(Protein-energy) malnutrition in individuals living with obesity presents complex diagnostic challenges due to the distinctive physiological characteristics of obesity. This narrative review critically examines the identification of malnutrition within the population with obesity, distinguishing malnutrition in obesity from related conditions such as sarcopenic obesity. While noting some shared features, the review highlights key differences between these conditions. The review also highlights the limitations of current malnutrition screening tools, which are not designed for individuals living with obesity. These tools primarily rely on anthropometric measurements, neglecting (among others) nutrient intake assessment, which hinders accurate malnutrition detection. Additionally, this review discusses limitations in existing diagnostic criteria, including the Global Leadership Initiative on Malnutrition (GLIM) criteria, when applied to individuals living with obesity. Challenges include the identification of appropriate cut-off values for phenotypic criteria (unintentional weight loss, low body mass index and muscle mass) and aetiological criteria such as reduced food intake and inflammation for the population with obesity. Overall, this review emphasises the need for modified screening tools and diagnostic criteria to recognise and assess malnutrition in obesity, leading to improved clinical outcomes and overall wellbeing.

Nutritional status is a critical factor in the selection of patients for solid tumor resection. A variety of indices have been developed to quantify nutritional status, and they have differing degrees of predictive power for various postoperative outcomes.

This study aimed to comprehensively evaluate the predictive ability of commonly used nutritional indices in relation to postoperative complications (POCs), recurrence-free survival (RFS), and OS.

We performed a systematic review of 14 established nutritional indices from January 2015 to July 2022.

The primary end point was OS, while the secondary end points were POCs and RFS. A subsequent meta-analysis was performed to further assess the predictive ability of these indices for OS based on general index type, primary tumor site, and the patient's index status.

In this evaluation, 38 articles reporting data on 23 970 patients were analyzed, focusing on 14 nutritional indices. The indices were categorized into phenotypic, metabolic, immunologic, and combined types. Patients within the cut-off range of any index were predicted to have lower OS (hazard ratio [HR] 2.14, 95% CI 1.84-2.49, P < .01). Lower gastrointestinal (GI) and "other" sites were less predictive than upper GI primary tumors (HR 1.63, HR 1.82, and HR 2.54, respectively; all with P < .01). Phenotypic indices were less predictive than combined indices (HR 1.73 vs HR 2.47, P < .01). Within the combined category, there was no significant difference in the predictive ability of Prognostic Nutritional Index (PNI) vs Geriatric Nutritional Risk Index (GNRI) vs Controlling Nutritional Index (CONUT) (HR 2.63 vs HR 2.42 vs HR 2.07, P = .07).

The predictive efficacy of a nutritional index was found to be highly dependent on the index type, the primary tumor site, and the outcome of interest. In the context of upper GI resections, nutritional status appeared to be more of a significant predictor of OS, compared with cases involving lower GI and hepatic malignancies. Indices that integrate phenotypic, metabolic, and immunologic patient factors potentially offer greater clinical utility in forecasting OS.

Cancer cachexia, a multifactorial syndrome characterized by body weight loss, muscle, and adipose tissue wasting, affects patients with cancer. Over time, the definition of cachexia has been modified, including inflammation as one of the main causal factors. Evidence has suggested that a range of proinflammatory mediators may be involved in the regulation of intracellular signaling, resulting in enhanced resting energy expenditure, metabolic changes, and muscle atrophy, all of which are typical features of cachexia. Physiologically speaking, however, inflammation is a response aimed at facing potentially damaging events. Along this line, its induction in the cancer hosts could be an attempt to restore the physiological homeostasis. Interesting observations have shown that cytokines such as interleukins 4 and 6 could improve muscle wasting, supporting the view that the same mediator may exert pro- or anti-inflammatory activity depending on the immune cells involved as well as on the tissue metabolic demand. In conclusion, whether inflammation is crucial to the occurrence of cachexia or just one contributor among others, is still unclear. Indeed, while inflammation is a trigger of cachexia, the alterations of energy and protein metabolism and of the hormonal homeostasis occurring in cachexia likely act as inflammatory stimuli on their own. Whether the causative role prevails over the compensatory one likely depends on the tumor type and stage, patient lifestyle, the presence of comorbidities, and the response to anticancer treatments paving the way to a holistic, personalized approach to cancer cachexia.

The role of cyclooxygenase-2 (COX-2), a well-known pharmacological target for attenuating inflammation, in regulating obesity and its co-morbidities remains unclear. We sought to determine the role of COX-2 in modulating metabolic inflammation and systemic metabolic homeostasis in obesity. Male wild type (WT) and COX-2 knock-out (KO) mice were fed a chow diet (CD) or a high fat diet (HF, 45% fat) for 13 wk. While the body weight gain did not alter, the visceral adipose tissue (VAT) mass was significantly higher in KO-HF mice compared to WT-HF mice. Plasma triglycerides and total cholesterol levels were higher in KO-HF mice compared to WT-HF mice. Total body fat mass was higher with a concomitant reduction in lean mass in KO-HF mice compared to WT-HF mice. Paradoxically, hepatic steatosis was reduced in KO-HF mice. While liver triglycerides were reduced, the liver cholesterol was increased in KO-HF mice. Bile acids and markers of cholesterol biosynthesis were unaltered between WT-HF and KO-HF groups. The mRNA and/or protein levels of autophagy markers were significantly decreased in KO-HF mice compared to WT-HF mice, indicating that a reduction in autophagy may increase cholesterol levels in these mice. The liver inflammatory markers were significantly increased only in WT mice fed a HF diet but not in KO-HF fed mice compared to their respective controls. VAT showed a reduction in inflammatory markers in spite of an increase in adiposity. These data suggest that despite being effective in attenuating the inflammatory processes, inhibition of COX-2 exerts undesirable consequences on metabolic homeostasis.

Pre-cancer onset of cachexia raises uncertainties regarding the optimal timing for early intervention in lung cancer patients. We aimed to examine changes in physical function, nutritional status, and cachexia incidence in patients with lung cancer from the initial visit to treatment initiation and determine the effect of these changes on lung cancer treatment.

This single-center retrospective cohort study enrolled patients suspected of having advanced lung cancer who visited Kansai Medical University Hospital between January and February 2023 and were definitely diagnosed with the disease. Patients were categorized into three groups based on their cachexia status: those with cachexia at initial diagnosis (group C), those who developed cachexia between the initial visit and treatment initiation (group OC), and those without cachexia (group NC).

Out of 61 patients, 21 had cachexia at their first outpatient visit (group C). The time between the first visit and treatment initiation was 42.5 days. The rate of cachexia in patients with stage IV lung cancer in group OC was significantly higher than that in patients with other stages (P = 0.008). Of the 33 patients with advanced lung cancer, 11 received supportive care only. The first-line treatment induction rate for the OC group was low. Half of the patients declined chemotherapy and received the best supportive care; their disease control rate (37.5%) was significantly worse than that of the other groups (P = 0.007).

Cachexia negatively impacts the effectiveness of initial cancer treatment, necessitating early anti-cachexia interventions at the first clinical visit.

