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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.

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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:



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.


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.


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


Regional cancer center (Alberta, Canada).


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


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).


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).


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.


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