The Prognostic Role of Early Skeletal Muscle Mass Depletion in Multimodality Management of Patients with Advanced Gastric Cancer Treated with First Line Chemotherapy: A Pilot Experience from Modena Cancer Center

Background: Few data about the link between nutritional status and survival are available in the metastatic gastric cancer (GC) setting. The aim of this work was to evaluate the prognostic role of tissue modifications during treatment and the benefit of a scheduled nutritional assessment in this setting. Methods: Clinical and laboratory variables of 40 metastatic GC patients treated at Modena Cancer Center were retrieved: 20 received a nutritional assessment on the oncology’s discretion, the other 20 received a scheduled nutritional assessment at baseline and every 2–4 weeks. Anthropometric parameters were calculated on Computed Tomography (CT) images at the baseline and after 3 months of chemotherapy. Results: A correlation between baseline Eastern Cooperative Oncology Group Performance Status (ECOG PS), Lymphocyte to Monocyte Ratio (LMR), C-reactive protein (PCR), Prognostic Nutritional Index (PNI) and Overall survival (OS) was highlighted. Among the anthropometric parameters, early skeletal muscle mass depletion (ESMMD) >10% in the first months of treatment significantly impacted on mOS (p = 0.0023). A link between ESMMD and baseline LDH > 460 U/L, baseline CRP > 2.2 mg/dL and weight decrease during treatment emerged. Patients evaluated with a nutritional scheduled support experienced a mean gain in subcutaneous and visceral fat of 11.4% and 10.21%, respectively. Conclusion: We confirm the prognostic impact of ESMMD > 10% during chemotherapy in metastatic GC. The prognostic role of a scheduled nutritional assessment deserves further confirmation in large prospective trials.

Prevalência de risco de sarcopenia e obesidade sarcopênica entre idosos não-institucionalizados do interior do Ceará

Introduction: The loss of muscle mass is an expected consequence of aging, but excess adiposity has also been increasing in this age group. Both in isolation compromise health and quality of life, but a greater impact happens when they associate. Objective: To verify the prevalence of risk for sarcopenia and sarcopenic obesity among elderly in the municipality of Morada Nova-CE. Methods: Quantitative, transversal, descriptive and analytical study. Simple Questionnaire to Rapidly Diagnosed Sarcopenia (SARC-F) was applied. After, weight, height, calf circumference (CP) and triceps skinfolds (DCT), bicipital, subscapular and supra iliac were collected for diagnoses of nutritional status, sarcopenia and sarcopenic obesity. In descriptive statistics, mean and standard deviation were calculated. In inferential statistics, Pearson’s correlation tests, ANOVA and chisquare were applied. Results: A total of 121 elderly people aged 60 or over and of both sexes participated in the study. The majority of the elderly people (72%, n = 87) were female, with a mean age of 68.8 ± 6.18 years, ranging from 60 to 86 years. The main findings were: predominance of BMI eutrophy, obesity due to DCT adequacy and percentage of fat (% GC), absence of muscle mass depletion, sarcopenia and sarcopenic obesity. Conclusions: Most elderly people did not have sarcopenia or sarcopenic obesity. No association was found between these two diagnoses, nor between the results of SARC-F and CP. Women were more likely to have sarcopenia than men. We suggest studies that allow the establishment of consensus bridges for the diagnosis of sarcopenia and sarcopenic obesity, as well as studies involving the use of SARC-F for its diffusion and evaluation of its sensitivity for the diagnosis of sarcopenia.

Evaluating Impacts of Irrigation and Drought on River, Groundwater and a Terminal Wetland in the Zayanderud Basin, Iran

The Zayanderud Basin is an important agricultural area in central Iran. In the Basin, irrigation consumes more than 90 percent of the water used, which threatens both the downstream historical city of Isfahan and the Gavkhuni Wetland reserve—the final recipient of the river water. To analyze impacts of land use changes and the occurrence of metrological and hydrological drought, we used groundwater data from 30 wells, the standardized precipitation index (SPI) and the streamflow drought index (SDI). Changes in the wetland were analyzed using normalized difference water index (NDWI) values and water mass depletion in the Basin was also assessed with gravity recovery and climate experiment (GRACE)-derived data. The results show that in 45 out of studied 50 years, the climate can be considered as normal in respect to mean precipitation amount, but hydrological droughts exist in more than half of the recorded years. The hydrological drought occurrence increased after the 1970s when large irrigation schemes were introduced. In recent decades, the flow rate reached zero in the downstream part of the Zayanderud River. NDWI values confirmed the severe drying of the Gavkhuni Wetland on several occasions, when compared to in situ data. The water mass depletion rate in the Basin is estimated to be 30 (±5) mm annually; groundwater exploitation has reached an average of 365 Mm3 annually, with a constant annual drop of 1 to 2.5 meters in the groundwater level annually. The results demonstrate the connection between groundwater and surface water resources management and highlight that groundwater depletion and the repeated occurrence of the Zayanderud River hydrological drought are directly related to human activities. The results can be used to assess sustainability of water management in the Basin.