Sarcopenia is characterized by a loss of muscle mass and function, with significant implications for the physical performance of the affected people. Although commonly associated with aging, disease-related sarcopenia is of great clinical importance, particularly as it impacts disease progression and outcomes. Individuals with rheumatic diseases (RDs), including rheumatoid arthritis, systemic sclerosis, spondyloarthritides, systemic lupus erythematosus, fibromyalgia, myositis, or vasculitis, exhibit a high prevalence of sarcopenia, which exacerbates their clinical symptoms and contributes to poorer disease outcomes. Chronic inflammation influences muscle tissue degradation, causing a decline in physical performance. Apart from the apparent clinical manifestations, patients with RDs also use pharmacological treatments that negatively impact muscle mass further, increasing the risk of sarcopenia. Nutrition (diet and dietary supplements) and exercise interventions have been recommended as protective measures for sarcopenia as they may mitigate its adverse events. The present narrative review seeks to explore the methods used to assess sarcopenia in patients with RDs, its prevalence among them, and the challenges faced by the affected individuals, while critically assessing the appropriateness and limitations of current sarcopenia assessment tools in the context of RDs.

Sarcopenia has recently been shown to increase risk of early adjacent segment disease (ASD) development after transforaminal lumbar interbody fusion. We sought to evaluate whether sarcopenia increases risk of ASD after retroperitoneal approaches for lumbar interbody fusion (eg, anterior lumbar interbody fusion or oblique lateral lumbar interbody fusion).

Retrospective data were collected from 104 adult patients aged older than 18 years who underwent short-segment fusion through anterior lumbar interbody fusion or oblique lateral lumbar interbody fusion approach from 2013 to 2023. The primary outcome was development of ASD within 3 years of surgery. Patients who had prior surgery for ASD, underwent long-construct deformity correction, had an ongoing oncological process, or lacked sufficient follow-up were excluded. Psoas and vertebral body volumetric measurements were calculated at the L4 pedicle level using preoperative MRI. Spinopelvic parameters of pelvic tilt, pelvic incidence (PI), lumbar lordosis (LL), and PI-LL mismatch were recorded from standing upright radiographs. Odds ratios were calculated with logistic regression analyses.

Of 104 patients undergoing fusion through retroperitoneal approaches, 25 (24.04%) developed ASD within 3 years. Patient demographics and medical comorbidities did not predict early ASD. Left and right psoas area (cm2) and psoas:vertebral body ratio strongly predicted ASD development (P < .0001). Nineteen patients were categorized as sarcopenic, defined as bilateral psoas:vertebral body ratios >1 SD below the study population gender mean. 16 of the 19 sarcopenic patients developed ASD within 3 years, compared with 9 of the 85 nonsarcopenic patients (84.21% vs 10.59%, P < .0001). Postoperative pelvic tilt and PI-LL mismatch were predictive of ASD on univariate but not multivariate analysis.

Sarcopenia significantly predicts ASD development within 3 years after lumbar fusion through retroperitoneal approaches. Irrespective of approach, sarcopenia is a risk factor of ASD formation and should be evaluated preoperatively. Morphometric analysis provides a simple screening tool and can be used to tailor preoperative and postoperative therapies to improve outcomes.

Sarcopenia is characterized by progressive muscle loss with reduced physical function and/or reduced muscle strength. Operational definitions of sarcopenia include a measurement of muscle mass, most often from dual-energy X-ray absorptiometry (DXA)-derived appendicular lean mass. Appendicular lean mass can be derived from whole-body dual-DXA scans; however, these scans are performed less commonly than hip and spine scans as part of clinical care. The objective of our study was to develop an algorithm to predict appendicular lean mass index (ALMI) from regional spine and hip dual-energy X-ray absorptiometry (DXA) scans.

We performed a retrospective cross-sectional study using a subset of patients from the Manitoba Bone Mineral Density Registry who had hip, spine, and whole-body DXA scans at the same visit. We developed the algorithm using the following candidate covariates: age, sex, height, weight, DXA-derived spine and hip fat fraction, DXA-derived spine and hip tissue thickness. We internally validated the algorithm using the bootstrap method. Mean bootstrap parameter estimates were used as the final equation.

DXA scans from 676 patients were included in the analytic dataset. Mean ALMI was 6.73 (SD 1.43) kg/m2. The final predictive model included sex, age, height, weight, spine fat fraction and hip fat fraction. Sex also acted as an interaction term on weight and hip fat fraction. After bootstrap validation, model adjusted R2 was 0.863, root mean square error was 0.529 kg/m2, and AUROC to predict low ALMI per the European Working Group on Sarcopenia version 2 was 0.88.

Hip and spine DXA scans can be used to predict appendicular lean mass index. Future studies should test whether these predictions can be used to assess relationships between sarcopenia and other clinical conditions.

This study aimed to compare sarcopenia prevalence in older adults using nine diagnostic criteria from different regions to assess how these guidelines influence prevalence rates within the same population. Additionally, we analyzed variations across subgroups to identify factors contributing to prevalence differences.

A total of 1760 participants aged 65-99 were enrolled. Bioelectrical impedance analysis was used to assess muscle mass, while muscle strength and physical performance were evaluated using grip strength, gait speed, and the repeated chair stands test. Sarcopenia prevalence was determined based on definitions provided by ESPEN (European Society for Clinical Nutrition and Metabolism), EWGSOP (European Working Group on Sarcopenia in Older People), IWGS (International Working Group on Sarcopenia), SCWD (Society for Sarcopenia, Cachexia, and Wasting Disorders), AWGS (Asian Working Group for Sarcopenia), FNIH (Foundation for the National Institutes of Health), and SDOC (Sarcopenia Definitions and Outcomes Consortium). Additionally, prevalence rates were assessed across subgroups based on age, sex, and BMI categories.

Sarcopenia prevalence varied from 4.8 % (n = 79), based on the FNIH criteria, to 16.1 % (n = 261), according to the EWGSOP criteria. Among females, higher prevalence rates were observed using the ESPEN, AWGS, and EWGSOP2 criteria, while the FNIH criteria indicated a higher prevalence in males. Prevalence increased with age, especially in those aged 85 and older. Lower BMI was associated with higher sarcopenia prevalence according to most criteria, except the FNIH and ESPEN.

The notable variability in sarcopenia prevalence across different diagnostic criteria highlights the need for population-specific guidelines. Refining diagnostic criteria to address demographic variations could enhance the accuracy and applicability of sarcopenia assessments. Future studies should aim to further tailor diagnostic approaches and interventions to meet the needs of diverse populations.

Cachexia status is a drastic issue in cancer patients. The main goal of this study; which is considered the first of its kind in Sudan, was to enhance our understanding of the clinical implications of oral cancer cachexia. Newly diagnosed Sudanese patients with oral squamous cell carcinoma (OSCC) were evaluated for the incidence and impact of cachexia.

This is a longitudinal descriptive study conducted at Khartoum Teaching Dental Hospital before April 2023. A number of 40 OSCC participants above 18 years old were analyzed for Cachexia based on weight loss, low hemoglobin levels, albumin levels, elevated C-reactive protein, decreased mid-upper arm circumference, loss of appetite, and anorexia. Data were collected over three visits, and analyzed using descriptive and bivariate statistics.

The study included 40 newly diagnosed patients with OSCC, with a mean of age 56.8 years. The incidence of cachexia was 33.2% before surgery, 55% one month postoperatively, and 65% six months later. Cachexia was significantly correlated (p < 0.05) with delayed wound healing (p = 0.008), prolonged nasogastric feeding tube usage (p = 0.023), interrupted adjuvant therapy (p = 0.003), and mortality (p = 0.007). Low BMI, loss of appetite, food intake, low hemoglobin, and elevated CRP were significant diagnostic criteria as well (p < 0.05).

In this study, Cachexia was found to be a critical prognostic factor for OSCC patients. Larger-scale clinical research in Sudan is needed to provide definitive findings and strategies to support nutritional status during therapy.

