Sarcopenia and perioperative management of elderly surgical patients

Shi, Yan; Zhou, Ling; Yan, Enshi; Yang, Lifen; Yang, Chun; Liu, Cunming

doi:10.52586/4995

Cited by 13 publications

(4 citation statements)

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“…In addition, recent research indicates that individuals with sarcopenia experience immune abnormalities, persistent elevation of inflammatory biomarkers including tumor necrosis factor-α, interleukin-6, and dysbiosis of the gut microbiota. Notably, these biomarkers have the potential to increase the perioperative hazards associated with PD[ 29 , 31 - 34 ].…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia adversely impacts clinical outcomes in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis

Zhang,

Ma,

et al. 2024

World J Gastrointest Surg

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BACKGROUND Sarcopenia is a syndrome marked by a gradual and widespread reduction in skeletal muscle mass and strength, as well as a decline in functional ability, which is associated with malnutrition, hormonal changes, chronic inflammation, disturbance of intestinal flora, and exercise quality. Pancreatoduodenectomy is a commonly employed clinical intervention for conditions such as pancreatic head cancer, ampulla of Vater cancer, and cholangiocarcinoma, among others, with a notably high rate of postoperative complications. Sarcopenia is frequent in patients undergoing pancreatoduodenectomy. However, data regarding the effects of sarcopenia in patients undergoing pancreaticoduodenectomy (PD) are both limited and inconsistent. AIM To assess the influence of sarcopenia on outcomes in patients undergoing PD. METHODS The PubMed, Cochrane Library, Web of Science, and Embase databases were screened for studies published from the time of database inception to June 2023 that described the effects of sarcopenia on the outcomes and complications of PD. Two researchers independently assessed the quality of the data extracted from the studies that met the inclusion criteria. Meta-analysis using RevMan 5.3.5 and Stata 14.0 software was conducted. Forest and funnel plots were used, respectively, to demonstrate the outcomes of the sarcopenia group vs the non-sarcopenia group after PD and to evaluate potential publication bias. RESULTS Sixteen studies encompassing 2381 patients were included in the meta-analysis. The patients in the sarcopenia group (n = 833) had higher overall postoperative complication rates [odds ratio (OR) = 3.42, 95% confidence interval (CI): 1.95-5.99, P < 0.0001], higher Clavien-Dindo class ≥ III major complication rates (OR = 1.41, 95%CI: 1.04-1.90, P = 0.03), higher bacteremia rates (OR = 4.46, 95%CI: 1.42-13.98, P = 0.01), higher pneumonia rates (OR = 2.10, 95%CI: 1.34-3.27, P = 0.001), higher pancreatic fistula rates (OR = 1.42, 95%CI: 1.12-1.79, P = 0.003), longer hospital stays (OR = 2.86, 95%CI: 0.44-5.28, P = 0.02), higher mortality rates (OR = 3.17, 95%CI: 1.55-6.50, P = 0.002), and worse overall survival (hazard ratio = 2.81, 95%CI: 1.45-5.45, P = 0.002) than those in the non-sarcopenia group (n = 1548). However, no significant inter-group differences were observed regarding wound infections, urinary tract infections, biliary fistulas, or postoperative digestive bleeding. CONCLUSION Sarcopenia is a common comorbidity in patients undergoing PD. Patients with preoperative sarcopenia have increased rates of complications and mortality, in addition to a poorer overall survival rate and longer hospital stays after PD.

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Section: Discussionmentioning

confidence: 99%

Sarcopenia adversely impacts clinical outcomes in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis

Zhang,

Ma,

et al. 2024

World J Gastrointest Surg

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“…30 With the increase of age, the intracellular oxidative stress and reactive oxygen species (ROS) production in the skeletal muscle increase. 31 Excessive ROS can further aggravate mitochondrial damage, reduce the sensitivity of the insulin-like growth factors-1 (IGF-1) signal pathway, 32 and induce protein hydrolysis through enhancing UPP, leading to skeletal muscle atrophy. 15 (3) A series of changes have also occurred in mitochondrial structure and function with aging, including volume increase and crista loss.…”

Section: Pathogenesismentioning

confidence: 99%

Potential of Food Protein-Derived Bioactive Peptides against Sarcopenia: A Comprehensive Review

Zhu

Wang

et al. 2023

J. Agric. Food Chem.

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Sarcopenia is an age-related progressive muscle disorder characterized by accelerated loss of muscle mass, strength, and function, which are important causes of physiological dysfunctions in the elderly. At present, the main alleviating method includes protein supplements to stimulate synthesis of muscle proteins. Food protein-derived peptides containing abundant branched-chain amino acids have a remarkable effect on the improvement of sarcopenia. Understanding the underlying molecular mechanism and clarifying the structure–activity relationship is essential for the mitigation of sarcopenia. This present review recaps the epidemiology, pathogenesis, diagnosis, and treatment of sarcopenia, which facilitates a comprehensive understanding of sarcopenia. Moreover, the latest research progress on food-derived antisarcopenic peptides is reviewed, including their antisarcopenic activity, molecular mechanism as well as structural characteristics. Food-derived bioactive peptides can indeed alleviate/mitigate sarcopenia. These antisarcopenic peptides play a pivotal role mainly by activating the PI3K/Akt/mTOR and MAPK pathways and inhibiting the ubiquitin-proteasome system and AMPK pathway, thus promoting the synthesis of muscle proteins and inhibiting their degradation. Antisarcopenic peptides alleviate sarcopenia via specific peptides, which may be absorbed into the circulation and exhibit their bioactivity in intact forms. The present review provides a theoretical reference for mitigation and prevention of sarcopenia by food protein-derived bioactive peptides.

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“…Sarcopenia contributes to an increased risk of falls and disability, increased hospitalizations, and mortality [69,70]. In some sense, primary sarcopenia is inevitable, but its severity depends on the amount of physical activity, hormonal balance, the ability to synthesize and regenerate proteins, or early developmental influences [71]. Sarcopenia appears to be a physiological process, as it begins between the ages of 30 and 40 and is found to increase after the age of 60 [72].…”

Section: Sarcopeniamentioning

confidence: 99%

What Does Sarcopenia Have to Do with Nonalcoholic Fatty Liver Disease?

Ferenc,

Jarmakiewicz-Czaja,

Filip

2023

Life

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Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease. As the second stage of developing steatosis, nonalcoholic hepatitis (NASH) carries the risk of fibrosis, cirrhosis, and hepatocellular carcinoma. Sarcopenia is defined as a condition characterized by a decrease in muscle mass and functional decline. Both NAFLD and sarcopenia are global problems. The pathophysiological mechanisms that link the two entities of the disease are insulin resistance, inflammation, nutritional deficiencies, impairment of myostatin and adiponectin, or physical inactivity. Furthermore, disorders of the gut-liver axis appear to induce the process of developing NAFLD and sarcopenia. The correlations between NAFLD and sarcopenia appear to be bidirectional, so the main objective of the review was to determine the cause-and-effect relationship between the two diseases.

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Sarcopenia and perioperative management of elderly surgical patients

Cited by 13 publications

References 135 publications

Sarcopenia adversely impacts clinical outcomes in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis

Sarcopenia adversely impacts clinical outcomes in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis

Potential of Food Protein-Derived Bioactive Peptides against Sarcopenia: A Comprehensive Review

What Does Sarcopenia Have to Do with Nonalcoholic Fatty Liver Disease?

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