Staying informed on the latest in cachexia, sarcopenia, and wasting disorders research is essential yet challenging. The SCWD Digest offers concise updates and expert insights into significant studies and developments. We highlight and link directly to leading research, making it easier for healthcare professionals to access and apply groundbreaking findings. Our goal: empower the medical community to advance patient care worldwide efficiently.
Currently, medical treatment for cancer is personalised by looking at genetic and molecular factors of cancer cells. However, for characterising patients, factors such as age, weight, BMI, comorbidities, etc are used. Hence, there is no set, universal variable(s) to be used in managing cancer. It is possible that this is the reason that many anticancer drugs perform poorly clinically, due to this variability between patients. One of the factors that can be used is chronological age, which defines the patient’s accumulated damage to their system. Age is an accurate predictor of various outcomes, including the outcomes of anticancer drug therapies. For example, patients between the ages of 65-69 are often less likely to respond well to chemotherapy. A way to index age is sarcopenia, but due to the complex, varying body compositions associated with tumour growth, it is difficult to use sarcopenia consistently as an index for age in cancer management.
This review by Laviano A aimed to explore variables, such as sarcopenia and ageing, in their effects on cancer and anticancer drug successes.
Out of all non-accidental deaths in the United States, paediatric cancer is the number one cause of death. Of children with cancer, 80% experience malnutrition during their treatment programmes. This statistic is dangerous, as malnutrition, as well as cachexia, worsen toxicity of treatment and the child’s quality of life. Yet, there are no standard definitions and nutritional interventions within clinical practice, with this varying between hospitals and clinicians on how to screen for and intervene with malnutrition. For example, some studies have explored Peptamen supplements for children with acute lymphoblastic leukaemia, whilst others tried isocaloric and hypercaloric supplements. Overall, there is a significant lack of nutrition-based studies in paediatric oncology patients. Yet, overall, it has been seen that nutritional interventions in general are seen to increase the patient’s weight and decrease the risk of complications during treatment. Furthermore, incorporating nutritional screening into the patient’s management decreases their risk for malnutrition.
This review by Franke J et al. aimed to explore the current available malnutrition screening and intervention methods across different hospitals and studies for childhood cancer, and to underscore the lack of a standard management system.
Which intervention is more effective in improving sarcopenia in older adults? A systematic review with meta-analysis of randomized controlled trials No pharmacologic intervention has yet been approved for the treatment of sarcopenia. Only exercise and nutritional support via increased protein…
📰 Journal: Mechanisms of Ageing and Development 2022
Three new definitions of sarcopenia have emerged in the past four years, proposed by the Sarcopenia Definition and Outcome Consortium (2020, SDOC), the European Working Group on Sarcopenia in Older People (2019, EWGSOP2) and the Asian Working Group on Sarcopenia (2019, AWGS2). No consensus on a unique definition of sarcopenia has yet been achieved, as the three new definitions proposed exhibit significant differences from each other. EWGSOP2’s definition of sarcopenia, for instance, characterises it as low muscle strength and mass, while the one developed by SDOC focuses on low muscle strength and gait speed instead.
The aim of this scoping review was to investigate all three recent sarcopenia definitions’ predictive validity for clinical outcomes.
The Journal of Cachexia, Sarcopenia and Muscle mainly publishes research on cachexia, sarcopenia and muscle wasting disorders, but also includes papers on cancer, heart failure, ageing and many other conditions. Before November 2022, there were seen to be 775,000 downloads of the articles within the journal, with the top three countries downloading articles being China, the US and Japan. The most downloaded and cited article is entitled, Cachexia as a major underestimated and unmet medical need: facts and numbers.
This review by Frohlich A et al. aimed to review the successes of the Journal of Cachexia, Sarcopenia and Muscle in 2022.
Frailty is a known risk factor for negative surgical outcomes, and the Liver Frailty Index (LFI) has been shown to predict mortality in patients awaiting liver transplants. Despite this, neither a diagnosis of frailty nor a patient’s LFI holds any weight when determining their position on liver transplant waitlists.
The aim of this article was to assess frailty and the LFI’s ability to predict pre- and post-transplant outcomes.
Sarcopenia is characterised by an age-related decline in muscle mass and strength combined with impairments in physical function. The risk of falls, fractures, and death is doubled in individuals with sarcopenia compared to those without. This patient population also frequently possesses comorbid diseases, including diabetes, cardiovascular disease, dementia, and chronic obstructive pulmonary disease. This may significantly increase their risk of suffering adverse outcomes post-surgery.
The aim of this editorial was to expose the serious nature of sarcopenia and underscore associated knowledge gaps in clinical practice.
Around half of a healthy person’s body weight is made up of skeletal muscle. This type of muscle is able to demonstrate high levels of plasticity. In muscle homeostasis, as well as repair processes, there are satellite cells and inflammatory cells which play key roles. However, if the recruitment of inflammatory cells is not carefully controlled, muscle atrophy and fibrosis may occur, leading to muscle function impairment. Hence, the inflammation occurring in muscle repair as a double-edged sword. This is because inflammatory mediators play a role in fighting pathogens as well as in the formation of mature myofibres, but may also cause damage to the muscle. For example, inflammation is also associated with cachexia - specifically, there is a correlation between cachexia and high levels of circulating cytokines.
This paper also ends with a summary of approaches to treating muscle wasting disorders, such as cachexia, discussing exercise, nutritional interventions and targeting inflammatory pathways.
This review by Bouredji Z et al. aimed to discuss inflammation in muscle homeostasis and repair, as well as some management approaches to muscle wasting disorders such as cachexia.