Predicting chemoradiotherapy (CRT) response in esophageal cancer is essential as outcomes vary among patients. This study aimed to evaluate the impact of osteosarcopenia on the effectiveness of neoadjuvant CRT (NACRT).

Ninety-five patients with advanced esophageal cancer who underwent surgical resection post-NACRT were included. Sarcopenia and osteopenia were determined using pre-NACRT skeletal muscle index and bone density at L3 and Th11 levels. Patients were categorized based on osteosarcopenia status.

Thirty-seven patients (39%) had osteosarcopenia. Among tumors, 49 (51.6%) were grade 1 (non-responders), 12 (12.6%) were grade 2, and 34 (35.8%) were grade 3 (responders). NACRT was significantly more effective in patients with above-median body mass index, shallow tumor depth, low squamous cell carcinoma antigen levels, and without osteosarcopenia. Osteosarcopenia was independently correlated with the histopathologic response to NACRT. No significant differences in overall or relapse-free survival were observed based on osteosarcopenia status.

Osteosarcopenia may predict NACRT response in esophageal cancer.

Elexacaftor/Tezacaftor/Ivacaftor (ETI) has led to improved lung function, life expectancy, and body mass index for people with Cystic Fibrosis (CF). The aim of this systematic review was to evaluate the impact that ETI has had on body composition in people with CF. A systematic review was performed using MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials. Quality assessment using the Joanna Briggs Institute critical appraisal tools were performed. Results were summarised narratively. Five observational cohort studies involving a total of 185 participants were reviewed. Three studies showed an increase in fat mass (7.0-8.6 kg, 13.2-14.3 kg, and 13.4-15.5 kg). Two studies reported an increase in fat-free mass (49.4-50.1 kg, 52.5-55 kg), while one reported a decrease (50.5-48.9 kg). Two studies found an increase in fat mass index (4.1-6.3 kgm/2 and 4.7-5.4 kg/m2) and fat-free mass index (17.4-17.7 kg/m2 and 18.1-18.8 kg/m2). Two studies observed an increase in percentage body fat mass (12.1-15.4% and 23.1-27.6%). Four studies were classified as low quality, while one was considered medium quality. This review suggest that commencing ETI results in changes in body composition. Firm conclusions about the type and distribution of change in body composition cannot be made due to limited studies, high heterogeneity, and methodical weaknesses. It highlights the necessity for higher quality and longer-term studies to explore the impact that ETI is having on body composition.

Cachexia is associated with poor survival rates. In the clinical setting, the diagnosis of cancer cachexia is challenging. The cachexia index (CXI), a new index for predicting survival time, is a promising tool for diagnosing cancer cachexia; however, its efficacy in predicting patient survival has not been validated.

This meta-analysis and systematic review aimed to explore the CXI's prognostic value in patients with cancer.

The PubMed, Embase, MEDLINE, and Cochrane Library databases were searched for relevant studies to determine the association between CXI findings and prognosis.

The outcomes were overall survival (OS), progression-, disease-, and recurrence-free survival (PFS/DFS/RFS) rates, and the rate of complete response.

The QUality In Prognostic Studies (QUIPS) tool was used to evaluate the quality of the included trials. This meta-analysis comprised 14 studies involving 2777 patients. A low CXI was associated with decreased OS (hazard ratio [HR] 2.34, 95% confidence interval [CI] 2.01-2.72; P < .001), PFS/DFS/RFS (HR 1.93, 95% CI 1.68-2.22; P < .001), and complete response (odds ratio [OR] 0.49, 95% CI 0.36-0.66; P < .001). Patients with a low CXI had a lower body mass index (mean difference [MD] -0.75, 95% CI -1.00 to 0.50; P < .001), skeletal muscle index (standardized MD -0.80, 95% CI -0.98 to -0.61; P < .001), and serum albumin level (MD -0.23, 95% CI -0.26 to -0.20; P < .001); and a higher neutrophil-lymphocyte ratio (MD 1.88, 95% CI 1.29-2.47; P < .001) and more advanced disease stages (OR 0.80, 95% CI 0.71-0.91; P = .001).

A low CXI was found to be associated with poor survival in patients with cancer. While the CXI is a promising marker for predicting cancer cachexia, further studies are required to verify its usefulness.

Sarcopenia, characterized by progressive loss of skeletal muscle mass and strength, is a prevalent but often overlooked condition in patients with cancer who are terminally ill. It contributes to functional decline, increased symptom burden, and reduced quality of life, yet remains underrecognized in palliative care. Diagnosing sarcopenia in this population is challenging because conventional imaging techniques are often impractical. Instead, alternative assessments, such as the Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls questionnaire (SARC-F), anthropometric measurements, and bioelectrical impedance analysis offer feasible options. Management should focus on symptom relief, functional preservation, and patient comfort, rather than on muscle mass restoration. Nutritional support must be tailored to prognosis, with aggressive interventions generally avoided during end-of-life care. Although exercise may help to maintain mobility and alleviate symptoms, its feasibility is often limited. Pharmacological interventions, including appetite stimulants and anti-cachexia agents, remain largely investigational, with insufficient evidence for routine use in palliative care. Future research should refine sarcopenia assessment methods and develop patient-centered interventions that align with palliative care principles, emphasizing quality of life and individualized needs.

Muscle mass measurements are vital for predicting health outcomes and diagnosing muscle disorders. This study provides reference data for appendicular lean mass (ALM) and total lean mass (TLM) in healthy Polish adults with normal muscle strength and physical performance as per EWGSOP2 guidelines.

The study included healthy volunteers with normal muscle strength and functional status. Lean mass was measured using Hologic Horizon DXA. Mean values of TLM, ALM, fat-free mass (FFM), and indices (TLMI, ALMI, FFMI) were calculated for seven age groups (by decade). Cut-off points equivalent to T-scores of -1 and -2 standard deviations (SDs) below the young adult reference mean (ages 20-39) were determined.

Data from 1,111 participants (328 men, 46.3 ± 20 years; 783 women, 43.7 ± 23 years) were analyzed. In young adults, mean ALM was 28.1 kg (men) and 17.2 kg (women), and ALMI was 8.6 kg/m2 (men) and 6.1 kg/m2 (women). Low muscle mass cut-off points (2 SDs below) were 18 kg and 10.9 kg (ALM) and 6 kg/m2 and 4.3 kg/m2 (ALMI) for men and women, respectively. Men exhibited significantly greater lean mass than women across all age groups (P < 0.001). Lean mass declined with age in both genders, following a nonlinear pattern, except for ALMI in men.

This study provides the first population-based reference values for ALM and TLM in healthy Polish adults aged 20-89 years, integrating criteria for normal muscle strength and physical performance.

Sarcopenia is a common indicator of systemic nutritional status in patients with cancer progression. This study investigated the impacts of sarcopenia on adverse effects and prognosis of sarcopenia on patients with esophageal cancer receiving chemoradiotherapy.

The clinical data of 158 patients with initially diagnosed esophageal cancer who received chemoradiotherapy were collected, and nutritional indexes and inflammatory markers were calculated. The cross-sectional areas of the skeletal muscle, subcutaneous fat and visceral fat were calculated using computed tomography (CT) images of the midpoint of the third lumbar (L3) vertebra. The incidence of adverse events, response evaluation, 1-year and 3-year overall survival (OS) and progression-free survival (PFS) were compared between sarcopenia group and non-sarcopenia groups.

