title: Sarcopenia is Associated with Chemotherapy Toxicity in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis from Colorectal Cancer Sarcopenia: Prevalence, and Impact on Operative and Oncologic Outcomes in the Multimodal Management of Locally Advanced Esophageal Cancer A Novel Nomogram for Predicting Postsurgical Intra-abdominal Infection in Gastric Cancer Patients: a Prospective Study Impact of visceral fat on surgical complications and long-term survival of patients with gastric cancer after radical gastrectomy Sarcopenic obesity: A probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients. Impact of Visceral Obesity and Sarcopenia on Short-Term Outcomes After Colorectal Cancer Surgery Value of sarcopenia assessed by computed tomography for the prediction of postoperative morbidity following oncological colorectal resection: A comparison with the malnutrition screening tool. Sarcopenia during neoadjuvant therapy for oesophageal cancer: characterising the impact on muscle strength and physical performance Prognostic Significance of Sarcopenia in Patients with Esophagogastric Junction Cancer or Upper Gastric Cancer Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer Sarcopenia in overweight and obese patients is a predictive factor for postoperative complication in gastric cancer: A prospective study. Sarcopenia predicts 1-year mortality in elderly patients undergoing curative gastrectomy for gastric cancer: a prospective study Functional compromise reflected by sarcopenia, frailty, and nutritional depletion predicts adverse postoperative outcome after colorectal cancer surgery. GRADE guidelines: 3. Rating the quality of evidence. Physical activity as a determinant of change in mobility performance: the Longitudinal Aging Study Amsterdam. Sarcopenia Adversely Impacts Postoperative Clinical Outcomes Following Gastrectomy in Patients with Gastric Cancer: A Prospective Study Prognostic Value of Computed Tomography: Measured Parameters of Body Composition in Primary Operable Gastrointestinal Cancers Impact of different sarcopenia stages on the postoperative outcomes after radical gastrectomy for gastric cancer Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy. Impact of low skeletal muscle mass and density on short and long-term outcome after resection of stage I-III colorectal cancer. Sarcopenic Obesity Is Associated with Severe Postoperative Complications in Gastric Cancer Patients Undergoing Gastrectomy: a Prospective Study Marked Loss of Muscle, Visceral Fat, or Subcutaneous Fat After Gastrectomy Predicts Poor Survival in Advanced Gastric Cancer: Single-Center Study from the CLASSIC Trial Sarcopenia is associated with the neutrophil/lymphocyte and platelet/lymphocyte ratios in operable gastric cancer patients: a prospective study The Impact of Muscle and Adipose Tissue on Long-term Survival in Patients With Stage I to III Colorectal Cancer Development of a simple screening test for sarcopenia in older adults.
abstract: Background Despite the positive survival results of cytoreductive surgery ( CRS ) plus hyperthermic intraperitoneal chemotherapy ( HIPEC ) , criticisms have been put forward regarding the safety of this treatment as a result of a high morbidity rate . Muscle depletion ( sarcopenia ) is associated with the occurrence of postoperative complications . The purpose of this study was to determine the association between sarcopenia and postoperative morbidity after  CRS-HIPEC for peritoneal carcinomatosis from colorectal cancer by distinguishing the complications linked to CRS itself and those associated with chemotherapy ( HIPEC ) toxicities . Methods Data concerning 97 consecutive patients who had undergone CRS-HIPEC were recorded . We analyzed the events occurring within 30 days after surgery that were prospect ively recorded in a data base . Sarcopenia was assessed using the L3 muscle index on computed tomography performed during the 2 months preceding surgery . Results The sarcopenic patients experienced significantly more chemotherapy toxicities ( 57 vs. 26 % ; p = 0.004 ) and especially neutropenia ( 36 vs. 17 % ; p = 0.04 ) than their nonsarcopenic counterparts . There was no difference in complications linked to the CRS procedure between sarcopenic and nonsarcopenic patients . In the multivariate analysis , sarcopenia was the only parameter independently associated with the risk of chemotherapy toxicity ( odds ratio 3.97 ; 95 % confidence interval 1.52–10.39 ; p = 0.005 ) . Conclusions Despite the local administration of chemotherapy , systemic toxicity was observed in sarcopenic patients after CRS-HIPEC . This relationship favors new treatment strategies with white blood cell growth factors or chemotherapy dosing based on muscle value Objective : The aim of this article was to study the prevalence and significance of sarcopenia in the multimodal management of locally advanced esophageal cancer ( LAEC ) , and to assess its independent impact on operative and oncologic outcomes . Summary of Background Data : Sarcopenia in cancer may confer negative outcomes , but its prevalence and impact on modern multimodal regimens for LAEC have not been systematic ally studied . Methods : Two hundred fifty-two consecutive patients were studied .  