Associations of upper- and lower-limb muscle strength, mass, and quality with health-related quality of life in community-dwelling older adults.

AIM: This study aimed to investigate the associations between upper- and lower-limb muscle strength, mass, and quality and health-related quality of life (HRQoL) among community-dwelling older adults. METHODS: A cross-sectional study was conducted with 428 Brazilian community-dwelling older adults aged 60 to 80 years. Upper- and lower-limb muscle strength were evaluated through the handgrip strength (HGS) test and the 30-s chair stand test, respectively. Muscle mass was assessed by dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA). Muscle quality was evaluated using the muscle quality index (MQI). HRQoL was assessed using the World Health Organization Quality of Life Brief Version questionnaire. RESULTS: Lower-limb, but not upper-limb, muscle strength and quality were independently associated with HRQoL, particularly within the domains of physical capacity, environment, and overall HRQoL for both males and females (P < 0.05). DXA- and BIA-derived analyses provided similar results in relation to muscle mass and muscle quality. CONCLUSIONS: Lower-limb, but not upper-limb, muscle strength and quality were independently associated with HRQoL among community-dwelling older adults. Moreover, the results obtained from both BIA and DXA were similar, highlighting that BIA can serve as a viable surrogate method for estimating body composition in resource-limited clinical settings. Geriatr Gerontol Int 2024; 24: 683-692.

Prognostic value of overhydration and bioelectrical impedance vector on short- and long-term outcomes in hospitalized patients with cancer.

BACKGROUND & AIMS: Water, an essential component of body composition, appears to be a significant predictor of adverse outcomes in clinical populations, despite being frequently underexplored. Bioelectrical impedance analysis (BIA) and vector analysis (BIVA) are easy and cost-effective bedside tools for estimating body composition, particularly water content. Therefore, our study aimed to assess the impact of hydration and fluid status using both BIA and BIVA on outcomes in hospitalized patients with cancer. METHODS: A prospective cohort study involving hospitalized individuals with cancer was conducted. Total body water (TBW) was estimated using BIA. Extracellular-water/TBW (ECW/TBW) and ECW/intracellular-water (ECW/ICW) ratios were calculated. BIVA ellipses vectors were constructed to enhance our analysis of hydration status. Participants were followed during their hospital stay and up to six months after discharge to assess outcomes, including in-hospital mortality, 6-month non-elective rehospitalization, and 6-month mortality. RESULTS: TBW, ECW/TBW, ECW/ICW ratios, and BIVA plots were not associated with non-elective rehospitalization during the follow-up period. However, TBW and an elevated ECW/ICW ratio were independent predictors of in-hospital mortality [hazard ratio (HR): 1.07 (1.01; 1.13) p = 0.020; HR: 4.23 (1.69; 10.58) p = 0.002]. Elevated ratios ECW/TBW and ECW/ICW were independent predictors of 6-month mortality [HR: 1.87 (1.10; 3.21) p = 0.022; HR: 2.49 (1.37; 4.51) p = 0.003]. BIVA vectors for in-hospital and 6-month mortality shifted significantly to the right, leading to cachexia and overhydration quadrants (p < 0.05). CONCLUSION: Abnormalities related to overhydration were important predictors of short- and long-term mortality in hospitalized patients with cancer.

Is there a difference in the parameters of the bioelectrical impedance obtained from devices from different manufacturers? A cross-sectional study in hospitalized cancer patients.

BACKGROUND: Cancer is a disease with high and increasing incidence rates in the world and its course tends to harm the body composition. Monitoring these body changes is very important. Therefore, it is essential to have reliable, accessible, and practical methods for evaluating body compartments. This study aims to evaluate the correlation and agreement of results for the bioelectrical impedance analysis (BIA) obtained from devices from different manufacturers. METHODS: This is a single-center cross-sectional study including hospitalized patients with cancer. Two devices from different brands used for obtaining the BIA were used; both with a tetrapolar model and a single frequency (50 kHz). The results were evaluated for resistance (R) and reactance (Xc) and used to calculate the phase angle (PhA) and fat-free mass (FFM) indicators. Pearson and Spearman correlation tests and Bland-Altman plots were performed, with results expressed as bias and limits of agreement at 95% confidence intervals (95%CI). RESULTS: We have included 116 patients, with a mean age of 60.8 ± 14.8, 51.7% were women. We have found very strong correlations between the measurements of R (rho = 0.971) and FFM (r = 0.979), and strong correlations for Xc (rho = 0.784) and PhA (rho = 0.768). However, the measurements did not agree between the methods. CONCLUSIONS: Commercial brands of devices used for the BIA influence the results generated, a factor that must be considered when choosing the most appropriate method for this analysis.

