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J Frailty Aging. 2014;3(1):3-8. doi: 10.14283/jfa.2014.1.

Age, Obesity, Sarcopenia, and Proximity to Death Explain Reduced Mean Muscle Attenuation in Patients with Advanced Cancer.

Author information

1
Dr. Vickie E Baracos, Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, Canada, T6G 1Z2, Telephone: +1 (780) 432-8232 Fax: +1 (780) 432-8425 Email: vickie.baracos@ualberta.ca.

Abstract

BACKGROUND:

Cancer cachexia is characterized by skeletal muscle loss. A feature of muscle wasting, reduction in the mean muscle attenuation from computed tomography images is believed to reflect pathological infiltration of fat into muscle. It is a reported prognostic indicator in cancer patients.

OBJECTIVES:

To develop an explanatory multivariate model of muscle attenuation of cancer patients incorporating age, sex, disease characteristics, body composition. Time to death ≤92 days was included in the model as the demarcation of end-stage disease.

DESIGN:

Multivariate general linear model regression analysis of total mean muscle attenuation and change in muscle attenuation.

SETTING:

Regional cancer center (Alberta, Canada).

PARTICIPANTS:

Patients with gastrointestinal and respiratory tract cancers (mean age 64±11 years, 44% female).

MEASUREMENTS:

Total adipose tissue and skeletal muscle cross sectional area, and mean muscle attenuation at the 3rd lumbar vertebra were assessed from baseline computed tomography (n=1719), and a subset with repeated measures (n=246 patients with a total of 871 images).

RESULTS:

At baseline, muscle attenuation associated with total skeletal muscle (β 0.09; 95% CI 0.07 to 0.11; p<0.001) and adipose tissue (β -0.032; 95% CI -0.035 to -0.029; p<0.001) cross sectional areas, age (β -0.28; 95% CI -0.32 to -0.24; p<0.001), time to death ≤92 days (β -1.9; 95% CI -3.1 to -0.7; p=0.003) and male sex (β -2.3; 95% CI -3.5 to -1.1; p<0.001). Change in muscle attenuation over time associated with total adipose tissue cross sectional area (β -0.008; 95% CI -0.012 to -0.004; p<0.001) and time to death ≤92 days (β -1.6; 95% CI -3.0 to -0.2; p=0.03).

CONCLUSIONS:

The radiation attenuation of skeletal muscle is lowest in individuals who are older, less muscular, have a higher fat mass and are within 92 days of death. Men had lower muscle attenuation than women when controlled for other variables.

PMID:
27049818
DOI:
10.14283/jfa.2014.1

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