Lean body mass ( LBM ) , skeletal muscle index ( SMI ) , and fat mass ( FM ) were determined pre-treatment , preoperatively , and 1 year postoperatively . Sarcopenia was defined by computed tomography ( CT ) at L3 as SMI < 52.4 cm2/m2 for males and SMI < 38.5 cm2/m2 for females . All complications were recorded prospect ively , including comprehensive complications index ( CCI ) , Clavien-Dindo complication ( CDC ) , and pulmonary complications ( PPCs ) . Multivariable linear , logistic , and Cox regression analysis was performed . Results : In-hospital mortality was 1 % , and CCI was 21 ± 19 . Sarcopenia increased ( P = 0.02 ) from 16 % at diagnosis to 31 % post-neoadjuvant therapy , with loss of LBM ( -3.0 ± 5.4 kg , P < 0.0001 ) , but not FM ( -0.3 ± 2.7 kg , P= 0.31 ) during treatment . On multivariable analysis , preoperative sarcopenia was associated with CCI ( P = 0.043 ) , and CDC ≥IIIb ( P = 0.003 ) . PPCs occurred in 36 % nonsarcopenic versus 55 % sarcopenic patients ( P = 0.01 ) . Sarcopenia did not impact disease-specific ( P = 0.14 ) or overall survival ( P = 0.11 ) after resection . At 1 year , 35 % had sarcopenia , significantly associated with pre-treatment BMI ( P = 0.013 ) but not complications ( P = 0.20 ) . Conclusions : Sarcopenia increases through multimodal therapy , is associated with an increased risk of major postoperative complications , and is prevalent in survivorship . These data highlight a potentially modifiable marker of risk that should be assessed and targeted in modern multimodal care pathways Background This study aim ed to determine the relationship between intra-abdominal infection ( IAI ) and sarcopenia prospect ively and to construct a nomogram to identify patients at a high risk of IAI . Methods We conducted a prospect i ve study of 682 consecutive patients with gastric cancer who underwent radical gastrectomy .  The sarcopenia elements , including lumbar skeletal muscle index , h and grip strength , and gait speed , were measured before surgery . Factors contributing to IAI were determined through univariate and multivariate analysis . A nomogram consisting of the independent risk factors was constructed to quantify the individual risk of IAI . Results Of the 682 patients enrolled in this study , 132 patients were diagnosed with sarcopenia and 61 were diagnosed with IAI . Logistic analysis revealed that sarcopenia , tumor size , pathological type , and multivisceral resection were independent prognostic factors for IAI . The nomogram model for IAI was able to reliably quantify the risk of IAI with a strong optimism-adjusted discrimination ( concordance index , 0.736 ) . Conclusions Sarcopenia is an independent predictor of IAI . Our nomogram was a simple and practical instrument to quantify the individual risk of IAI and could be used to identify patients at a high risk Background / objectives The aim of this study was to examine the impact of visceral fat on surgical complications and long-term survival for patients undergoing radical gastrectomy . Subjects/ methods From 2009 to 2013 , 859 patients who underwent curative resection for gastric cancer were enrolled from a prospect ively maintained data base .  Visceral fat area ( VFA ) was assessed by preoperative CT scans . Patients were divided into two groups by VFA .  Perioperative variables and postoperative outcomes were compared between the high VFA group and low VFA group . Univariable and multivariable analysis were performed to investigate independent risk factors of postoperative complications and survival . Results Some 859 patients were included in the study , 308 of whom were classified as high VFA . High VFA was correlated with advance age ( P = 0.020 ) , higher albumin levels ( P = 0.001 ) , hemoglobin levels ( P < 0.05 ) , ASA grade ( P = 0.043 ) and Charlson Comorbidity Index ( P = 0.004 ) . Relative to patients with low VFA , those with high VFA had longer surgical duration s ( P = 0.004 ) , higher rate of postoperative complications ( P = 0.004 ) , and longer hospital stays ( P = 0.004 ) . High VFA was identified as the only determinant for surgical complications by logistic regression analysis ( OR , 2.236 , 95 % CI , 1.537–3.254 ; P < 0.001 ) . Cox proportional hazards regression revealed no correlation between VFA and overall survival ( OS ) or disease-free survival ( DFS ) . Conclusions Increased VFA independently predicts surgical complications in patients after gastrectomy . However , VFA is not a prognostic biomarker of OS or DFS in patients with gastric cancer BACKGROUND & AIMS Profound weight loss and malnutrition subsequent to severe dysphagia and cancer cachexia are cardinal symptoms in oesophageal cancer ( OC ) . Low muscle mass/sarcopenia has been linked to toxicity during neo-adjuvant therapy in other cancers , with worser effects in sarcopenic obesity . In this study the association between sarcopenia and /or sarcopenic obesity and dose limiting toxicity ( DLT ) during cycle one chemotherapy in resectable OC patients was evaluated . METHODS Body composition was assessed from computed tomography scans of 72 consecutively diagnosed OC patients . Lean body mass and body fat mass were estimated . Patients were grouped as sarcopenic or non-sarcopenic based on pre-defined gender-specific cut-offs for sarcopenia , and as underweight/normal ( BMI < 25 ) or overweight/obese ( BMI ≥ 25 ) . Sarcopenic obesity was defined as sarcopenia combined with overweight and obesity . DLT was defined as temporary reduction/delay or permanent discontinuation of drugs due to adverse effects . Odds ratios for developing toxicity were ascertained using multiple logistic regression . RESULTS Of 72 patients , 85 % ( n = 61 ) were males . Sarcopenia and sarcopenic obesity were present in 31 ( 43 % ) and 10 ( 14 % ) , respectively , prior to chemotherapy . Sarcopenic patients had significantly lower adipose tissue index ( p = 0.02 ) compared to non-sarcopenic patients . Patients with DLT ( n = 24 ) had lower skeletal muscle mass ( p = 0.04 ) than those without DLT . Sarcopenic patients ( OR = 2.47 ; 95 % CI : 0.88 - 6.93 ) showed a trend towards increased DLT risk ( p < 0.10 ) . Logistic regression with BMI as an interaction term indicated higher DLT risk in sarcopenic patients with normal BMI ( OR = 1.60 ; 95 % CI 0.30 - 8.40 ) , but was non-significant . In the sarcopenic obese , risk of DLT increased significantly ( OR = 5.54 ; 95 % CI 1.12 - 27.44 ) . CONCLUSIONS Sarcopenic and sarcopenic obese OC patients may be at a higher risk for developing DLT during chemotherapy compared to non-sarcopenic OC patients Background With the increased prevalence of obesity and sarcopenia , those patients with both visceral obesity and sarcopenia were at higher risk of adverse outcomes . Aim The aim of this study was to ascertain the combined impact of visceral obesity and sarcopenia on short-term outcomes in patients undergoing colorectal cancer surgery . Methods We conducted a prospect i ve study from July 2014 to February 2017 . Patients ’ demographic , clinical characteristics , physical performance , and postoperative short-term outcomes were collected . Patients were classified into four groups according to the presence of sarcopenia or visceral obesity . Clinical variables were compared . Univariate and multivariate analyses evaluating the risk factors for postoperative complications were performed . Results A total of 376 patients were included ; 50.8 and 24.5 % of the patients were identified as having “ visceral obesity ” and “ sarcopenia , ” respectively . Patients with sarcopenia and visceral obesity had the highest incidence of total , surgical , and medical complications . Patients with sarcopenia or/ and visceral obesity all had longer hospital stays and higher hospitalization costs . Age ≥ 65 years , visceral obesity , and sarcopenia were independent risk factors for total complications . Rectal cancer and visceral obesity were independent risk factors for surgical complications . Age ≥ 65 years and sarcopenia were independent risk factors for medical complications .  Laparoscopy-assisted operation was a protective factor for total and medical complications . Conclusion Patients with both visceral obesity and sarcopenia had a higher complication rate after colorectal cancer surgery . Age ≥ 65 years , visceral obesity , and sarcopenia were independent risk factors for total complications . Laparoscopy-assisted operation was a protective factor BACKGROUND Computed tomography ( CT ) can be used for accurate estimation of whole-body muscle mass and muscle density and for detection of sarcopenia . The goal of this study was to evaluate the additional value of CT measured sarcopenia and muscle attenuation alongside the Malnutrition Universal Screening Tool ( MUST ) for the prediction of post-operative morbidity after oncological colorectal resection , whilst correcting for known risk factors . METHODS A prospect i ve cohort study of 80 patients undergoing elective colorectal surgery in the Netherl and s. Patients were screened for nutritional risk upon admission using the MUST . Additionally , preoperative CT scans were used to determine skeletal muscle mass for the detection of sarcopenia and muscle attenuation . Univariate and multivariable analyses were performed to evaluate associations between the MUST , muscle attenuation and sarcopenia on the one h and and post-operative complications measured by the Clavien-Dindo score on the other h and . RESULTS American Society of Anesthesiology-classification ( ASA ) ≥3 , age ≥70 , MUST ≥2 and lower than median muscle attenuation were significantly associated with a higher risk for postoperative complications ( Clavien-Dindo score ≥2 ) ( p ≤ 0.05 ) , whereas sarcopenia was not ( p = 0.59 ) . Multivariate analyses showed that only MUST ≥2 remained significantly associated with postoperative complications when corrected for age ( p = 0.03 , OR 5.8 , 95%CI 1.1 - 29.6 ) , but not when corrected for age ≥70 and ASA ≥3 . Muscle attenuation and sarcopenia were not significantly associated with postoperative complications . CONCLUSION Our results suggest that using CT measured sarcopenia may have only little additional value over the MUST for the prediction of increased short-term post-operative morbidity after oncological colorectal surgery . It also underlines the importance of currently implemented easy-to-use nutritional screening tools ( MUST ) and raises the question of the evaluation of muscle quality versus quantity in body composition imaging . However , further research is needed to investigate the role of sarcopenia for predicting outcome after colorectal surgery , and investigate the role of muscle attenuation measurements for the prediction of muscle function . CATEGORY OF SU BMI SSION : observational study Purpose Preoperative chemo(radio)therapy for oesophageal cancer ( OC ) may have an attritional impact on body composition and functional status , impacting postoperative outcome . Physical decline with skeletal muscle loss has not been previously characterised in OC and may be amenable to physical rehabilitation . This study characterises skeletal muscle mass and physical performance from diagnosis to post-neoadjuvant therapy in patients undergoing preoperative chemo(radio)therapy for OC . Methods Measures of body composition ( axial computerised tomography ) , muscle strength ( h and grip ) , functional capacity ( walking distance ) , anthropometry ( weight , height and waist circumference ) , physical activity , quality -of-life and nutritional status were captured prospect ively . Sarcopenia status was defined as pre-sarcopenic ( low muscle mass only ) , sarcopenic ( low