Early nutritional intervention does not prevent long-term adverse events in women with breast cancer: A pilot study.

AIM: This study aims to evaluate the effect of early nutritional intervention on adverse clinical events in women with breast cancer undergoing neoadjuvant chemotherapy. DESIGN AND SETTINGS: This is a randomized clinical trial performed at the beginning of neoadjuvant chemotherapy for women with breast cancer treated at an oncology referral center (Brazil) and followed until the end of radiotherapy period, at least. Registered under ClinicalTrials.gov Identifier no. RBR-3SHHXS. METHODS: Participants were allocated to a control group - CG (nutritional guidance on healthy eating practices) or an intervention group - IC (nutritional guidance and individualized food plan). Chemotherapy toxicity (primary endpoint) was considered a precocious adverse clinical event and it was evaluated by self-reported gastrointestinal symptoms observed at any time during the first three cycles of treatment. Post-surgical complications, radiotherapy toxicity, and weight change were considered long-term adverse events. RESULTS: 34 women (19 in the IG and 15 in the CG) were evaluated. The early nutritional intervention was associated with low gastrointestinal chemotoxicity (nausea, vomiting, and constipation, p < 0.001, p < 0.048, and p < 0.024, respectively). However, there were no statically significant differences between both groups in the presence of long-term adverse events (radiotherapy toxicity-88.2% vs 76.9%, weight loss-21.1% vs 26.7% for IC and CG respectively, p > 0.05 for both). CONCLUSION: The early nutritional intervention was associated with a low frequency of precocious events, but not with long-term adverse events in women with breast cancer during treatment.

Comparison of revised EWGSOP2 criteria of sarcopenia in patients with cancer using different parameters of muscle mass.

Calf circumference (CC) has been established as a marker of muscle mass (MM) with good performance for predicting survival in individuals with cancer. The study aims to determine the prevalence of sarcopenia according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria and to evaluate the accuracy of sarcopenia using low CC relative to MM assessment by computed tomography (CT) at third lumbar vertebra level (L3) as a reference. Cross-sectional study with cancer patients aged ≥ 60 years. Data included socio-demographic, clinical and anthropometric variables. MM was assessed by CC and by CT images at the L3. Sarcopenia was diagnosed according to the EWGSOP2 criteria: a) low handgrip strength (HGS) + reduced MM evaluated by CT; and b) low HGS + low CC. Pearson's correlation, accuracy, sensitivity, specificity, positive predictive and negative predictive value were analyzed. A total of 108 patients were evaluated, age of 70.6 ± 7.4 years (mean ± standard deviation). The prevalence of sarcopenia was of 24.1% (low MM) and 25.9% (low CC). The Kappa test showed a substantial agreement (K = 0.704), 81% sensitivity, and 92% specificity. Although the EWGSOP2 advises that we should use CC measures in the algorithm for sarcopenia when no other MM diagnostic methods are available, the findings allow the use of CC instead of MM by CT in cancer patients.

Low skeletal muscle radiodensity is the best predictor for short-term major surgical complications in gastrointestinal surgical cancer: A cohort study.

The aim of this study was to evaluate whether body composition, muscle function, and their association are predictive factors for short-term postoperative complications in patients with gastric and colorectal cancer. A prospective cohort study was conducted with patients undergoing resection of gastric and colorectal tumors. Nutritional status was assessed using Patient-Generated Subjective Global Assessment (PG-SGA) and anthropometric techniques. Low handgrip strength (HGS) was observed when <16kg for women, and <27kg for men. Computed tomography images were used to measure visceral adipose tissue, skeletal muscle index (SMI), and skeletal muscle radiodensity (SMD). Complications of grade II or above (according to Clavien-Dindo's classification) were considered in a follow-up period of up to 30 days after surgery. Major complications were defined when they reached grade III or above. A total of 84 patients were analyzed (57.1% female, 59.7 ± 12.6 years) and 19% were diagnosed with low HGS + low SMI or SMD. Postoperative complications occurred in 51.2%, and these patients presented significantly longer duration of surgery and hospital stay. Major complications were observed in 16.7% of the total number of patients. Binary logistic regression adjusted by age, sex, and tumor staging showed that low SMD, low HGS + low SMI or SMD, and obesity were independent risk factors for postoperative complications, but only low SMD was an independent risk factor for major postoperative complications. Low SMD is an independent risk factor for short-term major complications following surgery in patients with gastric and colorectal cancer.

Induction chemotherapy reduces extracellular heat shock protein 72 levels, inflammation, lipoperoxidation and changes insulin sensitivity in children and adolescents newly diagnosed with acute lymphoblastic leukemia.

