Characteristics of sarcopenia after distal gastrectomy in elderly patients

Sadamu Takahashi, Shota Shimizu, Satoshi Nagai, Hiroshi Watanabe, Yuuko Nishitani, Yasuro Kurisu, Sadamu Takahashi, Shota Shimizu, Satoshi Nagai, Hiroshi Watanabe, Yuuko Nishitani, Yasuro Kurisu

Abstract

Presence of preoperative sarcopenia is a risk factor for postoperative complications. However, there are few reports on the presence of sarcopenia and its characteristics following gastrectomy. Sarcopenia is closely related to quality of life in elderly people. To date, the main purpose of follow-up after gastrectomy is surveillance for early detection of recurrence and secondary cancer. However, henceforth, quality of life in elderly gastric cancer patients after gastrectomy must also be evaluated. The present study aimed to investigate sarcopenia during a 1-year postoperative course in elderly gastric cancer patients and examine their characteristics. The subjects were 50 patients aged ≥70 years who underwent laparoscopy-assisted distal gastrectomy for gastric cancer and who experienced no recurrence 1 year postoperatively. Height, weight, serum albumin levels, food intake amount, grip strength, gait speed, visceral fat area, and appendicular skeletal muscle mass index were measured preoperatively and 6 months and 1 year postoperatively. Sarcopenia, obesity, and visceral obesity were diagnosed. Compared with preoperatively, indicators other than height decreased 6 months postoperatively. Compared with 6 months postoperatively, body weight, amount of food intake, and visceral fat area increased by 1 year postoperatively, unlike appendicular skeletal muscle mass index. The frequency of sarcopenia increased 6 months postoperatively compared with preoperatively; this frequency remained almost unchanged 1 year postoperatively compared with 6 months postoperatively. Further, the frequency of visceral obesity increased 1 year postoperatively compared with 6 months postoperatively. Weight increased after > 6 months postoperatively; however, most of the weight increase was in terms of fat and not muscle. We emphasize the importance of considering postoperative sarcopenia and visceral obesity. In particular, sarcopenia and visceral obesity should be carefully monitored after increases in body mass index and food consumption.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Change in SMI preoperatively and…
Fig 1. Change in SMI preoperatively and 6 months after gastrectomy.
SMI: appendicular skeletal muscle mass index 6.57: SMI cut-off value for diagnosing sarcopenia in men. 4.94: SMI cut-off value for diagnosing sarcopenia in women.
Fig 2. Relationship between gait speed and…
Fig 2. Relationship between gait speed and SMI at 1 year after gastrectomy.
SMI: appendicular skeletal muscle mass index 6.57: SMI cut-off value for diagnosing sarcopenia in men. 4.94: SMI cut-off value for diagnosing sarcopenia in women. 0.8: gait speed cut-off value for diagnosing sarcopenia.
Fig 3. Relationship between the visceral fat…
Fig 3. Relationship between the visceral fat area and SMI one year after gastrectomy.
SMI: appendicular skeletal muscle mass index 6.57: SMI cut-off value for diagnosing sarcopenia in men. 4.94: SMI cut-off value for diagnosing sarcopenia in women. There was no correlation between the visceral fat area and SMI at 1 year postoperatively in men (r = 0.048, p = 0.821) and women (r = 0.376, p = 0.150).