muscle mass and low muscle strength or function ) or severely sarcopenic ( low muscle mass and low muscle strength and low muscle function ) . Results Twenty-eight participants were studied at both time points ( mean age 62.86 ± 8.18 years , n = 23 male ) . Lean body mass reduced by 4.9 ( 95 % confidence interval 3.2 to 6.7 ) kg and mean grip strength reduced by 4.3 ( 2.5 to 6.1 ) kg from pre- to post-neoadjuvant therapy . Quality -of-life scores capturing gastrointestinal symptoms improved . Measures of anthropometry , walking distance , physical activity and nutritional status did not change . There was an increase in sarcopenic status from diagnosis ( pre-sarcopenic n = 2 ) to post-treatment ( pre-sarcopenic n = 5 , severely sarcopenic n = 1 ) . Conclusions Despite maintenance of body weight , functional capacity and activity habits , participants experience declines in muscle mass and strength . Interventions involving exercise and /or nutritional support to build muscle mass and strength during preoperative therapy , even in patients who are functioning normally , are warranted Background The association between sarcopenia and postoperative outcomes for patients with gastrointestinal malignancies remains controversial . This study aim ed to assess the impact of sarcopenia on short- and long-term outcomes after surgery for esophagogastric junction cancer ( EGJC ) or upper gastric cancer ( UGC ) . Methods The study review ed 148 patients with EGJC or UGC who underwent surgical resection .  The patients were categorized into the sarcopenia group or the non-sarcopenia group according to their skeletal muscle index calculated using abdominal computed tomography images . The study compared clinicopathologic factors , postoperative complications , and prognosis between the two groups . Results Sarcopenia was present in 19 patients ( 32.2 % ) with EGJC and 23 patients ( 25.8 % ) with UGC . The 5-year overall survival ( OS ) and recurrence-free survival ( RFS ) rates were significantly poorer in the sarcopenia group than in the non-sarcopenia group ( OS 85.5 vs 54.8 % , P = 0.0010 ; RFS 78.7 vs 51.7 % , P = 0.0054 ) . The development of postoperative complications did not differ significantly between the two groups . Both the uni- and multivariate analyses showed that N stage ( P < 0.0001 ) and sarcopenia ( P = 0.0024 and 0.0293 , respectively ) were independent poor prognostic factors for OS . Conclusions Sarcopenia was strongly associated with a poor long-term prognosis for patients with EGJC or UGC who underwent surgery . The results suggest that special attention might be needed during the development of treatment strategies for patients with sarcopenia who intend to undergo operations for EGJC and UGC Abstract Currently , the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated . Moreover , the association between sarcopenia and postoperative complications remains controversial . This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer . From December 2008 to April 2013 , the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospect ively . Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis . Skeletal muscle mass was determined by abdominal ( computed tomography ) CT scan , and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification . Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed . A total of 937 patients were included in this study , and 389 ( 41.5 % ) patients were sarcopenic based on the diagnostic cut-off values ( 34.9 cm2/m2 for women and 40.8 cm2/m2 for men ) . Sarcopenia was an independent risk factor for severe postoperative complications ( OR = 3.010 , P < 0.001 ) , but not for total complications . However , sarcopenia did not show significant association with operative mortality . Moreover , sarcopenia was an independent predictor for poorer overall survival ( HR = 1.653 , P < 0.001 ) and disease-free survival ( HR = 1.620 , P < 0.001 ) . Under the adjusted tumor-node-metastasis ( TNM ) stage , sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III , but not in patients with TNM stage I.Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer . Moreover , sarcopenia is independently associated with overall and disease-free survival in patients with TNM stage II and III , but not in patients with TNM stage BACKGROUND Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength . This study aims to explore the prevalence of sarcopenia in overweight and obese gastric cancer ( GC ) patients and figured out the impacts of sarcopenia on the postoperative complication of overweight and obese GC patients . METHODS According to the recommended body-mass index ( BMI ) for Asian population s by WHO , we conducted a prospect i ve study of overweight and obese gastric cancer patients ( BMI ≥ 23 kg/m2 ) under curative gastrectomy from August 2014 to December 2015 . Including  lumbar skeletal muscle index , h and grip strength and gait speed as the sarcopenic components were measured before surgery . Patients were followed up after gastrectomy to gain the actual clinical outcomes . Factors contributing to postoperative complications were analyzed by univariate and multivariate analysis . RESULTS Total of 206 overweight or obese patients were enrolled in this study , 14 patients were diagnosed sarcopenia and were demonstrated having significantly association with higher risk of postoperative complications , higher hospital costs , and higher rate of 30-days readmission compared with the non-sarcopenic ones . On the basis of univariate and multivariate analysis , sarcopenia was an independent risk factor for postoperative complication of overweight