Generalized loss of muscle mass is associated with increased morbidity and mortality in patients with cancer. The gold standard to measure muscle mass is by using computed tomography (CT). However, the aim of this prospective observational cohort study was to determine whether point-of-care ultrasound (POCUS) could be an easy-to-use, bedside measurement alternative to evaluate muscle status. Patients scheduled for major abdominal cancer surgery with a recent preoperative CT scan available were included. POCUS was used to measure the muscle thickness of mm. biceps brachii, mm. recti femoris, and mm. vasti intermedius 1 day prior to surgery. The total skeletal muscle index (SMI) was derived from patients’ abdominal CT scan at the third lumbar level. Muscle force of the upper and lower extremities was measured using a handheld dynamometer. A total of 165 patients were included (55% male; 65 ± 12 years). All POCUS measurements of muscle thickness had a statistically significant correlation with CT-derived SMI (r ≥ 0.48; p < 0.001). The strongest correlation between POCUS muscle measurements and SMI was observed when all POCUS muscle groups were added together (r = 0.73; p < 0.001). Muscle strength had a stronger correlation with POCUS-measured muscle thickness than with CT-derived SMI. To conclude, this study indicated a strong correlation between combined muscle thickness measurements performed by POCUS- and CT-derived SMI and measurements of muscle strength. These results suggest that handheld ultrasound is a valid tool for the assessment of skeletal muscle status.
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Muscle fiber-type specific expression of UCP3-protein is reported here for the firts time, using immunofluorescence microscopy
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BACKGROUND: Muscle quantity at intensive care unit (ICU) admission has been independently associated with mortality. In addition to quantity, muscle quality may be important for survival. Muscle quality is influenced by fatty infiltration or myosteatosis, which can be assessed on computed tomography (CT) scans by analysing skeletal muscle density (SMD) and the amount of intermuscular adipose tissue (IMAT). We investigated whether CT-derived low skeletal muscle quality at ICU admission is independently associated with 6-month mortality and other clinical outcomes.METHODS: This retrospective study included 491 mechanically ventilated critically ill adult patients with a CT scan of the abdomen made 1 day before to 4 days after ICU admission. Cox regression analysis was used to determine the association between SMD or IMAT and 6-month mortality, with adjustments for Acute Physiological, Age, and Chronic Health Evaluation (APACHE) II score, body mass index (BMI), and skeletal muscle area. Logistic and linear regression analyses were used for other clinical outcomes.RESULTS: Mean APACHE II score was 24 ± 8 and 6-month mortality was 35.6%. Non-survivors had a lower SMD (25.1 vs. 31.4 Hounsfield Units (HU); p < 0.001), and more IMAT (17.1 vs. 13.3 cm(2); p = 0.004). Higher SMD was associated with a lower 6-month mortality (hazard ratio (HR) per 10 HU, 0.640; 95% confidence interval (CI), 0.552-0.742; p < 0.001), and also after correction for APACHE II score, BMI, and skeletal muscle area (HR, 0.774; 95% CI, 0.643-0.931; p = 0.006). Higher IMAT was not significantly associated with higher 6-month mortality after adjustment for confounders. A 10 HU increase in SMD was associated with a 14% shorter hospital length of stay.CONCLUSIONS: Low skeletal muscle quality at ICU admission, as assessed by CT-derived skeletal muscle density, is independently associated with higher 6-month mortality in mechanically ventilated patients. Thus, muscle quality as well as muscle quantity are prognostic factors in the ICU.TRIAL REGISTRATION: Retrospectively registered (initial release on 06/23/2016) at ClinicalTrials.gov: NCT02817646 .
