Diagnosis and outcomes of cachexia in Asia: Working Consensus Report from the Asian Working Group for Cachexia

IF 8.9 1区 医学 Journal of Cachexia, Sarcopenia and Muscle Pub Date : 2023-09-05 DOI:10.1002/jcsm.13323
Hidenori Arai, Keisuke Maeda, Hidetaka Wakabayashi, Tateaki Naito, Masaaki Konishi, Prasert Assantachai, Wai Tung Auyeung, Chalobol Chalermsri, Wei Chen, Justin Chew, Ming-Yueh Chou, Chih-Cheng Hsu, Allyn Hum, In Gyu Hwang, Toshimi Kaido, Lin Kang, Shahrul Bahyah Kamaruzzaman, Miji Kim, Jenny Shun Wah Lee, Wei-Ju Lee, Chih-Kuang Liang, Wee Shiong Lim, Jae-Young Lim, Yen Peng Lim, Raymond See-Kit Lo, Terence Ong, Wen-Harn Pan, Li-Ning Peng, Pornpoj Pramyothin, Nurul Huda Razalli, Masakazu Saitoh, Suzana Shahar, Han Ping Shi, Heng-Hsin Tung, Yasuhito Uezono, Stephan von Haehling, Chang Won Won, Jean Woo, Liang-Kung Chen
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引用次数: 2

Abstract

Chronic diseases often lead to metabolic disorders, causing anabolic resistance and increased energy consumption, which result in cachexia. Cachexia, in turn, can lead to major clinical consequences such as impaired quality of life, shortened life expectancy, and increased healthcare expenditure. Existing international diagnostic criteria for cachexia employ thresholds derived from Western populations, which may not apply to Asians due to differing body compositions. To address this issue, the Asian Working Group for Cachexia (AWGC) was initiated. The AWGC comprises experts in cachexia research and clinical practice from various Asian countries and aims to develop a consensus on diagnostic criteria and significant clinical outcomes for cachexia in Asia. The AWGC, composed of experts in cachexia research and clinical practice from several Asian countries, undertook three-round Delphi surveys and five meetings to reach a consensus. Discussions were held on etiological diseases, essential diagnostic items for cachexia, including subjective and objective symptoms and biomarkers, and significant clinical outcomes. The consensus highlighted the importance of multiple diagnostic factors for cachexia, including chronic diseases, either or both weight loss or low body mass index, and at least one of the following: anorexia, decreased grip strength (<28 kg in men and <18 kg in women), or elevated C-reactive protein levels (>5 mg/L [0.5 mg/dL]). The AWGC proposed a significant weight change of 2% or more over a 3–6 month period and suggested a tentative cut-off value of 21 kg/m2 for low body mass index in diagnosing cachexia. Critical clinical outcomes were determined to be mortality, quality of life as assessed by tools such as EQ-5D or the Functional Assessment of Anorexia/Cachexia Therapy, and functional status as measured by the Clinical Frailty Scale or Barthel Index, with significant emphasis on patient-reported outcomes. The AWGC consensus offers a comprehensive definition and user-friendly diagnostic criteria for cachexia, tailored specifically for Asian populations. This consensus is set to stimulate future research and enhance the multidisciplinary approach to managing cachexia. With plans to develop further guidelines for the optimal treatment, prevention, and care of cachexia in Asians, the AWGC criteria are expected to drive research across chronic co-morbidities and cancer in Asia, leading to future refinement of diagnostic criteria.

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亚洲恶病质的诊断和结果:亚洲恶病病质工作组的工作共识报告。
慢性疾病通常会导致代谢紊乱,导致合成代谢抵抗和能量消耗增加,从而导致恶病质。恶病质反过来会导致重大的临床后果,如生活质量下降、预期寿命缩短和医疗支出增加。现有的恶病质国际诊断标准采用来自西方人群的阈值,由于身体成分不同,这可能不适用于亚洲人。为了解决这个问题,成立了亚洲恶病质问题工作组。AWGC由来自亚洲各国的恶病质研究和临床实践专家组成,旨在就亚洲恶病质的诊断标准和重要临床结果达成共识。AWGC由来自几个亚洲国家的恶病质研究和临床实践专家组成,进行了三轮德尔菲调查和五次会议以达成共识。讨论了病因疾病、恶病质的基本诊断项目,包括主观和客观症状和生物标志物,以及重要的临床结果。共识强调了恶病质的多种诊断因素的重要性,包括慢性疾病、体重减轻或低体重指数,以及以下至少一种:厌食症、,握力下降(5 mg/L[0.5 mg/dL])。AWGC提出在3-6个月内体重显著变化2%或更多,并建议在诊断恶病质时,低体重指数的暂定临界值为21 kg/m2。关键临床结果被确定为死亡率、通过EQ-5D或厌食症/恶病质治疗功能评估等工具评估的生活质量,以及通过临床虚弱量表或Barthel指数测量的功能状态,重点关注患者报告的结果。AWGC共识为恶病质提供了一个全面的定义和用户友好的诊断标准,专门为亚洲人群量身定制。这一共识将促进未来的研究,并加强管理恶病质的多学科方法。随着计划为亚洲人恶病质的最佳治疗、预防和护理制定进一步的指南,AWGC标准有望推动亚洲慢性合并症和癌症的研究,从而进一步完善诊断标准。
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来源期刊
Journal of Cachexia, Sarcopenia and Muscle
Journal of Cachexia, Sarcopenia and Muscle Medicine-Orthopedics and Sports Medicine
自引率
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期刊介绍: The Journal of Cachexia, Sarcopenia, and Muscle is a prestigious, peer-reviewed international publication committed to disseminating research and clinical insights pertaining to cachexia, sarcopenia, body composition, and the physiological and pathophysiological alterations occurring throughout the lifespan and in various illnesses across the spectrum of life sciences. This journal serves as a valuable resource for physicians, biochemists, biologists, dieticians, pharmacologists, and students alike.
期刊最新文献
Comment on 'Diagnosis of Sarcopenia by Evaluating Skeletal Muscle Mass by Adjusted Bioimpedance Analysis Validated With Dual-Energy X-Ray Absorptiometry' by Cheng et al. Comment on 'Association Between Dynapenic Obesity and Risk of Cardiovascular Disease: The Hisayama Study' by Setoyama et al. Comment on 'Detection of Cancer-Associated Cachexia in Lung Cancer Patients Using Whole-Body [18F]FDG-PET/CT Imaging: A Multicentre Study' by Ferrara et al. Comment on 'Factors Associated With Skeletal Muscle Mass in Middle-Aged Men Living With HIV' by Xu et al. Comment on 'Impact of Cachexia and First-Line Systemic Therapy for Previously Untreated Advanced Non-Small Cell Lung Cancer: NEJ050A' by Miura et al.
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