and obese patients with gastric cancer ( P = 0.002 ) . CONCLUSION Sarcopenia is an independent predictor of postoperative complications in overweight or obese patients with gastric cancer after radical gastrectomy Purpose One-year mortality is vital for elderly oncologic patients undergoing surgery . Recent studies have demonstrated that sarcopenia can predict outcomes after major abdominal surgeries , but the association of sarcopenia and 1-year mortality has never been investigated in a prospect i ve study . Methods We conducted a prospect i ve study of elderly patients ( ≥65 years ) who underwent curative gastrectomy for gastric cancer from July 2014 to July 2015 . Sarcopenia was determined by the measurements of muscle mass , h and grip strength , and gait speed . Univariate and multivariate analyses were used to identify the risk factors associated with 1-year mortality . Results A total of 173 patients were included , in which 52 ( 30.1 % ) patients were identified as having sarcopenia . Twenty-four ( 13.9 % ) patients died within 1 year of surgery . Multivariate analysis showed that sarcopenia was an independent risk factor for 1-year mortality . Area under the receiver operating characteristic curve demonstrated an increased predictive power for 1-year mortality with the inclusion of sarcopenia , from 0.835 to 0.868 . Solely low muscle mass was not predictive of 1-year mortality in the multivariate analysis . Conclusions Sarcopenia is predictive of 1-year mortality in elderly patients undergoing gastric cancer surgery . The measurement of muscle function is important for sarcopenia as a preoperative assessment tool OBJECTIVE To determine the association of sarcopenia with postoperative morbidity and mortality after colorectal surgery . BACKGROUND Functional compromise in elderly colorectal surgical patients is considered as a significant factor of impaired postoperative recovery . Therefore , the predictive value of preoperative functional compromise assessment was investigated . Sarcopenia is a hallmark of functional compromise . METHODS A total of 310 consecutive patients who underwent oncologic colorectal surgery  were included in a prospect i ve digital data base . Sarcopenia was assessed using the L3 muscle index utilizing Osirix on preoperative computed tomography . Groningen Frailty Indicator and Short Nutritional Assessment Question naire scores were used to assess frailty and nutritional compromise . Predictors for anastomotic leakage , sepsis , and mortality were analyzed by logistic regression analysis . RESULTS Age was an independent predictor of mortality [ P = 0.04 ; odds ratio , 1.17 ; 95 % confidence interval ( CI ) , 1.01 - 1.37 ] . Thirty-day/in-hospital mortality rate in sarcopenic patients was 8.8 % versus 0.7 % in nonsarcopenic patients ( P = 0.001 ; odds ratio , 15.5 ; 95 % CI , 2.00 - 120 ) . Sarcopenia was not predictive for anastomotic leakage or sepsis . Combination of high  Short Nutritional Assessment Question naire score , high Groningen Frailty Indicator score , and sarcopenia strongly predicted sepsis ( P = 0.001 ; odds ratio , 25.1 ; 95 % CI , 5.11 - 123 ) , sensitivity , 46 % ; specificity , 97 % ; positive likelihood ratio , 13 ( 95 % CI , 4.4 - 38 ) ; negative likelihood ratio , 0.57 ( 95 % CI , 0.33 - 0.97 ) . CONCLUSIONS Functional compromise in colorectal cancer surgery is associated with adverse postoperative outcome . Assessment of functional compromise by means of a nutritional question naire ( Short Nutritional Assessment Question naire ) , a frailty question naire ( Groningen Frailty Indicator ) , and sarcopenia measurement ( L3 muscle index ) can accurately predict postoperative sepsis This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence OBJECTIVES This study examined the association of ( change in ) physical activity and decline in mobility performance in older men and women . DESIGN A 3-year prospect i ve study using data of the Longitudinal Aging Study . SETTING Netherl and s. PARTICIPANTS Two thous and one hundred nine men and women aged 55 to 85 . MEASUREMENTS  Total physical activity  ( expressed as hours per day and kilocalories per day ) and sports participation  were measured using a vali date d , interviewer-administered question naire .  Mobility performance was assessed using two timed tests : 6-meter walk and repeated chair st and s. RESULTS Mobility performance declined for 45.6 % of the sample . At baseline , the mean time + /- st and ard deviation spent on total physical activity was 3.0 + /- 2.1 h/d or 719 + /- 543 kcal/d , and 56.6 % of the sample participated in sports . Sports participation and a higher level of total physical activity , walking , or household activity were associated with a smaller mobility decline . After 3 years , total physical activity declined , and only 53.4 % of those reporting sports at baseline continued doing so . Continuation of physical activity over time was associated with the smallest decline in mobility . The observed associations were similar for those with and without chronic disease ( P > 0.3 ) . The conclusions did not change after adjustment for potential confounders , including demographic and lifestyle variables , depression , and cognitive status . CONCLUSIONS Physical activity , and especially a regularly active lifestyle , may slow the decline in mobility performance . A beneficial effect was observed for sports and nonsports activities , independent of the presence of chronic disease Background Sarcopenia is characterized by decreased skeletal muscle plus low muscle strength and /or physical performance . This study was performed to determine the association of sarcopenia with short-term postoperative outcomes after gastrectomy for gastric cancer . Methods We conducted a prospect i ve study of 255 consecutive patients with gastric cancer who underwent curative gastrectomy .  