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Rationale: Patients with cancer of the upper gastrointestinal tract or lung are more likely to present with malnutrition at diagnosis than, for instance, patients with melanoma. Low muscle mass is an indicator of malnutrition and can be determined by computed tomography (CT) analysis of the skeletal muscle index (SMI) at the 3rd lumbar vertebra (L3) level. However, CT images at L3 are not always available. At each vertebra level, we determined if type of cancer, i.e., head and neck cancer (HNC), oesophageal cancer (OC) or lung cancer (LC) vs. melanoma (ME) was associated with lower SMI. Methods: CT images from adult patients with HNC, OC, LC or ME were included and analyzed. Scans were performed in the patient’s initial staging after diagnosis. MIM software version 7.0.1 was used to contour the muscle areas for all vertebra levels. Skeletal muscle area was corrected for stature to calculate SMI (cm2/m2). We tested for the association of HNC, OC, or LC diagnosis vs ME with SMI by univariate and multivariate linear regression analyses. In the multivariate analyses, age (years), sex, and body mass index (BMI; kg/m2) were included. Betas (B;95%CI) were calculated and statistical significance was set at p
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OBJECTIVES: Assessment of malnutrition-related muscle depletion with computed tomography (CT) using skeletal muscle index (SMI) and muscle radiation attenuation (MRA) at the third lumbar vertebra is well validated. However, SMI and MRA values at other vertebral locations and interchangeability as parameters in different types of cancer are less known. We aimed to investigate whether adult patients with different types of cancer show differences in SMI and MRA at all vertebral levels.METHODS: We retrospectively analyzed CT images from 203 patients:120 with head and neck cancer, esophageal cancer, or lung cancer (HNC/EC/LC) and 83 with melanoma (ME). Univariate and multivariate linear regression analyses determined the association between SMI (cm²/m 2) and MRA (Hounsfield units) and cancer type at each vertebral level (significance corrected for multiple tests, P ≤ 0.002). The multivariate analyses included age, sex, cancer stage, comorbidity, CT protocol, and body mass index (BMI) (MRA analyses). RESULTS: SMI was lower in the HNC/EC/LC group versus the ME group at all vertebral levels, except C4 through C6 in the multivariate analyses. Female sex was associated with lower SMI at almost all levels. MRA was similar at most vertebral levels in both cancer groups but was lower at C1 through C4, T7, and L5 in the multivariate analyses. Use of contrast fluid and BMI were associated with higher MRA at all vertebral levels except T8 to T9 and C1 to C2, respectively.CONCLUSIONS: SMI, but not MRA, was lower in HNC/EC/LC patients than in ME patients at most vertebral levels. This indicates that low muscle mass presents itself across the various vertebral muscle areas. MRA may less consistently mark muscle depletion in malnourished patients.
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INTRODUCTION: In patients with cancer, low muscle mass has been associated with a higher risk of fatigue, poorer treatment outcomes, and mortality. To determine body composition with computed tomography (CT), measuring the muscle quantity at the level of lumbar 3 (L3) is suggested. However, in patients with cancer, CT imaging of the L3 level is not always available. Thus far, little is known about the extent to which other vertebra levels could be useful for measuring muscle status. In this study, we aimed to assess the correlation of the muscle quantity and quality between any vertebra level and L3 level in patients with various tumor localizations.METHODS: Two hundred-twenty Positron Emission Tomography (PET)-CT images of patients with four different tumor localizations were included: 1. head and neck ( n = 34), 2. esophagus ( n = 45), 3. lung ( n = 54), and 4. melanoma ( n = 87). From the whole body scan, 24 slices were used, i.e., one for each vertebra level. Two examiners contoured the muscles independently. After contouring, muscle quantity was estimated by calculating skeletal muscle area (SMA) and skeletal muscle index (SMI). Muscle quality was assessed by calculating muscle radiation attenuation (MRA). Pearson correlation coefficient was used to determine whether the other vertebra levels correlate with L3 level. RESULTS: For SMA, strong correlations were found between C1-C3 and L3, and C7-L5 and L3 ( r = 0.72-0.95). For SMI, strong correlations were found between the levels C1-C2, C7-T5, T7-L5, and L3 ( r = 0.70-0.93), respectively. For MRA, strong correlations were found between T1-L5 and L3 ( r = 0.71-0.95). DISCUSSION: For muscle quantity, the correlations between the cervical, thoracic, and lumbar levels are good, except for the cervical levels in patients with esophageal cancer. For muscle quality, the correlations between the other levels and L3 are good, except for the cervical levels in patients with melanoma. If visualization of L3 on the CT scan is absent, the other thoracic and lumbar vertebra levels could serve as a proxy to measure muscle quantity and quality in patients with head and neck, esophageal, lung cancer, and melanoma, whereas the cervical levels may be less reliable as a proxy in some patient groups.