This study included 158 patients, 103 (71.5%) in the sarcopenia group and 45 (28.5%) in the non-sarcopenia group. The last follow-up date was January 31, 2024. The median follow-up time was 36 months for all patients. The chi-square test revealed no significant difference in the incidence of serious adverse events between the two groups. The complete response rates (CR) of patients in the sarcopenia and non-sarcopenia groups 1 month after chemoradiotherapy were 2.7 and 13.3%, respectively, p = 0.017, and the difference was statistically significant. Moreover, the objective response rates (ORR) were 38.9 and 60.0%, respectively (χ2 = 5.770, p = 0.016). The median survival time for all patients was 36 months [95% Confidence Interval CI 24-48]. Univariate analysis (Cox proportional risk model) showed that sarcopenia, KPS score, albumin level, T stage, and N stage were correlated with patients' OS. Multivariate analysis showed that sarcopenia (Hazard Ratio HR 2.84, 95%CI [1.45-5.57], p = 0.002), KPS score, albumin level and N stage were independent prognostic factors for OS.

Sarcopenia reduced OS in patients with EC treated with chemoradiotherapy. It can be used as an independent indicator to predict the OS of such patients, which may help in developing optimal treatment strategies.

Skeletal muscle plays a pivotal role in physical activity, protein storage and energy utilization. Skeletal muscle wasting due to immobilization, aging, muscular dystrophy and cancer cachexia has negative impacts on the quality of life. The deletion of myostatin, a growth and differentiation factor-8 (GDF-8) augments muscle mass through hyperplasia and hypertrophy of muscle fibers. The present study examines the impact of myostatin deletion using CRISPR/Cas9 editing on the myogenic differentiation (MD) of C2C12 muscle stem cells. A total of five myostatin loci were targeted using guided RNAs that had been previously cloned into a vector. The clones were transfected in C2C12 cells via electroporation. The cell viability and MD of myostatin-edited clones (Mstn-/-) were compared with C2C12 (Mstn+/+) using a series of assays, including MTT, sulforhodamine B, immunocytochemistry, morphometric analysis and RT-qPCR. The clones sequenced showed evidence of nucleotides deletion in Mstn-/- cells. Mstn-/- cells demonstrated a normal physiological performance and lack of cytotoxicity. Myostatin depletion promoted the myogenic commitment as evidenced by upregulated MyoD and myogenin expression. The number of MyoD-positive cells was increased in the differentiated Mstn-/- clones. The Mstn-/- editing upregulates both mTOR and MyH expression, as well as increasing the size of myotubes. The differentiation of Mstn-/- cells upregulates ActRIIb; in contrast, it downregulates decorin expression. The data provide evidence of successful CRISPR/Cas9-mediated myostatin deletion. In addition, targeting myostatin could be a beneficial therapeutic strategy to promote MD and to restore muscle loss. In conclusion, the data suggest that myostatin editing using CRISPR/Cas9 could be a potential therapeutic manipulation to improve the regenerative capacity of muscle stem cells before in vivo application.

Sarcopenia, a common condition observed in the elderly, presenting a significant public health challenge due to its high prevalence, insidious onset and diverse systemic effects. Despite ongoing research, the precise etiology of sarcopenia remains elusive. Aging-related processes, which included inflammation, oxidative stress, compromised mitochondrial function and apoptosis, have been implicated in its development. Notably, effective pharmacological treatments for sarcopenia are currently lacking, highlighting the necessity for a deeper understanding of its pathogenesis and causative factors to enable proactive interventions. This article is aimed to provide an extensive overview of the pathogenesis of sarcopenia, along with a summary of current treatment and prevention strategies.

Restless legs syndrome (RLS) is a disorder characterized by nocturnally exacerbating pain that leads to significant sleep disturbances. The hormonal and metabolic changes caused by sleep disruption may increase the incidence of muscle-related diseases like sarcopenia in older adults, which is defined by a progressive loss of muscle strength and mass. This study aimed to investigate the relationship between RLS and sarcopenia, which may affect each other through common pathophysiological pathways in older adults.

This was a cross-sectional study including 109 patients with RLS and 220 without RLS who applied to the geriatric clinic. RLS was assessed using the Turkish version of the International Restless Legs Syndrome Study Group (IRLSSG). Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People-2 criteria. All the demographics, comorbid conditions, medications and findings of comprehensive geriatric assessments were recorded. The association between RLS and sarcopenia was examined by logistic regression.

The mean age was 75 ± 7.4 and 73.8 ± 7 years for the RLS and the control groups, respectively (p > 0.05) and the ratio of females was higher in the RLS group (69.7% vs. 57.9%) (p = 0.035). The frequencies of coronary artery disease (CAD), hypertension (HT) and peripheral artery disease (PAD) were significantly higher in RLS patients (p = 0.020, p = 0.047, p = 0.010, respectively), while the prevalence of anaemia was 41% and 25-OH Vitamin D levels (25[OH]D) were higher than in the control group (p < 0.001). The frequency of probable sarcopenia and sarcopenia was higher in patients with RLS than in controls (20% vs. 11%, p = 0.037 and 8% vs. 2.3%, p = 0.047, respectively). A significant association between RLS and an increased likelihood of probable sarcopenia, sarcopenia and slow gait speed (odds ratio [OR]: 2.621, 95% confidence interval [CI] [1.265, 5.431]; OR: 4.542, 95% CI [1.284, 16.071]; OR: 2.663, 95% CI [1.432, 4.951], respectively) was found after adjusting for factors such as gender, HT, CAD, PAD, serum 25(OH)D levels, anaemia, chronic kidney disease (CKD) and nutritional status. However, the significance of low muscle mass disappeared (p > 0.05).

This study demonstrated that sarcopenia is prevalent among older patients with RLS, which seems to be associated with low muscle strength and slow gait speed. Given the negative health outcomes related to sarcopenia, interventions aimed at preventing its development could be significantly beneficial for patients with RLS in older adults as well.

Growth differentiation factor (GDF)-15 is a pleiotropic cytokine that is associated with appetite-suppressing effects and weight loss in patients with malignancy.

This study aims to investigate the relationships between GDF-15 levels, anorexia, cachexia, and clinical outcomes in patients with advanced heart failure with reduced ejection fraction (HFrEF).

In this observational, retrospective analysis, a total of 344 patients with advanced HFrEF (age 58 ± 10 years, 85% male, 67% NYHA functional class III), underwent clinical and echocardiographic examination, body composition evaluation by skinfolds and dual-energy x-ray absorptiometry, circulating metabolite assessment, Minnesota Living with Heart Failure Questionnaire, and right heart catheterization.

The median GDF-15 level was 1,503 ng/L (Q1-Q3: 955-2,332 ng/L) (reference range: <1,200 ng/L). Higher GDF-15 levels were associated with more prevalent anorexia and cachexia. Patients with higher GDF-15 had increased circulating free fatty acids and beta-hydroxybutyrate, lower albumin, cholesterol, and insulin/glucagon ratio, consistent with a catabolic state. Patients with higher GDF-15 had worse congestion and more severe right ventricular dysfunction. In multivariable Cox analysis, elevated GDF-15 was independently associated with risk of the combined endpoint of death, urgent transplantation, or left ventricular assist device implantation, even after adjusting for coexisting anorexia and cachexia (T3 vs T1 HR: 2.31 [95% CI: 1.47-3.66]; P < 0.001).

