Impact of Obesity and Visceral Fat on Mortality in Hematopoietic Stem Cell Transplantation

Pereira, Andréa Z; Almeida-Pitito, Bianca de; Eugenio, Gisele Cristine; Prado, Rogério Ruscitto do; Silva, Cinthya Correa; Hamerschlak, Nelson

doi:10.1002/jpen.2048

Cited by 9 publications

(6 citation statements)

References 43 publications

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“…Higher echogenicity and lower muscle stiffness were associated with a higher BMI in the deltoid. The association of higher BMI and higher echogenicity is expected [ 38 ] but the predilection to the deltoid is interesting and warrants further study. Apart from the expected greater muscle bulk in the deltoid in males, there were no gender-related differences in muscle stiffness or other US measures in other muscles.…”

Section: Discussionmentioning

confidence: 99%

Muscle shear wave elastography, conventional B mode and power doppler ultrasonography in healthy adults and patients with autoimmune inflammatory myopathies: a pilot cross-sectional study

Paramalingam

Needham

Raymond

et al. 2021

BMC Musculoskelet Disord

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Background Before the role of shear wave elastography (SWE) and B mode ultrasound (US) in the diagnosis of different forms of idiopathic inflammatory myopathies (IIM) can be investigated, normative data is required. This study aimed to describe and then compare normative SWE and B mode ultrasound metrics of muscles in healthy controls and patients with IIM. Methods Twenty nine healthy adult controls and 10 IIM patients (5 with inclusion body myositis and 5 with necrotising autoimmune myopathy) underwent a full clinical examination, laboratory investigations, SWE and US measurements of selected proximal and distal limb muscles. Shear wave speed (SWS) and multiple US domains [echogenicity, fascial thickness, muscle bulk and power Doppler (PD)] were measured in both groups. Results In healthy controls (n = 29; mean age 46.60 ± 16.10; 44.8 % female), age was inversely correlated with SWS at the deltoid (stretch) (Rs. -0.40, p = 0.030) and PD score at the deltoid (rest) (Rs. -0.40, P = 0.032). Those ≥ 50 years old had a lower SWS at the deltoid (stretch) compared to the < 50 year group (2.92 m/s vs. 2.40 m/s, P = 0.032). Age correlated with increased echogenicity in the flexor digitorum profundus (Rs. 0.38, P = 0.045). Females had a smaller muscle bulk in the deltoid (P = 0.022). Body mass index (BMI) was inversely associated with SWS in the deltoid (stretch) (Rs – 0.45, P = 0.026), and positively correlated with echogenicity in the deltoid (Rs. 0.69, P = 0.026). In patients ≥50 years of age, patients with IIM (mean age 61.00 ± 8.18; females 20.0 %) had a higher proportion of abnormal echogenicity scores at the flexor digitorum profundus (FDP) (40.00 % vs. 14.30 %, P = 0.022) and tibialis anterior (TA) (80.00 % vs. 28.60 %, P = 0.004). Fascial thickness was lower in the FDP (0.63mm vs. 0.50mm, p = 0.012) and TA (0.58mm vs. 0.45mm, P = 0.001). Conclusions Our findings suggest there is scope for US techniques to be useful for diagnostic screening of affected muscles in patients with IIM, especially in those with suspected inclusion body myositis or necrotising autoimmune myopathy. We provide normative data for future studies into SWE and US techniques in skeletal muscle. The differences between IIM patients and controls warrant further study in a broader IIM patient cohort.

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Section: Discussionmentioning

confidence: 99%

Muscle shear wave elastography, conventional B mode and power doppler ultrasonography in healthy adults and patients with autoimmune inflammatory myopathies: a pilot cross-sectional study

Paramalingam

Needham

Raymond

et al. 2021

BMC Musculoskelet Disord

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“…In the context of allo-HSCT, we have recently demonstrated that mice with dietinduced obesity (DIO) placed on high-fat (HF) diets developed more severe acute GVHD due in part to the induction of a heightened pro-inflammatory cytokine storm (4). These effects were also observed clinically in high-BMI HSCT recipients (4)(5)(6)(7). Interestingly, it was also observed that obesity resulted in restricted microbiome diversity and increased gut permeability, which may account for the specific targeting of the gut for acute GVHD attack (4,(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Mechanisms by Which Obesity Promotes Acute Graft-Versus-Host Disease in Mice