References

    1. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39: 412–423. 10.1093/ageing/afq034
    1. Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia; Consensus Report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15: 95–101. 10.1016/j.jamda.2013.11.025
    1. Gariballa S, Alessa A. Sarcopenia: prevalence and prognostic significance in hospitalized patients. Clin Nutr. 2013;32:772–6. 10.1016/j.clnu.2013.01.010
    1. Oliveira A, Vaz C. The role of sarcopenia in the risk of osteoporotic hip fracture. Clin Rheumatol. 2015;34: 1673–1680. 10.1007/s10067-015-2943-9
    1. Chin SO, Rhee SY, Chon S, Hwang YC, Jeong IK, Oh S, et al. Sarcopenia is independently associated with cardiovascular disease in older Korean adults: the Korea National Health and Nutrition Examination Survey (KNHANES) from 2009. PLoS One. 2013;8: e60119 10.1371/journal.pone.0060119
    1. Harimoto N, Shirabe K, Yamashita YI, Ikegami T, Yoshizumi T, Soejima Y, et al. Sarcopenia as a predictor of prognosis in patients following hepatectomy for hepatocellular carcinoma. Br J Surg. 2013;100: 1523–1530. 10.1002/bjs.9258
    1. Kaido T, Ogawa K, Fujimoto Y, Ogura Y, Hata K, Ito T, et al. Impact of sarcopenia on survival in patients undergoing living donor liver transplantation. Am J Transplant. 2013;13: 1549–1556. 10.1111/ajt.12221
    1. Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer. 2012;107: 931–936. 10.1038/bjc.2012.350
    1. Dong-Dong H, Chong-Jun Z, Su-Lin W, Shu-Ting M, Xuan-You Z, Neng L, et al. Impact of different sarcopenia stages on the postoperative outcomes after radical gastrectomy for gastric cancer. Surgery. 2017;161: 680–693. 10.1016/j.surg.2016.08.030
    1. Fukuda Y, Yamamoto K, Hirao M, Nishikawa K, Nagatsuma Y, Nakayama T, et al. Sarcopenia is associated with severe postoperative complications in elderly gastric cancer patients undergoing gastrectomy. Gastric Cancer. 2016;19: 986–993. 10.1007/s10120-015-0546-4
    1. Takahashi S, Maeta M, Mizusawa K, Kaneko T, Naka T, Ashida K, et al. Long-term postoperative analysis of nutritional status after limited gastrectomy for early gastric cancer. Hepatogastroenterology. 1998;45: 889–894.
    1. Katai H, Ishikawa T, Akazawa K, Isobe Y, Miyashiro I, Oda I, et al. Five-year survival analysis of surgically resected gastric cancer cases in japan: a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001–2007). Gastric Cancer. 2018;21: 144–154. 10.1007/s10120-017-0716-7
    1. Japanese gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014(ver. 4). Gastric Cancer. 2017;20: 1–19.
    1. Kyle UG, Genton L, Hans D, Pichard C. Validation of a bioelectrical impedance analysis equation to predict appendicular skeletal muscle mass(ASMM). Clin Nutr. 2003;22: 537–543.
    1. Janssen I, Heymsfield SB, Baumgartner RN, Ross R. Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol. 2000;89: 465–471.
    1. Takahashi S, Kurisu Y, Nagai S, Watanabe H, Nishitani Y, Ishiguro S. The cutoff value of Japanese appendicular skeletal muscle mass-measurements using bioelectrical impedance analyzer (in Japanese). J Shimane M A. 2016;36: 46–51.
    1. Japan Society for the Study of Obesity. Guidelines for the management of obesity disease 2016. 1st ed Tokyo: Lifescience Press; 2016.
    1. Office for Resources Policy Division, Science and technology Policy Bureau Ministry of Education, Culture, Sports, Science and Technology, Japan. Standard Tables of Food Composition in Japan-2015-(Seventh Revised Version). 2015. Available from:
    1. Akishita M, Kozaki K, Iijima K, Tanaka T, Shibasaki K, Ogawa S, et al. Chapter 1 Definition and diagnosis of sarcopenia. Geriatr Gerontol Int. 2018;18: 7–12. 10.1111/ggi.13311