In patients with advanced HFrEF, elevated circulating GDF-15 levels are associated with a higher prevalence of anorexia and cachexia, right ventricular dysfunction, and congestion, as well as an independently increased risk of adverse events. Further studies are warranted to determine whether therapies altering GDF-15 signaling pathways can affect metabolic status and clinical outcomes in advanced HFrEF.

The aim of this study was to investigate the relationship between DII and sarcopenia in individuals with ischemic heart disease (IHD).

This was a retrospective study utilizing data of the National Health and Nutrition Examination Survey (NHANES) from 1999-2004. Adults aged ≥50 years diagnosed with IHD, having complete 24-hour dietary recall data, and dual energy X-ray absorptiometry (DEXA)-measured muscle mass were eligible for inclusion. Association between DII and sarcopenia, defined by reduced appendicular skeletal muscle mass, was determined by the logistic regression analyses.

Data of 1088 individuals were analyzed, with the mean age of 68.1±0.5 years. Significantly higher DII was observed in the sarcopenic group compared to the non-sarcopenic group (0.24 vs. -0.17, P=0.020). After adjusting for relevant confounders in the multivariable analysis, each unit increase in DII was significantly associated with higher odds of sarcopenia (adjusted odd ratio [aOR]=1.07, 95% confidence interval: 1.00-1.14, P value = 0.040). In stratified analyses, among patients with a Body Mass Index (BMI) ≥30 kg/m2, both DII tertile 2 and tertile 3 were significantly associated with greater odds of sarcopenia (tertile 2 vs. tertile 1: aOR=2.85, 95% CI: 1.56-5.23, P=0.001; tertile 3 vs. tertile 1: aOR=3.11, 95% CI: 1.53-6.31, P=0.002), whereas no significant associations was observed among patients with a BMI<30 kg/m2.

This study has established a significant independent association between a higher DII and an increased risk of sarcopenia in US adults with IHD regardless of type of IHD. BMI appears as a moderating factor in this association.

Sarcopenia describes the degenerative loss of muscle mass and strength, and is emerging as a pan-cancer prognostic biomarker. It is linked with increased treatment toxicity, decreased survival and significant healthcare financial burden. Systematic analyses of sarcopenia studies have focused on outcomes in patients treated surgically or with systemic therapies. There are few publications concerning patients treated with radiotherapy. This manuscript presents a pan-cancer systematic review of the association between sarcopenia and survival outcomes in patients treated with definitive (chemo-)radiotherapy. A literature search was performed, with 26 studies identified, including a total of 5,784 patients. The prognostic significance of sarcopenia was mixed. This may reflect lack of consensus in methods used to measure skeletal muscle mass and define sarcopenia. Many papers analyse small samples and present sarcopenia cutoffs optimised on the local population, which may not generalise to external populations. Recent advances in artificial intelligence allow for automatic measurement of body composition by segmenting the muscle compartment on routinely collected imaging. This provides opportunity for standardisation of measurement methods and definitions across populations. Adopting sarcopenia diagnosis into clinical workflows could reduce futile treatments and associated financial burden, by reducing treatment toxicities, and improving treatment completion, patient survival, and quality-of-life after cancer.

We present a case of insatiable appetite and harmful overeating in a hospice patient that showcases the burden of hypothalamic hyperphagia, a rare complication of brain cancer. While confounders exist such as progression of disease and prior tapering of dexamethasone, in this case the initiation of metformin was associated with substantial appetite reduction and resolution of our patient's debilitating food-seeking behaviors. We will explore metformin as a potential cost-effective option for palliation in a hospice setting and explore some of the physiologic mechanisms involved.

Sarcopenia is a condition characterized by inadequate muscle and function decline and is often associated with ageing and cancer. It is established that sarcopenia and muscle loss occurred during treatment are associated with the clinical outcomes of patients with cancer. This systematic review and meta-analysis aims to evaluate the association between sarcopenia at pretreatment and during treatment and overall survival or disease progression in patients with cervical cancer.

The Web of Science, Embase, Medline and Cochrane Library databases were searched until 4 July 2024. Studies evaluating the prognostic effect of muscle mass at pretreatment or muscle change during treatment on survival or disease progression for patients with cervical cancer were included. Study quality was evaluated with the Newcastle-Ottawa Scale (NOS). Forest plots and summary effect models were used to show the effect size of sarcopenia on clinical outcomes.

The search strategy yielded 1721 studies in four databases. Eleven and seven studies were included in the quantitative analysis of pretreatment sarcopenia and muscle change on clinical outcomes, respectively. A total of 1907 patients underwent pretreatment muscle assessment, but 1016 were monitored for muscle changes; however, none of the studies involved measures of muscle strength or function. Meta-analysis showed a significant association between pretreatment sarcopenia and OS [hazard ratio (HR) 1.58, 95% confidence interval (CI): 1.16-2.14, p = 0.003] and PFS (HR 1.63, 95%CI 1.16-2.29, p = 0.005) according to data of univariate analysis. In the meta-analysis of the multivariate data, pretreatment sarcopenia remained associated with poor OS (HR 3.09, 95% CI: 2.07-4.61, p < 0.00001) and PFS (HR: 1.55, 95%CI 1.06-2.28, p = 0.03). Additionally, muscle loss was significantly associated with OS (HR 5.18, 95%CI 3.54-7.56, p < 0.00001) and PFS (HR 2.62, 95%CI 1.63-4.22, p < 0.00001). Subgroup analysis showed that the association between pretreatment sarcopenia and OS, as well as PFS, was influenced by muscle mass measurements and cut-off values, whereas muscle loss consistently predicted worse OS and PFS when stratified by varying degrees of reduction. The NOS scores of all included studies were ≥ 6.

Pretreatment sarcopenia and muscle change during treatment are significantly associated with both overall survival and disease progression. Therefore, muscle assessment and monitoring should be conducted for appropriate diagnosis and intervention to improve clinical outcomes in patients with cervical cancer.

With ageing, older adults (≥ 65 years) may experience decreased appetite, contributing to declines in body weight and muscle mass, potentially affecting physical capabilities. Physical activity (PA) has been suggested as a potential strategy to enhance appetite in older adults, but evidence supporting this is insufficient. This study aimed to investigate the relationship between PA levels, total energy expenditure (TEE), body composition, energy intake (EI) and appetite in older adults.

One hundred and eight healthy older adults (age 70 ± 4 years; BMI 24.3 ± 2.6 kg/m2) were categorised into three groups (low, medium, high) based on accelerometer-measured PA level (AMPA) and TEE from 7-day PA diaries. Body composition was measured using bioelectrical impedance. Energy and nutrient intakes were assessed using 3-day weighed food diaries. Appetite was assessed using the visual analogue scales at 30-min intervals throughout 1 day.

TEE was positively correlated with EI and % muscle mass (p < 0.05), with higher % muscle mass and TEE associated with higher EI. Energy and protein intake were significantly higher in the high TEE group than the low group (p = 0.03, p = 0.01; respectively). No significant differences in energy and macronutrient intake were observed across AMPA groups, and appetite components (hunger, fullness, desire to eat, prospective consumption) did not differ significantly in either the AMPA or TEE groups.

Higher TEE is associated with higher energy and protein intake, with body composition playing a crucial role. These findings highlight the importance of considering PA, TEE, and body composition in interventions aimed at improving EI in older adults.

clinicaltrials.gov as NCT05067036. Registered 2 October 2021, https://classic.

gov/ct2/show/NCT05067036.

This review aims to summarise recent evidence on the effects of dietary patterns on the risk of bone fractures and sarcopenia.

