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.
It is known that traumatic muscle injury damages mitochondria, which may cause them to leak their contents into the cytoplasm and subsequently trigger calcium accumulation, cell death, endoplasmic reticulum stress, and the release of reactive oxygen species (ROS). The latter reduces mitochondrial quality and increases the number of unhealthy mitochondria present in the cell, which may delay post-injury muscle regeneration. Although this knowledge has informed studies demonstrating the beneficial effects of mitochondrial transplant therapy (MTT) on ischaemia-damaged myocardium, its effects on injured skeletal muscle remain undefined.
The aim of this article was to examine the effects of MTT on skeletal muscle function after neuromuscular injury. The latter was induced using BaCl2, which causes widespread muscle proteolysis via myofibre Ca2+ overload and hyper-contractions.
All types of ovarian cancers hold a high risk of morbidity and mortality for the patients. Currently, there are many efforts to assess ovarian cancer progression, to allow for the development of accurate treatment and management plans for preventing mortality in the long-term. A physical indicator of increased vulnerability is frailty. Frailty can lead to falls, hospitalisation and increased risk of death. Generally, frailty is closely associated with poor prognosis and shorter progression-free survival in many conditions, including ovarian cancer. However, diagnosing frailty is complex, due to a lack of a set definition and due to comorbidities appearing in older patients. Although this study draws useful conclusions, its limitation holds that some confounding factors could not be adjusted for, meaning further research is needed to understand the interplay between ovarian cancer and frailty.
This review by Can E et al. aimed to understand the prognostic value of frailty to predict complications and mortality in patients with ovarian cancer.
A consensus is held that all tumour patients should be offered the opportunity for regular screenings for nutritional disorders, and their results should be monitored. This is because after cancer treatments, there is a high risk of metabolic syndrome. Healthy diets and regular exercise can help with this. Nutritional disorders are a huge issue for cancer patients because almost half of all advanced tumour patients experience eating and weight loss issues - this increases the threat of cachexia. Food intake should be kept normal (not through enteral tube or parenteral feeding) for as much as possible, with good nutrition reducing the risk of tumour recurrence. In palliative cases, hunger and thirst should be subjectively satisfied to alleviate distress.
This review by Arends J aimed to assess the role of nutrition in cancer patients, all the way to palliative cases.
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 patientโs 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 childโs 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 patientโs weight and decrease the risk of complications during treatment. Furthermore, incorporating nutritional screening into the patientโs 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 proteinโฆ
๐ฐ 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. EWGSOP2โs 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 definitionsโ 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 patientโs LFI holds any weight when determining their position on liver transplant waitlists.
The aim of this article was to assess frailty and the LFIโs 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 personโs 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 organโlike 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 patientsโ 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 patientsโ 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 obesityโs protective role against sarcopenia in the elderly, is the basis of the commonly known โobesity paradoxโ.
The aim of this review was to assess the current clinical evidence relating to SO.
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