    1. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48: 452–458. 10.1038/bmt.2012.244
    1. Heber D, Ingles S, Ashley JM, Maxwell MH, Lyons RF, Elashoff RM. Clinical detection of sarcopenic obesity by bioelectrical impedance analysis. Am J Clin Nutr. 1996;64: 472S–477S. 10.1093/ajcn/64.3.472S
    1. Prado CM, Wells JC, Smith SR, Stephan BC, Siervo M. Sarcopenic obesity: A critical appraisal of the current evidence. Clin Nutr. 2012;31: 583–601. 10.1016/j.clnu.2012.06.010
    1. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363: 157–163.
    1. Czernichow S, Kengne AP, Stamatakis E, Hamer M, Batty GD. Body mass index, waist circumference and waist-hip ratio: which is the better discriminator of cardiovascular disease mortality risk?: evidence from an individual-participant meta-analysis of 82864 participants from nine cohort studies. Obes Rev. 2011;12: 680–687. 10.1111/j.1467-789X.2011.00879.x
    1. Nazare JA, Smith J, Borel AL, Aschner P, Barter P, Van Gaal L, et al. Usefulness of measuring both body mass index and waist circumference for the estimation of visceral adiposity and related cardiometabolic risk profile(from the INSPIRE ME IAA study). Am J Cardiol. 2015;115: 307–315. 10.1016/j.amjcard.2014.10.039
    1. Miyawaki T, Abe M, Yahata K, Kajiyama N, Katsuma H, Saito N. Contribution of visceral fat accumulation to the risk factors for atherosclerosis in non-obese Japanese. Intern Med. 2004;43: 1138–1144.
    1. Keele AM, Bray MJ, Emery PW, Duncan HD, Silk DB. Two phase randomized controlled clinical trial of postoperative oral dietary supplements in surgical patients. Gut. 1997;40: 393–399. 10.1136/gut.40.3.393
    1. Rana SK, Bray J, Menzies-Gow N, Jameson J, Payne James JJ, Frost P, et al. Short term benefits of post-operative oral dietary supplements in surgical patients. Clin Nutr. 1992;11: 337–344.
    1. Smedley F, Bowling T, James M, Stokes E, Goodger C, O'Connor O, et al. Randomized clinical trial of the effects of preoperative and postoperative oral nutritional supplements on clinical course and cost care. Br J Surg. 2004;91: 983–990.
    1. Imamura H, Nishikawa K, Kishi K, Matsuyama J, Akamaru Y, Kimura Y, et al. Effects of an oral elemental nutritional supplement on post-gastrectomy body weight loss in gastric cancer patients: A randomized controlled clinical trial. Ann Surg Oncol. 2016;23: 2928–2935. 10.1245/s10434-016-5221-4
    1. Mortensen K, Nilsson M, Slim K, Schäfer M, Mariette C, Braga M, et al. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Br J Surg. 2014;101: 1209–1229. 10.1002/bjs.9582
    1. Kim JW, Kim WS, Cheong JH, Hyung WJ, Choi SH, Noh SH. Safety and efficacy of fast-track surgery in laparoscopic distal gastrectomy for gastric cancer: a randomized clinical trial. World J Surg. 2012;36: 2879–2887. 10.1007/s00268-012-1741-7
    1. Wray CJ, Mammen JM, Hasselgren PO. Catabolic response to stress and potential benefits of nutrition support. Nutrition. 2012;18: 971–977.
    1. Wilmore DW. Postoperative protein sparing. World J Surg. 1999;23: 545–552.
    1. Fiatarone MA, O'Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994;330: 1769–1775.
    1. Cruz-Jentoft AJ, Landi F, Schneider SM, Zúñiga C, Arai H, Boirie Y, et al. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing. 2014;43: 748–759. 10.1093/ageing/afu115
    1. Kim HK, Suzuki T, Saito K, Yoshida H, Kobayashi H, Kato H, et al. Effects of exercise and amino acid supplementation on body composition and physical function in community-dwelling elderly Japanese sarcopenic women: a randomized controlled trial. J Am Geriatr Soc. 2012;60: 16–23. 10.1111/j.1532-5415.2011.03776.x

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever