CT-Determined Sarcopenia in GLIM-Defined Malnutrition and Prediction of 6-Month Mortality in Cancer Inpatients

Abstract

Our objective was to evaluate the clinical application of third lumbar vertebra (L3)-computer tomography (CT)-determined sarcopenia as a marker of muscle mass in cancer inpatients diagnosed with malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and to establish its association with 6-month mortality. Methods: This was an observational, prospective study in patients from an inpatient oncology unit. We performed a nutritional assessment according to GLIM criteria, including muscle cross-sectional area at L3 by CT and skeletal muscle index (SMI). Six-month mortality was evaluated. Results: A total of 208 patients were included. The skeletal muscle cross-sectional area at L3 was 136.2 ± 32.5 cm2 in men and 98.1 ± 21.2 cm2 in women. The SMI was 47.4 ± 12.3 cm2/m2 in men and 38.7 ± 8.3 cm2/m2 in women. Sarcopenia (low SMI) was detected in 59.6% of the subjects. Using SMI as a marker of low muscle mass in application of GLIM criteria, we found 183 (87.9%) malnourished patients. There were 104 deaths (50%) at 6 months. The deceased patients had a lower skeletal muscle cross-sectional area (112.9 ± 27.9 vs. 126.1 ± 37.8 cm2; p = 0.003) and a lower SMI (41.3 ± 9.5 vs. 45.7 ± 12.9 cm2/m2; p = 0.006). An increased risk of 6-month mortality was found in malnourished patients according to GLIM criteria using SMI (HR 2.47; 95% confidence interval 1.07–5.68; p = 0.033). Conclusions: Low muscle mass, assessed by L3-CT, was observed to affect more than half of cancer inpatients. The deceased patients at 6 months had a lower skeletal muscle cross-sectional area and SMI. Malnutrition according to GLIM criteria using CT-determined sarcopenia was shown to adequately predict 6-month mortality.

Sarcopenia as Manifested by L3SMI Is Associated with Increased Long-Term Mortality amongst Internal Medicine Patients—A Prospective Cohort Study

“…Currently, CT is considered the gold standard for Sarcopenia evaluation due to its accuracy in body composition measurement and its availability in the clinical setting [ 20 , 21 ]. As a result, this imaging method is used to detect low muscle mass, even in patients with normal or high body weights, and it can also predict prognosis in various diseases [ 22 , 23 , 24 ]. L3SMI is not limited to patients with cancer; for example, this parameter has been used as a predictor of mortality and other outcomes in the intensive care unit [ 25 ].…”

The Determination of a Consensus Nutritional Approach for Cancer Patients in Spain Using the Delphi Methodology

“…Parallel to the global nutritional status of cancer patients, body composition and the importance of muscle mass and its relationship with the functional capacity of these patients are becoming increasingly important, as they are key aspects both in the clinical evolution of a patient’s disease and in a patient’s physical and mental health [ 28 ]. In recent years, the relationship between malnutrition and sarcopenia has become more relevant (in fact, the GLIM criteria themselves introduce a decrease in muscle mass as a criterion for malnutrition).…”

Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating

“…Chemotherapy and radiation toxicity reduction should result in better eating and less sarcopenia [47,[74][75][76][77][78]113,[116][117][118]. This complex and often bidirectional interaction (Figure 1) may also translate into fewer episodes of fever and neutropenia and improved survival [75][76][77].…”

“…Medical professionals and cancer patients alike believe toxicities are inevitable and general amelioration techniques are often overlooked. Difficulty eating and malnutrition during cancer therapy are common problems that can be assessed with many tools [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]. The challenge is to have an acceptable quality and quantity of nutrient intake with minimal toxicity without compromising effective cancer treatment.…”

“…Malnutrition in cancer patients is a common problem. There are many indices and tools to define malnutrition, cachexia, and sarcopenia [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]62,[69][70][71][72][73][74][75][76][77]. Although weight loss from the time of diagnosis is one measure, the quantity and quality of food in the diet and information from the patient generated subjective global assessment (PG-SGA) tool can provide more specific information [35,36,45,51,62,66,[69][70][71][72][73][78][79][80].…”