Several dietary patterns have been investigated in relation to musculoskeletal health, including Mediterranean Dietary Patterns (MDP), Dietary Inflammatory Indices, vegetarian and vegan diets. Adherence to 'healthier' dietary patterns appears to be protective against fractures and sarcopenia, with the strongest protective associations found between the MDP and fractures. Individuals following vegan or vegetarian eating patterns need to be aware of calcium and vitamin D requirements to maintain musculoskeletal health. Although more healthy dietary patterns may be protective for musculoskeletal health the current evidence base is limited by variation in the construction of dietary pattern scores and reported outcome measures. Future research should fully report scoring methods, intakes of dietary components across scoring groups or categories, and consider outcome measures that allow for better comparison between studies.

Sarcopenia, a condition characterized by the gradual decline of muscle mass, strength, and function, is a key indicator of malnutrition in cancer patients and has been linked to poor prognoses in oncology. Sarcopenia is commonly assessed by measuring the skeletal muscle index (SMI) of the third lumbar spine (L3) using computed tomography (CT). This meta-analysis aimed to explore the relationship between low SMI and clinicopathological features, as well as prognosis, in individuals with endometrial cancer (EC).

Data from various databases including PubMed, Embase, Cochrane, Medline, and Web of Science were searched up until October 20th, 2024. Studies that investigated the association of low SMI and EC survival or clinicopathological characteristics were included. Pooled effect sizes were reported as hazards ratio (HR), odds ratios (ORs) or weighted mean difference (WMD). The quality and risk of bias in the studies were evaluated using the Newcastle-Ottawa Scale (NOS) and the Quality In Prognosis Studies (QUIPS), and the study was registered on PROSPERO (CRD42024509949) before commencing the search.

A total of 218 studies were identified across all five databases, with 11 studies meeting the criteria for qualitative and quantitative analysis, involving 1588 patients. The findings of our meta-analysis demonstrated a significant link between low SMI and progression-free survival [P = 0.002; HR: 1.62, 95% CI: 1.20-2.17]. Low SMI was also associated with a BMI < 25 (P < 0.00001; OR: 4.55, 95% CI: 3.01-6.87), FIGO stage (P = 0.04; OR: 1.33, 95% CI: 1.01-1.75), pathology grades (P = 0.001; OR: 1.77, 95% CI: 1.26-2.49), and the endometrioid pathological type (P = 0.01; OR: 0.68, 95% CI: 0.51-0.92). However, no significant correlation was found between low SMI and 5-year overall survival, serous pathological type, recurrence, length of hospital stay, intraoperative complications, and postoperative complications. All the included studies scored ≥ 7 on the NOS, indicating relatively high-quality evidence.

The meta-analysis highlighted the association between low SMI and unfavorable clinical features and outcomes in EC patients, emphasizing the importance of early diagnosis and appropriate management of sarcopenia assessed by low SMI to enhance prognoses in EC patients.

Malnutrition is common with esophagogastric cancers and is associated with negative outcomes. We aimed to evaluate if immunonutrition during neoadjuvant treatment improves patient's health-related quality of life (HRQOL) and reduces postoperative morbidity and toxicities during neoadjuvant treatment.

A multicenter double-blind randomized controlled trial (RCT) was undertaken. Included patients had untreated nonmetastatic esophagogastric tumor, aged 18 ≥ years with a life expectancy of >3 months. The study was powered for 80% power to detect a clinically relevant difference in EORTC-QLQC30 with standard deviation of 15 between groups. Primary end point was the quality of life as measured by the global health status at 30 days after surgery. An intention-to-treat analysis was employed.

The study was terminated at the interim analysis stage. About 300 patients were randomized: 149 to the IMPACT group and 151 to the control-formula group. Patient groups were well-balanced in terms of age, sex, body mass index, WHO performance status, and clinical tumor stage. Analysis of the primary end point for the study of global health status at 30-day postoperatively failed to show any significant differences between the groups (55.4 ± 18.6 [IMPACT] vs. 55.9 ± 19.8 [control]; P = 0.345). No significant differences between the groups were detected in the majority of domains from EORTC QLQC30 and OG25 tools after neoadjuvant therapy and 30 days postoperatively. Finally, no significant differences were seen between groups in neoadjuvant therapy or postoperative complications, or tumor response.

The results of this multicenter double-blind RCT fail to demonstrate any HRQOL benefits to the utilization of immunonutrition during neoadjuvant therapy in patients with esophagogastric cancer.

Cancer cachexia is a multifactorial syndrome characterized by persistent skeletal muscle loss, with or without fat loss, which cannot be completely reversed by traditional nutritional support and leads to impaired organ function. Cachexia seriously reduces the quality of life of (QOL) patients, affects the therapeutic effect against cancers, increases the incidence of complications, and is an important cause of death for patients with advanced cancers. To date, no effective medical intervention has completely reversed cachexia, and no medication has been agreed upon. Here, we describe recent advances in the diagnosis, molecular mechanism and treatment of cancer-related cachexia.

Osteosarcopenia, recognized as a consequence of aging, has garnered attention as a prognostic marker in recent years; however, its clinical significance in esophageal cancer remains uncertain. This study aimed to investigate the impact of osteosarcopenia on esophageal cancer surgery outcomes.

This retrospective study included patients with advanced esophageal cancer who underwent surgical resection between 2018 and 2021. Skeletal muscle index at the L3 vertebral level and bone density at the Th11 vertebral level were measured on preoperative computed tomography scans. Based on the findings, we divided patients into sarcopenia, osteopenia, and osteosarcopenia groups, and analyzed the relationship between osteosarcopenia and clinicopathological factors, including prognosis.

Of the 124 patients included, 59 (48%) were diagnosed with osteosarcopenia. Among all, 46 (37%) patients experienced postoperative recurrence, and a significant correlation was observed between osteosarcopenia and recurrence (p < 0.05). Overall survival and relapse-free survival were significantly shorter in the osteosarcopenia group than in the non-osteosarcopenia group (p < 0.05 for both). In a subgroup analysis, overall survival and relapse-free survival were significantly shorter in the osteosarcopenia group than in the non-osteosarcopenia group, or in the sarcopenia and osteopenia alone groups (all p < 0.05).

The presence of preoperative osteosarcopenia was found to affect the prognosis following esophageal cancer surgery.

Reduction in skeletal muscle mass during chemotherapy is associated with poor outcomes. This study investigated the impact of changes in the psoas muscle index (PMI) on the prognosis of patients with unresectable colorectal liver metastases (CRLM) undergoing chemotherapy, including subgroup analyses based on the initial treatment response assessment.

We evaluated 47 patients with unresectable CRLM who underwent systematic chemotherapy and assessed changes in PMI to determine their prognosis.

Changes in PMI were significantly associated with the presence or absence of primary tumor resection and the chemotherapeutic responses to first-line chemotherapy. The PMI reduction group was significantly associated with poor prognosis in both overall survival (OS) and progression-free survival (PFS) in patients with CRLM, and in both OS and PFS in the partial response (PR) group at the initial chemotherapy response assessment.

Skeletal muscle loss at chemotherapy initiation was significantly associated with poorer survival in patients with unresectable CRLM. Maintaining muscle mass could serve as a new indicator for identifying patients with a PR at the initial chemotherapy response assessment for prognosis. Personalized interventions should be investigated to determine whether they can improve muscle mass and lead to better clinical outcomes.