The sarcopenia elements , including lumbar skeletal muscle index , h and grip strength , and gait speed , were measured before surgery . Patients were followed up after gastrectomy to gain the actual clinical outcomes . Factors contributing to postoperative complications were analyzed by univariate and multivariate analysis . Results Sarcopenia was present in 32 of 255 patients ( 12.5 % ) , and was significantly correlated with advance age , lower body mass index , higher nutritional risk screening ( NRS ) 2002 score , and lower preoperative serum albumin and hemoglobin . Compared with non-sarcopenic patients , sarcopenic patients had a higher risk of postoperative complications , longer postoperative hospital stay , and more hospital costs . In univariate analysis , sarcopenia ( p < 0.001 ) , nutritional risk ( NRS 2002 score ≥3 ; p = 0.003 ) , advanced age ( ≥75 years ; p = 0.014 ) , anemia ( p = 0.012 ) , hypoalbuminemia ( p = 0.029 ) , and diabetes ( p = 0.014 ) were associated with postoperative complications . Multivariable analysis revealed that sarcopenia ( p < 0.001 ) and diabetes ( p = 0.006 ) were independent predictors of postoperative complications . Conclusions Sarcopenia is an independent predictor of postoperative complications in patients with gastric cancer after gastrectomy Background Previous reports suggest that body composition parameters can be used to predict outcomes for patients with gastrointestinal ( GI ) cancers . However , evidence for an association with long-term survival is conflicting , with much of the data derived from patients with advanced disease . This study examined the effect of body composition on survival in primary operable GI cancer . Methods Patients with resectable adenocarcinoma of the GI tract ( esophagus , stomach , colon , rectum ) between 2006 and 2014 were identified from a prospect i ve data base .  Computed tomography ( CT ) scans were analyzed using a transverse section at L3 to calculate sex-specific body composition indices for skeletal muscle , visceral fat , and subcutaneous fat . Kaplan – Meier and log-rank analysis were used to compare unadjusted survival . Multivariate survival analyses were performed using a proportional hazards model . Results The study enrolled 447 patients ( 191 woman and 256 men ) with esophagogastric ( OG ) ( n = 108 ) and colorectal ( CR ) ( n = 339 ) cancer .  Body composition did not predict survival for the OG cancer patients . Among the CR cancer patients , survival was shorter for those with sarcopenia ( p = 0.017 ) or low levels of subcutaneous fat ( p = 0.005 ) . Older age ( p = 0.046 ) and neutrophilia ( p = 0.013 ) were associated with sarcopenia in patients with CR . Tumor stage ( p = 0.033 ) , neutrophil count ( p = 0.011 ) , and hypoalbuminemia ( p = 0.023 ) were associated with sarcopenia in OG cancer patients . In the multivariate analysis , no single measure of body composition was an independent predictor of reduced survival . ConclusionS arcopenia and reduced subcutaneous adiposity are associated with reduced survival for patients with primary operable CR cancer . However , in this study , no parameter of body composition was an independent prognostic marker when considered with age , tumor stage , and systemic inflammation Background . The association between sarcopenia and postoperative outcomes has been well reported . However , the impact of different sarcopenia stages on postoperative outcomes has never been investigated . Methods . We conducted a large , prospect i ve study of patients who underwent radical gastrectomy for gastric cancer from August 2014 to December 2015 .  Sarcopenia was staged as “ presarcopenia , ” “ sarcopenia , ” and “ severe sarcopenia ” according to the definition of the European Working Group on Sarcopenia in Older People . Univariate and multivariate analyses evaluating the risk factors for total , surgical , and medical complications were performed . Results . A total of 470 patients were included , in which 20.6 % , 10 % , and 6.8 % of the patients were identified as having “ presarcopenia , ” “ sarcopenia , ” and “ severe sarcopenia  , ” respectively . Postoperative complications , duration of hospital stays , and costs increased with advancing sarcopenia stages . Severe sarcopenia , visceral fat area to total abdominal muscle area ratio , American Society of Anesthesiologists grade III , and tumor located at the cardia were independent risk factors for total complications . Visceral fat area to total abdominal muscle area ratio and tumor located at the cardia were independent risk factors for operative complications . Presarcopenia , sarcopenia , and severe sarcopenia were all identified as independent risk factors for medical complications , as well as age ≥75 years and Charlson Comorbidity Index . Conclusion . Patients had worse  postoperative outcomes after gastric cancer operation with advancing sarcopenia stages . Severe sarcopenia , but not presarcopenia or sarcopenia , was an independent risk factor for total postoperative complications . The 3 sarcopenia stages independently influence medical but not surgical complications . Recognizing sarcopenia stages is important for preoperative risk stratification BACKGROUND A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer . However , the current geriatric assessment has been considered to be either time-consuming or subjective . The present study aim ed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy . MATERIAL S AND METHODS We conducted a prospect i ve study of patients who underwent radical gastrectomy from August 2014 to December 2015 .  