JCSM rapid communications最新文献

Background

Subjective global assessment (SGA) and Royal Free Hospital-global assessment (RFH-GA) are clinically useful for assessing malnutrition. This study aimed to investigate the relationship between sarcopenia, which predicts poor clinical outcomes in patients with chronic liver disease (CLD), and these two methods.

Methods

This retrospective study included 240 consecutive patients admitted to our hospital between October 2011 and January 2014. Sarcopenia and RFH-GA were evaluated using anthropometric measurements and computed tomography-based skeletal muscle area. The primary outcome was whether nutritional assessment methods could predict sarcopenia. In addition, factors associated with sarcopenia and mortality were evaluated.

Results

The median age was 70 years, 67% were men, and 17% had sarcopenia. Malnourished patients assessed by SGA (P = 0.02) and RFH-GA (P < 0.001) had a significantly higher prevalence of sarcopenia than did well-nourished patients. After adjustment for age, sex, aetiology, and albumin, multivariate analysis revealed that RFH-GA, but not SGA, was a significant predictor of sarcopenia [odds ratio, 2.47; 95% confidence interval (CI), 1.15–5.33]. During a median follow-up of 2.7 years, 113 patients died. The overall survival rates were significantly lower in malnourished patients assessed by SGA (P < 0.001) and RFH-GA (P < 0.001) than in well-nourished patients. Multivariate analysis revealed that RFH-GA [hazard ratio (HR), 1.51; 95% CI, 1.02–2.23] and SGA (HR, 1.99; 95% CI, 1.19–3.32) were independently associated with mortality.

Conclusions

Royal Free Hospital-global assessment is a simple bedside screening tool for identifying sarcopenia and predicting mortality in patients with CLD.

Background

Cachexia, a complex multi-organ syndrome, shortens survival time of patients, particularly those with cancer. Many studies and clinical trials have been carried out to identify cachexia-inducing factors and potential treatments for cancer cachexia over the last 20 years. Of these factors, some are promising targets for treatment in humans, owing to their expression profiles in patients. Several clinical interventions, which act on either cachexia-inducing factors or tissues affected by cachexia, have been developed. Some have had positive effects in the treatment of cancer cachexia; however, the question remains whether these interventions reverse cancer cachexia and could be used as standard interventions for disease treatment. The aim of this review is to understand the basic mechanisms and factors that induce cancer cachexia and their efficacies in clinical trials, providing a better outlook for future studies of cancer cachexia.

Methods

A systematic search was performed using PubMed and ClinicalTrials.gov databases for cachexia mediators and clinical trials.

Results

Of all databases and peer-reviewed facts considered, 256 papers and 35 clinical trials were included in this systematic review. Twenty-one mediators were identified, and 17 clinical interventions were reported in these studies. Outcomes of these clinical trials were assessed on changes in overall survival, body weight, lean body mass, appetite, muscle strength, muscle function, quality of life, and cytokine levels.

Conclusions

There is no current standard or successful intervention for treating cancer cachexia. Further research is needed to improve our understanding of initiators of cachexia to achieve successful outcomes in cachexia clinical trials.

Background

Sarcopenia is the progressive generalized loss of skeletal muscle mass, strength, and function that occurs with aging. This study was undertaken to identify new biomarkers of sarcopenia by proteomics analysis of female sera.

Methods

A case–control study was set up, for which 19 sarcopenic subjects and 20 control subjects, according to the European Working Group on Sarcopenia Older People criteria published in 2010 (EWGSOP1), were enrolled. All the subjects were at least 65 years old and in majority female. Biomarker screening was performed by a comparative mass spectrometry analysis. Protein expression levels between the two groups were compared. One of the identified biomarkers, cathepsin D, was measured by immunoassay on the serum of the full sample set (n = 39). Its diagnostic performance was evaluated with a receiver operating characteristic curve (ROC curve).

Results

Two biomarkers were identified: fructose-biphosphate aldolase A (P ≤ 0.05) and cathepsin D (P ≤ 0.05). The levels of all of them were higher in sarcopenic patients. It was confirmed by immunoassay that cathepsin D levels in serum were significantly higher in the sarcopenic group of patients (P = 0.038). An inverse correlation (−0.385) was observed between cathepsin D levels in serum and gait speed. The area under the ROC curve measurement (AUC = 0.696) demonstrated that cathepsin D levels could discriminate between sarcopenic and non-sarcopenic subjects. A predictive model including cathepsin D, age, and body mass index was established to improve the diagnostic performance (AUC = 0.908).