Sarcopenia is defined as a muscle-wasting syndrome that occurs with accelerated aging, while cachexia is a severe wasting syndrome associated with conditions such as cancer and immunodeficiency disorders, which cannot be fully addressed through conventional nutritional supplementation. Sarcopenia can be considered a component of cachexia, with the bidirectional interplay between adipose tissue and skeletal muscle potentially serving as a molecular mechanism for both conditions. However, the underlying mechanisms differ. Recognizing the interplay and distinctions between these disorders is essential for advancing both basic and translational research in this area, enhancing diagnostic accuracy and ultimately achieving effective therapeutic solutions for affected patients. This review discusses the muscle microenvironment's changes contributing to these conditions, recent therapeutic approaches like lifestyle modifications, small molecules, and nutritional interventions, and emerging strategies such as gene editing, stem cell therapy, and gut microbiome modulation. We also address the challenges and opportunities of multimodal interventions, aiming to provide insights into the pathogenesis and molecular mechanisms of sarcopenia and cachexia, ultimately aiding in innovative strategy development and improved treatments.

The aim of this study was to evaluate the combined prognostic value of calf circumference (CC) and serum albumin on mortality in patients with cancer cachexia aged ≥65 years.

This multicenter cohort study involved 5322 older patients in hospital with cancer cachexia. The combined indicator of CC and albumin was defined as the calf circumference-albumin (CCA) index. Harrell's C index, a time-dependent receiver operating characteristic curve analysis, was used to assess the prognostic performance of the CCA index and other indices. The optimal thresholds method was used to determine the cutoff values of CC and albumin, and the association between the CCA index and all-cause mortality was assessed using Kaplan-Meier analysis and Cox proportional hazard regression models.

A total of 3875 men and 1447 women with a mean age of 72.0 years (range: 68.0-78.0 years) and a mean follow-up time of 55.0 months (range: 25.0-85.0 months) were included in the study. A total of 1269 patients were classified into the low CCA index group (0 score) by the optimal thresholds method. In the overall population, the CCA index showed better differentiating power at predicting mortality in older patients with cancer cachexia compared with CC or albumin alone (C index = 0.639; 95% CI: 0.612-0.666; P < 0.05). The time-dependent receiver operating characteristic curve showed that the CCA index had the highest prognostic value of all the measures studied (P < 0.05). In the overall population, male and female patients with a high CCA index (2 score) showed better performance than those with a low CCA index (0 or 1 score).

The CCA index could significantly predict the mortality of older patients with cancer cachexia, which might provide renewed assistance for future clinical management.

Recently, several investigators have focused on the clinical significance of osteosarcopenia in malignancies; however, its prognostic impact on patients with gastric cancer after conversion surgery (CS) remains unclear. Therefore, we aimed to investigate sarcopenia, osteopenia, and osteosarcopenia in this patient population.

We retrospectively analyzed 24 patients with gastric cancer who underwent CS. Before CS, the skeletal muscle index at the L3 vertebra and bone mineral density at the Th11 vertebra were measured to investigate sarcopenia and osteopenia, respectively. Osteosarcopenia was defined as the coexistence of sarcopenia and osteopenia. The relationship between perioperative osteosarcopenia and patient prognosis, including clinicopathological factors, was assessed.

Among the 24 patients, 10 (42%) had osteosarcopenia. Osteosarcopenia was significantly correlated with body mass index, depth of tumor invasion, and tumor stage (all p < 0.05). The median overall survival and disease-free survival after CS in patients with osteosarcopenia were significantly shorter than those in patients without osteosarcopenia (all p < 0.05). In the multivariate analysis, osteosarcopenia was identified as an independent factor related to overall survival alone (p = 0.04).

Assessment of osteosarcopenia has clinical utility in predicting the prognosis after CS in patients with stage IV gastric cancer after chemotherapy.

This review examines our current understanding of consensus definitions for frailty, sarcopenia, and cachexia and their perceived overlap with malnutrition. Patients with these syndromes will often meet the criteria for malnutrition. It is common for these overlap syndromes to be misapplied by practitioners, and confusion has been further exacerbated by the lack of a common malnutrition language. To address the latter concern, we recommend using either the standalone Global Leadership Initiative in Malnutrition (GLIM) framework or the GLIM consensus criteria integrated with other accepted approaches as dictated by preference and available resources. Established care standards should guide the recognition and treatment of malnutrition to promote optimal clinical outcomes and quality of life. The effectiveness of nutrition interventions may be reduced in settings of severe acute inflammation and in end-stage disease that is associated with cachexia. However, such interventions may still assist patients to tolerate treatments that target the underlying etiology for an overlap syndrome, and they may help to improve select clinical outcomes and quality of life. Recent, large, well-designed randomized controlled trials have demonstrated the compelling positive clinical effects of medical nutrition therapy. The application of concurrent malnutrition risk screening and assessment is therefore a high priority. The necessity to deliver specific interventions that target the underlying mechanisms of these overlap syndromes and also diagnose and address malnutrition is paramount. It must be highlighted that securing beneficial outcomes for frailty, sarcopenia, and cachexia will also require nonnutrition interventions, like comprehensive care plans, pharmacologic agents, and prescribed exercise.

Colorectal cancer is the second most prevalent type of cancer in the world. Surgical complications occur in up to 50% of patients which results in increased morbidity, mortality, and poor health-related quality of life. The negative impact on survival and physical function is exacerbated in those receiving neoadjuvant treatment. Prehabilitation offers a more effective approach to ameliorate both the physical and psychological factors important for recuperation and to address sarcopenia. Our study aimed to assess the effect of multimodal prehabilitation on muscle mass in rectal cancer patients receiving neoadjuvant treatment. This is a prospective observational study conducted in a tertiary care gastrointestinal surgical unit. All consecutive patients with locally advanced resectable rectal cancer who received standard long-course neoadjuvant therapy were given a multimodal home-based prehabilitation protocol, and their muscle mass calculated on imaging before surgery was compared with a historical cohort which comprised patients who had not received prehabilitation. A total of 100 patients were enrolled in the study-44 intervention and 56 historical cohort. There was a mean percentage increase in muscle mass in the intervention group, while there was a mean percentage decrease in the historical cohort group. Improved muscle mass was significantly associated with earlier functioning of stoma, earlier tolerance to soft diet, and less surgical site infections. The overall complications, 30-day readmissions, and 30-day emergency visits were less in the prehabilitation group. Prehabilitation has a definite role in improving the physiological status of patients and potentially correlates into better postoperative outcomes. Prehabilitation must be included in management guidelines and be started from the first outpatient visit itself.

The relationship between sarcopenia and the prognosis of patients with tumours who received radio- and/or chemotherapy still needs to be determined. In this study, we aim to investigate the relationship between sarcopenia and adverse effects and mortality in patients with tumours that received radio- and/or chemotherapy, stratified by study design, tumour category, the method sarcopenia assessed, treatment options, study location and among other factors.

PubMed, Web of Science and Embase were searched from inception to 15 August 2024, without language restrictions and with a manual search of references for additional articles retrieval. Cohort studies of ≥ 100 patients with tumours that evaluated the association between sarcopenia or muscle mass and the adverse effects or overall survival induced by radio- and/or chemotherapy were included.