Computed tomography-assessed lumbar skeletal muscle , h and grip strength , and gait speed were measured to define sarcopenia . RESULTS Sarcopenia was present in 69 of 240 patients ( 28.8 % ) and was associated with lower body mass index , lower serum albumin , lower hemoglobin , and higher nutritional risk screening 2002 scores . Postoperative complications significantly increased in the sarcopenic patients ( 49.3 % versus 24.6 % , P < 0.001 ) , compared with nonsarcopenic patients . The multivariate analysis demonstrated that sarcopenia ( odds ratio : 2.959 , 95 % CI : 1.629 - 5.373 , P < 0.001 ) and the Charlson comorbidity index ≥2 ( odds ratio : 3.357 , 95 % CI : 1.144 - 9.848 , P = 0.027 ) were independent risk factors for postoperative complications . CONCLUSIONS Sarcopenia , presented as a new geriatric assessment factor , was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer BACKGROUND Preoperative low skeletal muscle mass and density are associated with increased postoperative morbidity in patients undergoing curative colorectal cancer ( CRC ) surgery . However , the long-term effects of low skeletal muscle mass and density remain uncertain . METHODS Patients with stage I-III CRC undergoing surgery , enrolled in a prospect i ve observational cohort study , were included .  Skeletal muscle mass and density were measured on CT . Patients with high and low skeletal muscle mass and density were compared regarding postoperative complications , disease-free survival ( DFS ) , overall survival ( OS ) , and cancer-specific survival ( CSS ) . RESULTS In total , 816 patients ( 53.9 % males , median age 70 ) were included ; 50.4 % had low skeletal muscle mass and 64.1 % low density . The severe postoperative complication rate was significantly higher in patients with low versus high skeletal muscle and density ( 20.9 % versus 13.6 % , p = 0.006 ; 20.0 % versus 11.8 % , p = 0.003 ) . Low skeletal muscle mass ( OR 1.91 , p = 0.018 ) and density ( OR 1.87 , p = 0.045 ) were independently associated with severe postoperative complications . Ninety-day mortality was higher in patients with low skeletal muscle mass and density compared with patients with high skeletal muscle mass and density ( 3.6 % versus 1.7 % , p = 0.091 ; 3.4 % versus 1.0 % , p = 0.038 ) . No differences in DFS were observed . After adjustment for covariates such as age and comorbidity , univariate differences in OS and CSS diminished . CONCLUSIONS Low skeletal muscle mass and density are associated with short-term , but not long-term , outcome in patients undergoing CRC surgery . These findings recommend putting more emphasis on preoperative management of patients at risk for surgical complications , but do not support benefit for long-term outcome Objective This study aim ed to determine the risk of severe postoperative complications ( SPCs ) in patients with gastric cancer and to construct a nomogram based on independently related factors to identify high-risk patients . Methods We conducted a prospect i ve study of 636 consecutive patients with gastric cancer who underwent radical gastrectomy . Degrees of sarcopenia and obesity were calculated before surgery . Factors contributing to SPCs were determined using univariate and multivariate analysis . A nomogram consisting of the independent risk factors was constructed to quantify the individual risk of SPCs . Results Logistic analysis revealed that sarcopenic obesity , age , open surgery , and combined resection were independent prognostic factors for SPCs . Sarcopenic obese patients have the highest risk in all patients ( sarcopenic obesity vs normal , OR = 6.575 p = 0.001 ; sarcopenic obesity vs obesity , OR = 5.833 p = 0.001 ; sarcopenic obesity vs sarcopenia , OR = 2.571 p = 0.032 ) , while obese patients share the similar rate of SPCs with normal people ( obesity vs normal , OR = 1.056 p = 0.723 ) . The nomogram we constructed was able to quantify the risk of SPCs reliably ( c-index , 0.737 ) . Conclusions Sarcopenic obesity , together with age , open surgery , and combined resection are independent predictors of SPCs . Obesity will significantly increase the risk of SPCs in sarcopenic patient with gastric cancer , but it will not bring higher risk to normal patients . Our nomogram is a simple and practical instrument to identify patients at high risk of surgical complications Background There is increasing interest in the influence of body composition on oncological outcomes . We evaluated the role of skeletal muscle and fat among patients with gastric cancer ( GC ) who underwent gastrectomy with or without adjuvant chemotherapy  , as well as those changes ’ associations with survival outcomes . Methods The present study evaluated 136 patients with GC who were enrolled in the CLASSIC Trial at Yonsei Cancer Center . Baseline body compositions including skeletal muscle area , Hounsfield units ( HU ) , visceral fat area , and subcutaneous fat area were measured by preoperative computed tomography ( CT ) . CT before and after the gastrectomy were used to determine the 6-month relative changes in body composition parameters . Continuous variables were dichotomized according to the best cutoff values by Contal and O’Quigley method . Results Seventy-three patients ( 53.7 % ) underwent surgery alone , and 63 patients ( 46.3 % ) underwent surgery followed by adjuvant chemotherapy . The baseline body composition parameters were not associated with disease-free survival ( DFS ) or overall survival ( OS ) . Except for the HU , the marked loss of muscle , visceral fat , or subcutaneous fat significantly predicted shorter DFS and OS . Patients with a marked loss in at least one significant body composition parameter had significantly shorter DFS ( hazard ratio 2.9 , 95 % confidence interval 1.7–4.8 , P < 0.001 ) and OS ( hazard ratio 2.9 , 95 % confidence interval 1.7–5.0 , P < 0.001 ) . Conclusions Marked loss in body composition parameters significantly predicted shorter DFS and OS among patients with GC who underwent gastrectomy .  