Dietary Amino Acids and Immunonutrition Supplementation in Cancer-Induced Skeletal Muscle Mass Depletion: A Mini-Review

Cancer patients display systemic inflammation, which leads to an increase in protein catabolism, thus promoting the release of free amino acids to further support metabolism and remodelling of muscle proteins. Inflammation associated with tumor growth leads to malnutrition, a factor that increases the risk of developing cachexia. With cancer-induced cachexia, nutritional interventions have gained traction as a preventative method to manage this condition. Currently, cancer consensus recommendations suggest a protein intake above 1.0 g/kg.day-1 up to 2.0 g/k.day-1 for cancer patients, although an ideal amount for some amino acids in isolation has yet to be determined. Due to controversy in the literature regarding the benefits of the biochemical mechanisms of various muscle mass supplements, such as L-leucine (including whey protein and BCAA), β-hydroxy-beta-methyl butyrate (HMβ), arginine, glutamine and creatine, several studies have carefully examined their effects. L-leucine and its derivatives appear to regulate protein synthesis by direct or indirect activation of the mTORC1 pool of kinases, further promoting muscle protein balance. Arginine and glutamine may act by reducing inflammation and infection progression, thus promoting improvements in food intake. Creatine exerts anabolic activity, acting as an immediate energy substrate to support muscle contraction further increasing lean mass, mainly due to greater water uptake by the muscle. In this narrative review, we highlighted the main findings regarding protein consumption and amino acids to mitigate cancer-induced skeletal muscle depletion.

On the inclinations of the Jupiter Trojans

Jupiter Trojans are a resonant asteroidal population characterised by photometric colours that are compatible with trans-Neptunian objects, high inclinations, and an asymmetric distribution of the number of asteroids between the two swarms. Different models have been proposed to explain the high inclination of the Trojans and to interpret their relation with the Trans-Neptunian objects, but none of these models can also satisfactorily explain the asymmetry ratio between the number of asteroids in the two swarms. It has recently been found that the asymmetry ratio can arise if Jupiter has migrated inwards through the protoplanetary disc by at least a few astronomical units during its growth. The more numerous population of the leading swarm and the dark photometric colours of the Trojans are natural outcomes of this new model, but simulations with massless unperturbed disc particles led to a flat distribution of the Trojan inclinations and a final total mass of the Trojans that was 3–4 orders of magnitude larger than the current mass. We here investigate the possible origin of the peculiar inclination distribution of the Trojans in the scenario where Jupiter migrates inwards. We analyse different possibilities: (a) the secular evolution of an initially flat Trojan population, (b) the presence of planetary embryos among the Trojans, and (c) capture of the Trojans from a pre-stirred planetesimal population in which Jupiter grows and migrates. We find that the secular evolution of the Trojans and secular perturbations from Saturn do not affect the inclination distribution of the Trojans appreciably, nor is there any significant mass depletion over the age of the Solar System. Embryos embedded in the Trojan swarms, in contrast, can stir the Trojans to their current degree of excitation and can also deplete the swarms efficiently, but it is very difficult to remove all of the massive bodies in 4.5 Gyr of evolution. We propose that the disc where Jupiter’s core was forming was already stirred to high inclination values by other planetary embryos competing in the feeding zone of Jupiter’s core. We show that the trapped Trojans preserve their high inclination through the gas phase of the protoplanetary disc and that Saturn’s perturbations are more effective on highly inclined Trojans, leading to a lower capture efficiency and to a substantial depletion of the swarms during 4.5 Gyr of evolution.

Thumb adductor muscle thickness used in the nutritional assessment of chronic kidney disease patients under conservative treatment

Introduction: Evaluate the association between the thumb adductor muscle thickness and the patient's nutritional status, and propose cutoff points for muscle mass depletion in elderly patients with chronic kidney disease (CKD) under conservative treatment. Epidemiological and cross-sectional study, including patients with CKD stages 3 to 5, older than 60 years. Socioeconomic, clinical, physical activity and anthropometric data was obtained. TAMT was described and compared according to CKD stage, socioeconomic data, physical activity, nutritional status and correlated with age, glomerular filtration rate and anthropometric variables. Receiver Operating Characteristic (ROC) curves were produced, considering the lean tissue index classification as reference. The cut-off point was defined by the Youden index. Results: We evaluated 137 individuals. The TAMT was lower in malnourished and/or depleted muscle mass individuals; among males it was higher among those who practiced physical activities (p <0.05). This measure was moderately correlated with BMI, calf and brachial circumferences, lean body tissue, lean tissue index and body cell mass (r <0.7); negatively with age (r = -0.34). The ROC curve analysis determined cut points of 15.33 mm for females and 20.33 mm for males, with 72.22% and 62.50% accuracy, respectively. Conclusion: TAMT is used to estimate muscle mass and we suggest the cutoff point is useful to rule out the likelihood of muscle mass depletion. It is recommended that it be used in a complementary way in nutritional assessment.