The role of exercise and myokine production in counteracting frailty

Recent studies have identified energy dysregulation as one of the principle drivers of frailty. Exercise, the most effective tool to combat frailty, is associated with energy metabolism upregulation and reduction of inflammation. It has been hypothesised this therapeutic effect is linked to the production of myokines by skeletal muscle in response to acute and chronic exercise. Evidence has concluded that myokines play a crucial role in upholding energy metabolism and combating inflammation. However, despite this, only a limited number of studies have examined the changes in myokine concentrations with exercise in older adults.

This review aims to summarise evidence supporting an association between energy metabolism and frailty. It also assesses the role of myokines, released during exercise, in combating frailty.

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Cancer cachexia knowledge and practice gaps: a review

Cancer cachexia is a wasting disorder, where nutritional interventions cannot fully aid in restoring weight in patients. It severely impacts quality of life and survival rates of patients. In this study, a 58-question questionnaire was completed by clinicians to understand the knowledge and practice gaps within the treatment of cancer cachexia. Some issues raised included the lack of a standardised definition of cancer cachexia for diagnosis, with 43% of respondents stating that low levels of attention are given to providing such a diagnosis. Furthermore, it was reported that screening for cachexia was not completed routinely, among other practice gaps.
This review by Baracos VE et al. aimed to highlight the gaps in understanding of cancer cachexia that clinicians face worldwide.

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Body mass index, weight loss and survival in advanced lung cancer: a review

For patients with advanced-stage cancer, weight loss and lower body mass index has been associated with shorter rates of survival. On the other hand, obesity has been associated with longer survival. Weight loss or cachexia could therefore be used as a prognostic tool, although it has not yet been studied much in clinical trials. It is predicted to be due to the fact that decreased muscle mass is a predictor of shortened survival, as well as lowered nutrient stores and activity level. However, further research is required into understanding weight loss in relation to cancer survival rates, especially in the context of therapies such as chemotherapy, as it is not fully known how this interacts with body mass.
This review by Oswalt C et al. aimed to explore the relationship between body mass index, weight loss and survival rates in advanced lung cancer.

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Frailty instruments in patients with heart failure: a comparison of predictive performance

Frailty is characterised by increased vulnerability to acute stressors. As it is common in adults with heart failure (HF), frailty has been used as a predictor of mortality and morbidity for HF patients.
Frailty Phenotype, the most commonly used frailty instrument in HF, is used for the physical examination of frailty. While physical frailty instruments are commonly used in clinical practice, a proportion of studies have expressed issues with such tools. As HF may have detrimental effects on physical function, the use of physical instruments may lead to an under- or over-estimation of frailty.

This study aims to compare the predictive ability of three physical frailty instruments (the Frailty Phenotype, the St Vincent’s Frailty instrument and the SHARE-FI); and three multi-domain instruments (the FRAIL scale, the Deficit Accumulation Index, and St Vincent’s Frailty plus cognition 7 and mood) in adults with HF.

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Knowledge gaps surrounding the definition, diagnosis, and management of sarcopenia

While it was initially characterised by a loss of muscle mass, sarcopenia has been defined by several international panels as a decline in muscle function, with a focus on muscle strength and physical performance. Despite the existence of algorithms and research into screening tools for its diagnosis, sarcopenia has not yet been appropriately recognised by the World Health Organisation’s latest version of the ICD (ICD-11), which is used by most countries. Definitions of sarcopenia are growing more precise, yet this does not translate into improved patient care and outcomes.

This article aims to summarise the knowledge gaps surrounding sarcopenia’s definition, diagnosis, and treatment in current clinical practice. It also highlights the next steps in achieving worldwide sarcopenia recognition.

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Sarcopenia: an adverse prognostic factor for patients with head and neck cancer?

Sarcopenia is characterised by progressive and generalised skeletal muscle loss, both in terms of mass and function. Its main risk factors include ageing, gender, sedentary lifestyles and malnutrition. The latter is also frequently diagnosed alongside head- and- neck squamous cell carcinomas (HNSCC), with up to 46%-49% of patients being malnourished upon diagnosis.
Although sarcopenia has been identified as a prognostic factor for HNSCC, only a small number of studies investigate the association between sarcopenia and survival in HNSCC.

This study aimed to assess the association between pre-therapeutic sarcopenia and survival, as well as its impact on tolerance of chemoradiotherapy for the treatment of HNSCC. The outcomes measured in this study were overall survival (OS), disease-free survival (DFS), and treatment tolerance.

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