et al. 2021

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The efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) is limited by the occurrence of acute and chronic graft-versus-host disease (GVHD). We have recently demonstrated that obesity results in exacerbated acute gastrointestinal GVHD in both mouse models and clinical outcomes due to increased pro-inflammatory cytokine responses and microbiota alterations. We therefore wanted to delineate the role of the various parameters in obesity, adiposity, effects of high-fat (HF) diet, and the role of microbiome on GVHD pathogenesis, by taking advantage of a mouse strain resistant to diet-induced obesity (DIO). Female BALB/c mice are resistant to DIO phenotype with approximately 50% becoming DIO under HF diets. The DIO-susceptible recipients rapidly succumb to acute gut GVHD, whereas the DIO-resistant recipient littermates, which do not become obese, are partially protected from GVHD, indicating that being on HF diet alone contributes to but is not the primary driver of GVHD. Microbiome assessment revealed restricted diversity in both cohorts of mice, but coprophagy normalizes the microbiota in mice housed together. We then individually housed DIO-resistant, DIO-susceptible, and lean control mice. Notably, each of the individually housed groups demonstrates marked restricted diversity that has been shown to occur from the stress of single housing. Despite the restricted microbiome diversity, the GVHD pathogenesis profile remains consistent in the group-housed mice, with the lean control single-housed mice exhibiting no acute GVHD and DIO-resistant recipients showing again partial protection. These results demonstrate that the deleterious effects of obesity on acute gut GVHD are critically dependent on adiposity with the HF diet also playing a lesser role, and the microbiome alterations with obesity instead appear to fuel ongoing acute GVHD processes.

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“…6 Nutritional sequelae such as obesity, malnutrition and sarcopenia impact and predict HCT outcomes. Obesity pre-HCT is increasingly prevalent 7 negatively predicting 100-day readmission, nonrelapse mortality 8,9 and Graft-versus-Host Disease (GvHD) rates. 8 Malnutrition, defined as undernutrition in this context, impacts treatment outcome, length of admissions, infectious complications, 9 fatigue and quality of life.…”

Section: Introductionmentioning

confidence: 99%

“…Obesity pre-HCT is increasingly prevalent 7 negatively predicting 100-day readmission, nonrelapse mortality 8,9 and Graft-versus-Host Disease (GvHD) rates. 8 Malnutrition, defined as undernutrition in this context, impacts treatment outcome, length of admissions, infectious complications, 9 fatigue and quality of life. 10 Additionally, secondary sarcopenia, a loss of skeletal muscle mass associated with cancer related inflammation and nutritional deficiencies, 11 is an independent negative prognostic indicator for HCT outcomes.…”

Section: Introductionmentioning

confidence: 99%

Health professional attitudes and perceptions of prehabilitation and nutrition before haematopoietic cell transplantation

Miller,

Halliday,

Snowden

et al. 2024

J Human Nutrition Diet

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BackgroundNutritional prehabilitation may improve haematopoietic cell transplantation (HCT) outcomes, although little evidence exists. The present study aimed to understand healthcare professional (HCP) perceptions of prehabilitation and nutritional care pre‐HCT in UK centres.MethodsAn anonymous online survey (developed and refined via content experts and piloting) was administered via email to multidisciplinary HCPs in 39 UK adult centres, between July 2021 and June 2022. Data are presented as proportions of responses. Routine provision denotes that care was provided >70% of time.ResultsSeventy‐seven percent (n = 66) of HCPs, representing 61.5% (n = 24) of UK adult HCT centres, responded. All HCPs supported prehabilitation, proposing feasible implementation between induction chemotherapy (60.4%; n = 40) and first HCT clinic (83.3%; n = 55). Only 12.5% (n = 3) of centres had a dedicated prehabilitation service. Nutrition (87.9%; n = 58), emotional wellbeing (92.4%; n = 61) and exercise (81.8%; n = 54) were considered very important constituents. HCPs within half of the HCT centres (n = 12 centres) reported routine use of nutrition screening pre‐HCT with a validated tool; 66.7% of HCPs (n = 36) reported using the malnutrition universal screening tool (MUST). Sixty‐two percent (n = 41) of HCPs reported those at risk, received nutritional assessments, predominantly by dietitians (91.6%; n = 22) using the dietetic care process (58.3%; n = 14). Body mass index (BMI) was the most frequently reported body composition measure used by HCPs (70.2%, n = 33). Of 59 respondents, non‐dietitians most routinely provided dietary advice pre‐HCT (82.4%; n = 28 vs. 68%; n = 17, p = 0.2); including high‐energy/protein/fat and neutropenic diet advice. Prophylactic enteral feeding pre‐HCT was rare, indicated by low BMI and significant unintentional weight loss. Just under half (n = 25 of 59, 42.4%) HCPs reported exercise advice was given routinely pre‐HCT.ConclusionsNutrition and prehabilitation pre‐HCT are considered important and deliverable by HCPs, but current provision in UK centres is limited and inconsistent.

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Impact of Obesity and Visceral Fat on Mortality in Hematopoietic Stem Cell Transplantation

Cited by 9 publications

References 43 publications

Muscle shear wave elastography, conventional B mode and power doppler ultrasonography in healthy adults and patients with autoimmune inflammatory myopathies: a pilot cross-sectional study

Muscle shear wave elastography, conventional B mode and power doppler ultrasonography in healthy adults and patients with autoimmune inflammatory myopathies: a pilot cross-sectional study

Mechanisms by Which Obesity Promotes Acute Graft-Versus-Host Disease in Mice

Health professional attitudes and perceptions of prehabilitation and nutrition before haematopoietic cell transplantation

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