Thirty-nine studies were included, involving 8966 patients with tumours, including 3383 patients with sarcopenia. The pooled prevalence of sarcopenia in patients with tumours was 0.42 (95% CI 0.36-0.48, p < 0.001) overall. The prevalence of sarcopenia is higher in Oceania patients 0.60 (95% CI 0.28-0.89, p < 0.001), those with reproductive tumour 0.57 (95% CI 0.30-0.83, p < 0.001), and sarcopenia assessed by the lumbar-skeletal muscle index 0.46 (95% CI 0.39-0.53, p < 0.001) than in other subgroups, but not show significant differences in sex. Sarcopenia was associated with an increased risk of adverse effects in patients who received radio- and/or chemotherapy, with a relative risk (RR) of 1.44 (95% CI 1.21-1.71, p < 0.001). Retrospective studies (RR = 1.49; 95% CI 1.24-1.79; p < 0.001), sarcopenia assessed by other methods (RR = 2.98; 95% CI 1.52-5.87; p < 0.001), and patients in Europe (RR = 1.92; 95% CI 1.15-3.22; p = 0.013), received chemoradiotherapy (RR = 1.47; 95% CI 1.23-1.76; p < 0.001), and with head and neck tumours (RR = 1.54; 95% CI 1.17-2.01; p = 0.010) had higher relative risk than other subgroups. Sarcopenia was also associated with reduced overall survival in patients with tumours, with a pooled hazard ratio (HR) of 1.66 (95% CI 1.40-1.96, p < 0.001). Prospective studies (HR = 1.72; 95% CI 0.97-3.07; p = 0.065), sarcopenia assessed by the cervical-skeletal muscle index (HR = 2.66; 95% CI 1.73-4.09; p < 0.001), and patients in Asia (HR = 1.91; 95% CI 1.50-2.42; p < 0.001), received chemoradiotherapy (HR = 1.85; 95% CI 1.46-2.45; p < 0.001) and with head and neck tumours (HR = 2.35; 95% CI 1.88-2.95; p < 0.001) had higher HR than other subgroups.

Sarcopenia was associated with a higher risk of adverse effects and mortality in patients with tumours received radio- and/or chemotherapy.

This study aimed to clarify the relationship between preoperative sarcopenia and prognostic nutritional index (PNI) statuses and clinicopathological factors in patients with non-small cell lung cancer (NSCLC) who underwent surgical resection, and to evaluate short- and long-term outcomes by stratifying groups according to sarcopenia and PNI status as prognostic predictors.

This study included 300 patients with p-Stage I-IIIA NSCLC who underwent complete resection with lobectomy. Sarcopenia was assessed using the skeletal muscle index (SMI) and the immunonutritional index was evaluated using the PNI. The first quartile was used as the cutoff for the sarcopenia/non-sarcopenia and low/high-PNI groups.

The median patient age was 70 years, and 184 patients (61.3 %) were male individuals. The median PNI was 50.2, and the median SMI was 48.1 and 37.5 for male and female patients, respectively. The median follow-up period was 64 months (60 patients died). Survival analysis showed that overall survival was significantly worse in the sarcopenia and low-PNI groups than in the control group (p = 0.002 and p < 0.001, respectively). When stratified by sarcopenia and PNI status, the sarcopenia with low-PNI group had a particularly poor prognosis (5-year survival rate, 52.8 % [p < 0.001]). Multivariable Cox regression analysis revealed that sarcopenia with low PNI was an independent prognostic factor that indicated a poor outcome. The response to drug treatment for postoperative recurrence was significantly worse in the sarcopenia with low-PNI group than inthe other group.

The combination of preoperative sarcopenia and immunonutritional impairment had a negative clinical impact independent of tumor factors, and patients with these two indications had a particularly poor prognosis. These factors may be associated with poor responses to drug treatment for postoperative recurrence. The evaluation of skeletal muscle mass using preoperative imaging and nutritional assessment using serum markers may be useful for perioperative management and prognosis prediction.

The SARC-CalF was developed as a screening tool for sarcopenia, but little is still known about its validity in surgical patients. Thus, this study aimed to assess the prognostic value of SARC-CalF in predicting clinical outcomes in patients admitted for any elective surgery in a hospital.

Cohort study with prospective data collection of surgical patients ≥18 years of age screened for sarcopenia within 48 h of admission using the SARC-CalF (score ≥11 points classified patients at suggestive signs of sarcopenia). A standard questionnaire for sociodemographic and clinical data was filled and anthropometric data were measured. Clinical outcomes of interest comprised postoperative complications, length of postoperative hospital stay (LPHS), length of hospital stay (LOS), and in-hospital death.

Among the 303 patients admitted for elective surgery across various specialties (58.2 ± 14.6 years; 53.8% men) included, 21.5% presented suggestive signs of sarcopenia (SARC-CalF ≥11). LOS (16.0 [10.0-29.0] vs 13.5 [8.0-22.0] days; P < 0.05) and LPHS (6.0 [3.0-14.5] vs 5.0 [1.0-8.2] days; P < 0.05) were longer in patients with SARC-CalF ≥11 compared with those without this condition. The frequency of severe postoperative complications (23.1% vs 8.8%; P < 0.05) and the incidence of death (12.3% vs 2.9%; P < 0.05) were higher in patients with SARC-CalF ≥11. However, in the multivariate analyses, no association between SARC-CalF ≥11 and clinical outcomes was found.

Signs of sarcopenia (SARC-CalF ≥11) were present in >20% of patients who were hospitalized for any elective surgery, but it was not an independent predictor of extended hospital stay, complications, and death.

This investigation seeks to scrutinize the relationships between body composition metrics and the clinical outcomes observed in patients with cholangiocarcinoma (CCA). A comprehensive exploration was conducted across three prominent online databases: Embase, PubMed, and the Cochrane Library. This endeavor spanned the entirety of each database up to the cutoff date of September 29, 2023. To evaluate the quality of the included studies, the Newcastle-Ottawa scale was employed. This comprehensive analysis included a total of 26 articles with a combined patient cohort of 4398 individuals. The results demonstrated that CCA patients with low skeletal muscle index (SMI) had significantly inferior OS (HR: 1.93, p < 0.001) and RFS (HR: 2.02, p < 0.001), as well as a higher incidence of postoperative complications (OR: 1.69, 95% CI: 1.20-2.38, p < 0.001) compared to those with high SMI. The presence of sarcopenia in CCA patients was significantly related to poorer OS (HR: 1.96, p < 0.001) and RFS (HR: 2.05, p < 0.001), and a higher rate of postoperative complications (OR: 1.39, p = 0.049) in comparison to those without sarcopenia. Moreover, lower psoas muscle index (PMI) and myosteatosis were associated with shorter OS (PMI, HR: 1.56, p < 0.001; myosteatosis, HR: 1.49, p = 0.001) and RFS (PMI, HR: 2.16, p < 0.001; myosteatosis, HR: 1.35, p = 0.023). Our findings highlight incorporating body composition screening into clinical practice can help develop treatment strategies and optimize perioperative care, potentially improving patient outcomes.

Sarcopenia is a loss of muscle strength, muscle mass, and function that can increase a patient's risk of injury, illness, and can even severely impair quality of life and increase a patient's risk of death. A growing body of research suggests that sarcopenia and urinary tract disorders are closely related. In this review, we aimed to emphasize the definition of skeletal sarcopenia, summarize the methods used to diagnose skeletal sarcopenia, discuss the advances in the study of sarcopenia in benign diseases of the urinary system, discuss the advances in the study of sarcopenia in malignant diseases of the urinary system. Sarcopenia and urologic diseases interact with each other; urologic diseases cause sarcopenia, and sarcopenia aggravates the condition of the original disease, thus falling into a vicious circle. This review provides a comprehensive understanding of sarcopenia in urologic diseases, which is very important for the management and prognosis of urologic diseases.