Pancreatic ductal adenocarcinoma, PDAC, is one of the most fatal types of solid tumours. It is also linked to a high prevalence of cachexia, with around 80% of PDAC patients exhibiting cachexia. There is one hypothesis, the endocrine organ–like tumour hypothesis, which aims to explain the reasons behind cancer cachexia occurring during pancreatic ductal adenocarcinoma. Some of the reasons include metabolites, epigenetic changes, hormonal disturbance and genetic instability may be behind the development of cancer cachexia. Generally, the belief is held that metabolic disruption is the process behind cachexia development, but it is also believed there is not one single factor that triggers it.
This review by Yu Y et al aimed to synthesise an understanding of cancer cachexia development and the response of cachexia to current available treatments.
For patients with head and neck cancer, malnutrition and frailty are linked with adverse treatment outcomes, higher mortality rates, complications post-surgery and generally lower quality of life. However, the relationship between malnutrition and frailty is not fully known. It is, however, clear that these two conditions often coexist, suggesting they may share similar risk factors. In this study on 197 patients, it was found that the risk of malnutrition is strongly positively associated with frailty. However, some other interesting factors were discovered. Alcohol consumption was shown to present a greater risk of developing malnutrition, but on the other hand, alcohol consumption seems protective for being frail. Overall, these conditions often coexist but do not always fully overlap: screening for both conditions is therefore recommended.
This review by Dewansingh P et al aimed to understand the relationship between the risk of malnutrition and frailty in patients with head and neck cancer.
Dynapenia is characterised by an age-related loss of muscle strength. When coupled with low muscle mass, it is instead diagnosed as sarcopenia according to the European Working Group on Sarcopenia in Older People revised guidelines (EWGSOP2).
The SARS-CoV-2 infection is accompanied by severe inflammation and increased catabolism, which may significantly impact infected patients’ skeletal muscle structure and function. These impacts may be detrimental to elderly patients, who are disproportionately affected and already highly burdened by the disease. Recent studies have suggested that sarcopenia at the time of hospital admission may shape older patients’ length of stay and increase mortality in those with moderate to severe COVID-19.
The aim of this study was to examine the association between simple clinical biomarkers, including those for the assessment of muscle function and frailty, and the risk of poor survival as well as increased length of hospital stay in older patients with COVID-19. Sarcopenia was screened using SARC-F, while frailty was assessed in accordance with the Rockwood Clinical Frailty Scale.
Patients with chronic kidney disease (CKD) possess an increased risk of developing physical or phenotypic frailty. The skeletal muscle dysfunction underpinning physical frailty has been associated with increased mortality. CKD-related phenotypic frailty shares features with ageing-related frailty, and CKD has thus been touted as a clinically relevant model of premature ageing.
The aim of this review was to examine the metabolic basis and pathogenesis of the skeletal muscle dysfunction responsible for phenotypic frailty in patients with CKD.
Ageing is associated with increased fat accumulation and weight gain due to altered energy metabolism. Sarcopenia, defined as a loss of muscle mass and function associated with increased mortality risk, is also linked to ageing.
Sarcopenia obesity (SO) refers to the combination of age-related sarcopenia and obesity, and stems from the negative correlation between intermuscular adipose tissue accumulation and muscle performance.
While elderly patients with obesity possess lower death rates than those with lower body mass indexes, patients with SO have higher mortality rates than these same peers. This, as well as obesity’s protective role against sarcopenia in the elderly, is the basis of the commonly known ‘obesity paradox’.
The aim of this review was to assess the current clinical evidence relating to SO.
It is known that advanced liver disease and frailty are heavily interlinked, and frailty’s association with an increased risk of progression to cirrhosis and death has been widely documented. Patients with advanced liver disease who are on waiting lists for liver transplants are urged to increase their physical activity prior to surgery. However, this patient population only represents a minority of liver disease patients.
This article aims to examine the prevalence of frailty in patients with non-cirrhotic non-alcoholic fatty liver disease (NAFLD), and exposes the faults of current models of care for this patient population.
Cancer cachexia has no simple criteria to distinguish its severity in patients. Diagnostic criteria generally includes observing factors such as weight loss, fatigue, abnormal levels of albumin, reduced food intake and others. However, this study explored the cachexia staging score, a method of diagnosing cancer cachexia severity. This score explores strength, walking, rising from a chair, climbing up stairs and how often the patients fall. This allows clinicians to understand the patient’s muscle function. In this study, the cachexia staging score was testing in patients with advanced cancer who are receiving palliative care, to assess its usefulness in these patients. Here, the cachexia staging score was excellent at predicting life expectancy in the patients with advancing cancer receiving palliative care, and was able to classify patients according to their different stages of cachexia. This review by Ueshima J et al. aimed to assess whether the cachexia staging score could be applied to patients with advanced cancer under palliative care.
Cancer cachexia can be mainly categorised with the occurrence of muscle loss, malnutrition and systemic inflammation. Its prognosis can be assessed through the cachexia index, but the use of this index is limited due to it being a complicated procedure with high testing costs. This study explored using a hand grip strength-based cachexia index, testing it with 14, 682 cancer patients. A low hand grip strength index score was found to be associated with high systemic inflammation, high levels of malnutrition and co-morbidities, implying that this index may be associated with disease progression. Overall, using the hand grip strength index for cachexia reflects the muscular and inflammatory conditions of cachexia in one assessment, rather than using multiple such as serum albumin testing, in a simple, non-invasive measure. Furthermore, there is a potential that hand grip strength can provide information about the prognosis of other malignancies.
This review by Xie H et al. aimed to compare the hand grip strength-based cachexia index to the original cachexia index to understand its benefits.
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