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BACKGROUND: Survival of kidney transplant recipients (KTR) is low compared with the general population. Low muscle mass and muscle strength may contribute to lower survival, but practical measures of muscle status suitable for routine care have not been evaluated for their association with long-term survival and their relation with each other in a large cohort of KTR.METHODS: Data of outpatient KTR ≥ 1 year post-transplantation, included in the TransplantLines Biobank and Cohort Study (ClinicalTrials.gov Identifier: NCT03272841), were used. Muscle mass was determined as appendicular skeletal muscle mass indexed for height 2 (ASMI) through bio-electrical impedance analysis (BIA), and by 24-h urinary creatinine excretion rate indexed for height 2 (CERI). Muscle strength was determined by hand grip strength indexed for height 2 (HGSI). Secondary analyses were performed using parameters not indexed for height 2. Cox proportional hazards models were used to investigate the associations between muscle mass and muscle strength and all-cause mortality, both in univariable and multivariable models with adjustment for potential confounders, including age, sex, body mass index (BMI), estimated glomerular filtration rate (eGFR) and proteinuria. RESULTS: We included 741 KTR (62% male, age 55 ± 13 years, BMI 27.3 ± 4.6 kg/m 2), of which 62 (8%) died during a median [interquartile range] follow-up of 3.0 [2.3-5.7] years. Compared with patients who survived, patients who died had similar ASMI (7.0 ± 1.0 vs. 7.0 ± 1.0 kg/m 2; P = 0.57), lower CERI (4.2 ± 1.1 vs. 3.5 ± 0.9 mmol/24 h/m 2; P < 0.001) and lower HGSI (12.6 ± 3.3 vs. 10.4 ± 2.8 kg/m 2; P < 0.001). We observed no association between ASMI and all-cause mortality (HR 0.93 per SD increase; 95% confidence interval [CI] [0.72, 1.19]; P = 0.54), whereas CERI and HGSI were significantly associated with mortality, independent of potential confounders (HR 0.57 per SD increase; 95% CI [0.44, 0.81]; P = 0.002 and HR 0.47 per SD increase; 95% CI [0.33, 0.68]; P < 0.001, respectively), and associations of CERI and HGSI with mortality remained independent of each other (HR 0.68 per SD increase; 95% CI [0.47, 0.98]; P = 0.04 and HR 0.53 per SD increase; 95% CI [0.36, 0.76]; P = 0.001, respectively). Similar associations were found for unindexed parameters. CONCLUSIONS: Higher muscle mass assessed by creatinine excretion rate and higher muscle strength assessed by hand grip strength are complementary in their association with lower risk of all-cause mortality in KTR. Muscle mass assessed by BIA is not associated with mortality. Routine assessment using both 24-h urine samples and hand grip strength is recommended, to potentially target interdisciplinary interventions for KTR at risk for poor survival to improve muscle status.
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Objective The purpose of this study was to investigate the relationship between body mass index (BMI) class and physical activity and sedentary behavior in patients with acute coronary syndrome (ACS) during cardiac rehabilitation (CR). Methods This study was a secondary analysis of the OPTICARE trial. Physical activity and sedentary behavior were measured in participants with ACS (n = 359) using actigraphy at baseline, directly after completion of a multidisciplinary 12-week exercise-based CR program and 9 months thereafter. Outcome measures were step count and duration of time (percentage of wear time) spent in light physical activity, moderate-to-vigorous physical activity, and sedentary behavior. Participants were classified as normal weight (BMI = 18.5–24.99 kg/m2; n = 82), overweight (BMI = 25.0–29.99 kg/m2; n = 182), or obese (BMI ≥ 30.0 kg/m2; n = 95). Linear mixed-effects models were applied to study the relationship between BMI class and physical activity and sedentary behavior. Results At the start of CR, compared with participants with normal weight, participants with obesity made on average 1.11 steps fewer per minute (952 steps/d), spent 2.9% (25 min/d) less time in light physical activity, and spent 3.31% (28 min/d) more time in sedentary behavior. Participants of all BMI classes improved their physical activity and sedentary behavior levels similarly during CR, and these improvements were maintained after completion of CR. Conclusion Participants with ACS who had obesity started CR with a less favorable physical activity and sedentary behavior profile than that of participants with normal weight. Because all BMI classes showed similar improvement during CR, this deficit was preserved. Impact This study indicates that reconsideration of the CR program in the Netherlands for patients with ACS and obesity is warranted, and development of more inclusive interventions for specific populations is needed. A new program for people with obesity should include added counseling on increasing physical activity and preventing sedentary behavior to facilitate weight loss and reduce mortality risk. Lay Summary People with ACS who have obesity are less active and sit more than individuals with normal weight, both during and after CR. This study suggests that CR needs to be changed to help individuals increase their physical activity to help them lose weight and reduce their risk of death.
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BACKGROUND & AIMS: We studied whether low pre-treatment muscle mass, measured with CT at thoracic (T4) or lumbar level (L3) associates with early termination of chemotherapy related to toxicity in head and neck cancer (HNC) patients.METHODS: This was a retrospective chart and image review. Adult HNC patients treated with (surgery and) platinum-based chemo-radiotherapy were included if a pre-treatment CT scan at T4 or L3 level was available. Muscle mass was evaluated by assessment of skeletal muscle index (SMI; cm2/m2). T4 and L3 SMI measurements were corrected for deviation from their respective means and were merged into one score for SMI difference (cm2/m2). All cases were assessed for presence of toxicity-related unplanned early termination of chemotherapy ('early termination'). Univariate and multivariate logistic regression models were used to investigate associations between pooled SMI and early termination.RESULTS: 213 patients (age: 57.9 ± 10.3 y, male: 77%, T4 image: 45%) were included. A significant association between SMI as a continuous variable and early termination was found, both in the univariate analysis (p = 0.007, OR = 0.96 [0.94-0.99]) and the multivariate analysis (p = 0.021, OR 0.96 [0.92-0.99]). The multivariate models identified potential associations with type of chemotherapy, presence of co-morbidity, a combination of (former) smoking and alcohol consumption, and sex.CONCLUSION: Lower muscle mass was robustly associated with higher odds of early termination of chemotherapy in HNC patients. Further prospective studies are required to tailor the care for patients with low muscle mass and to avoid early termination of chemotherapy.
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