BACKGROUND: Acute lymphoblastic leukemia (ALL) is associated with higher levels of pro-inflammatory cytokines and oxidative stress. Recently, the levels of extracellular heat shock protein 72 (eHSP72) were found to be elevated in ALL, and its elevation associated with poor prognosis. Therefore, considering the possible role of eHSP72 as a modulator of the immunological system and metabolism, the aim of this study was to describe the response of eHSP72 to the induction phase of chemotherapy, along with metabolic, inflammatory and oxidative stress markers, in children and adolescents newly diagnosed with ALL. METHODS: Nineteen patients were recruited and analysed before and after the induction phase of chemotherapy (with 28 days of duration). Blood samples were taken for the analysis of C-reactive protein (CRP), levels of lipoperoxidation, insulin (and HOMA-IR), cortisol, glucose, lipid profile and eHSP72. RESULTS: We found that induction phase of chemotherapy leads to a drop in glucose levels (from 101.79±19 to 75.8±9.7 mg/dL), improvements on inflammation (CRP levels, p<0.01) and oxidative stress (TBARS levels, p<0.01), reduction on eHSP72 (p=0.03) and improved insulin sensitivity (HOMA-IR, p=0.02). CONCLUSION: Our results indicate that eHSP72 may have an immune and metabolic role and could be used as a marker of the treatment success and metabolic changes in children with ALL.

Impact of weight loss with or without exercise on abdominal fat and insulin resistance in obese individuals: a randomised clinical trial.

Evidence supports an important contribution of abdominal obesity and inflammation to the development of insulin resistance (IR) and CVD. Weight loss in obese individuals can reduce inflammation and, consequently, IR, but the role of training remains unclear. The aim of this study was to evaluate the effects of body weight reduction with and without exercise over abdominal fat tissue (primary outcome) and IR. In this randomised clinical trial, forty-eight obese individuals (age 31·8 (SD 6·0) years, BMI 34·8 (SD 2·7) kg/m2) were randomised to either a diet-only group (DI) or a diet and exercise group (DI þ EXE). Treatment was maintained until 5% of the initial body weight was lost. At baseline and upon completion, the following parameters were analysed: biochemical parameters such as glycaemia and insulin for the determination of homeostasis model assessment of insulin resistance (HOMA-IR), high-sensitivity C-reactive protein (hs-CRP) and abdominal computed tomography for the determination of visceral and subcutaneous adipose tissue. A total of thirteen individuals dropped out before completing the weight-loss intervention and did not repeat the tests. In both the DI (n 18) and DI þ EXE (n 17) groups, we observed significant and similar decreases of visceral adipose tissue (difference between means: 7·9 (95% CI 29·5, 25·2) cm2, P»0·36), hs-CRP (difference between means: 20·06 (95% CI 20·19, 0·03) mg/l, P»0·39) and HOMA (difference between means: 20·04 (95% CI 20·17, 0·08), P»0·53). In the present study, 5% weight loss reduced abdominal fat and IR in obese individuals and exercise did not add to the effect of weight loss on the outcome variables.

Abdominal circumference as a predictor of 30-day outcome in acute coronary syndrome.

BACKGROUND: Abdominal circumference (WC) is the measure that correlates most closely with the risk factors and death from cardiovascular disease. However, the impact of obesity on the prognosis of patients with cardiovascular disease remains controversial and requires further clarification. OBJECTIVE: To evaluate WA as a predictor of 30-day outcome in patients who were hospitalized with acute coronary syndrome (ACS), in a referral hospital for the treatment of cardiovascular diseases. METHODS: Contemporary cohort 267 patients who were hospitalized for ACS and who were followed for 30 days after discharge, taking into account the major cardiovascular events - MACE - (death, reinfarction, rehospitalization for coronary artery bypass grafting procedures). In the first 24 hours of admission, patients answered a questionnaire and were subsequently measured for WC. The statistical analysis was performed with SPSS 17.0, using the chi-square test for categorical variables and Student t test for numerical variables, with significance level of p < 0.05. The variables that had p < 0.10 in the bivariate analysis were included in a logistic regression model to evaluate the WC role as an independent predictor of MACE. RESULTS: After multivariate analysis, only the female gender (OR = 8.86; 95% CI: 4.55-17. 10, p < 0.00), hypertension (OR = 2.06; 95% CI: 1.10-3.87; p = 0.02) and family history of ischemic heart disease (OR = 2.10; 95% CI: 1.17-3.74; p = 0.01) remained associated with the MACE. CONCLUSION: In our study, the modified AC was not associated with increased incidence of MACE over the 30 days of follow-up.