Conclusions

Cathepsin D has been identified as a diagnostic biomarker of sarcopenia.

Background

Cardiorespiratory fitness (CRF) has important implications for post-operative recovery. The timed-up-and-go (TUG) test is a cheap and simple method to assess a patient's functional performance; although how well TUG correlates with results of a cardiopulmonary exercise test (CPET), the gold standard measure of CRF is unknown. Therefore, the aim of this study was to assess the correlation between CPET-derived parameters of CRF and TUG times in a group of older adults.

Methods

Ninety-eight independent community dwelling older adults [mean age: 72 years (range: 61–86), mean body mass index: 26.3 ± 3.1 kg/m², 54 male] were recruited to this study; completing 180 CPET and TUG testing sessions over a 28 month period. The correlation between CPET-derived CRF parameters and TUG time was assessed, and receiver operating characteristic curve analysis was performed to determine clinically useful cut-off points in TUG time.

Results

Median TUG time was 7.1 s [interquartile range (IQR): 4–8.5], median VO₂ peak was 24.4 mL/kg/min (IQR: 20.2–29.2), and the median anaerobic threshold (AT) was 13.4 mL/kg/min (IQR: 8.6–16.5). There was a statistically significant negative correlation between TUG time and AT (r = −0.317, P = <0.0001) and TUG time and VO₂ peak (r = −0.4247, P < 0.0001). Receiver operating characteristic curve analysis determined a TUG time of ≥6.5 s to have an 82% sensitivity and 60% specificity to detect an AT <11.0 mL/kg/min, the point at below which perioperative mortality is known to increase.

Conclusions

Despite strong evidence for the utility of pre-operative CPET in stratifying surgical risk, CPET is not universally available. Our finding of a correlation between TUG time and CPET-derived parameters of CRF (AT/VO₂ peak) suggests that TUG may be a useful surrogate in the pre-operative setting.

Background

Pre-clinical studies suggest that renin–angiotensin system blockade may improve muscle function. Clinical reports of the effect of angiotensin converting enzyme inhibitors (ACEIs) on physical functioning are inconsistent. There are no reports of the effect of angiotensin receptor blockers (ARBs) treatment in older adults.

Methods

We analysed data of 1268 participants in the Singapore Longitudinal Ageing Study (SLAS-2) who provided information on the use of ACEI, ARB, and other antihypertensive drugs at baseline and follow-up (mean 4.5 years later). Baseline and follow-up outcome measures were cumulated deficits frailty index (CD-FI), physical phenotype frailty index (PP-FI), calf circumference (CC), knee extension strength, composite muscle mass and strength (MMS) z-score, and gait speed (GS). In primary analyses, we compared the use and non-use of an anti-hypertensive drug class among participants with hypertensive and cardiac disease, and secondarily with participants having other chronic diseases, and those who reported no chronic diseases. Multi-variable analyses adjusted for socioeconomic status, body mass index ≥30, ≥5 comorbidities, ≥5 drugs use, other non-ARB or non-ACEI drugs (calcium channel blockers, beta blockers, or hydrochlorothiazide), MMSE <23, Geriatric Depression Scale score, Nutrition Screening Initiative nutritional risk, physical activities, baseline frailty, and physical performance.

Results

Among study participants, 7.8% (N = 99) were ARB users (62% used losartan), 11.7% (N = 148) were ACEI users (53% used enalapril), and 34.2% (N = 434) were users of other anti-hypertensive drug classes. The cohort participants overall showed increases in the mean levels and changes in CD-FI and PP-FI and decreases in knee extension strength, GS, CC, and MMS. However, among groups, ARB users showed decreasing trends in CD-FI and increasing trends of CC and MMS. Among participants with hypertensive and cardiovascular disease, there were significant differences in CD-FI and PP-FI changes, adjusted for confounding variables: ARB users compared with non-users showed lesser declines in CD-FI (0.013 vs. 0.028, P = 0.018) and PP-FI (0.924 vs. 1.170, P = 0.017). ARB users also showed statistically significantly greater gains in MMS z-scores: 0.329 vs. 0.076, P = 0.022. There was no association of ACEI or other anti-hypertensive class use with changes in frailty, MMS, or GS.

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