN criteria. Assessment of body composition was performed using L3-axial CT images acquired at diagnosis and after nCRT. Results Eighty-one patients were eligible for inclusion (67 M, 65.9 ± 9.7 yrs). Average weight loss and BMI at diagnosis was 11.4 ± 6.5 Kg and 26.1 ± 4.6 Kg/m2 respectively. Failure to complete nCRT as prescribed occurred in one patient. Following nCRT the prevalence of sarcopenia increased significantly in males despite jejunal feeding (69% vs. 87%; P = 0.013) but fell in females (57% vs. 50%; P = 0.705). Patients could be categorized into three distinct groups according to the degree of skeletal muscle loss (ΔSMM) during nCRT: minor-loss/no-change (n = 28; Δ > −6 cm2); moderate loss (n = 27; Δ−17 to −6 cm2), and; severe loss (n = 26; Δ<17 cm2). A female predominance was observed amongst patients with minor-loss/no-change in SMM compared to patients with moderate and severe losses during nCRT (36% vs. 11% vs. 4%; P = 0.005). Visceral obesity was also less common in patients with minor-loss/no-change in SMM compared to patients with moderate and severe losses during nCRT (39% vs. 48% vs. 58%; P = 0.401). Compared to patients with moderate and severe SMM losses patients in whom SMM was persevered by jejunal feeding during nCRT tended to have lower rates of over-all complications (62% vs. 59% vs. 43%; P = 0.318); pneumonia (27% vs. 11% vs. 11%; P = 0.186), and; pulmonary embolism (15% vs. 0% vs. 0%; P = 0.012). Long-term survival was not affected by either sarcopenia or SMM and adipose tissue loss during nCRT (P > 0.05). Conclusion This is the first study to report variation in body composition in esophageal cancer patients receiving a defined nutritional intervention during nCRT. In selected patients jejunal feeding appeared to stabilize parameters of body composition whilst other patients experienced significant losses. Observed changes in body composition predominantly reflect sex differences and may offer an opportunity to improve nutritional monitoring and future patient care. Disclosure All authors have declared no conflicts of interest.

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