Postoperative nutrition and active healthcare interventions could improve the prognosis of these GC patients Purpose Sarcopenia is distinguished by decreased skeletal muscle plus low muscle strength and /or physical performance . This study was design ed to demonstrate the relationship between sarcopenia and systemic inflammatory response ( neutrophil/lymphocyte ratio [ NLR ] , platelet/lymphocyte ratio [ PLR ] , and large platelet/lymphocyte ratio [ LPLR ] ) prior to radical gastrectomy for gastric cancer . Patients and methods We conducted a prospect i ve study of gastric cancer patients who underwent radical gastrectomy .  The clinical utility of the NLR , PLR , and LPLR was evaluated by receiver operating characteristic curves . Sarcopenia components including skeletal muscle index , h and grip strength , and 6 m usual gait speed were measured . Logistic analysis was used to identify the independent indices associated with sarcopenia . Results A total of 670 patients were included , representing 504 men and 166 women . Of these , 104 patients ( 15.5 % ) were diagnosed with sarcopenia and 567 ( 84.5 % ) were non-sarcopenia . PLR has a diagnostic sensitivity of 91.3 % for sarcopenia . In addition to the indicators of preoperative age , nutritional risk screening , body mass index , preoperative albumin , and diabetes , the NLR and PLR were independent predictors for sarcopenia ( P<0.05 ) . Conclusion The present study showed that at-diagnosis sarcopenia was associated with inflammation in patients with operable gastric cancer . Due to the complex assessment of muscle condition , PLR may be used as a primary screening test for sarcopenia . How systemic inflammatory response influences changes in sarcopenia may provide new therapeutic perception toward improving outcomes BACKGROUND : Computed tomography-derived body composition parameters are emerging prognostic factors in colorectal cancer . OBJECTIVE : This study aim ed to determine the roles of sarcopenia , myosteatosis , and obesity as independent and overlapping parameters in stage I to III colorectal cancer . DESIGN : This is a retrospective cohort study from a prospect ively collected data base . Multivariate Cox proportional hazards models were performed to assess the associations between body composition parameters and survival . SETTING S : All patients were seen in a tertiary care cancer center . PATIENTS : Adult patients with stage I to III colorectal cancer , undergoing curative resection from 2007 to 2009 , were included . INTERVENTION : Computed tomography-derived quantification of skeletal muscle and adipose tissues was used to determine population -specific cutoffs for sarcopenia , myosteatosis , and total adiposity . MAIN OUTCOME MEASURES : Primary outcome measures were overall , recurrence-free , and cancer-specific survival . RESULTS : In the 968 patients included , there were a total of 254 disease  recurrences and 350 deaths . Body mass index and CT-derived measures of adiposity did not result in worse survival outcomes . Sarcopenia was independently predictive of worse overall ( HR , 1.45 ; 95 % CI , 1.16 - 1.84 ) , recurrence-free ( HR , 1.32 ; 95 % CI , 1.00–1.75 ) , and cancer-specific survival ( HR , 1.46 ; 95 % CI , 1.09–1.94 ) in a multivariate model . Myosteatosis was also independently predictive of overall survival ( HR , 1.53 ; 95 % CI , 1.19–1.97 ) . In a model considering joint effects of sarcopenia and myosteatosis , the presence of both predicted the worst overall ( HR , 2.23 ; 95 % CI , 1.62–3.06 ) , recurrence-free ( HR , 1.53 ; 95 % CI , 1.06–2.21 ) , and cancer-specific survival ( HR , 2.40 ; 95 % CI , 1.69–3.42 ) in a multivariate model . LIMITATIONS : The limitations of this study are inherent in retrospective observational studies . CONCLUSIONS : Sarcopenia and myosteatosis are independent predictors of worse survival in stage I to III colorectal cancer , and their joint effect is highly predictive of reduced overall , recurrence-free , and cancer-specific survival . See Video Abstract at http://links.lww.com/DCR/A923 AIM To develop a simple screening test to identify older adults at high risk for sarcopenia . METHODS We studied 1971 functionally independent , community-dwelling adults aged 65 years or older r and omly selected from the resident register of Kashiwa city , Chiba , Japan . Data collection was carried out between September and November 2012 . Sarcopenia was defined based on low muscle mass measured by bioimpedance analysis and either low muscle strength characterized by h and grip or low physical performance characterized by slow gait speed . RESULTS The prevalence of sarcopenia was 14.2 % in men and 22.1 % in women . After the variable selection procedure , the final model to estimate the probability of sarcopenia included three variables : age , grip strength and calf circumference . The area under the receiver operating characteristic curve , a measure of discrimination , of the final model was 0.939 with 95 % confidence interval ( CI ) of 0.918 - 0.958 for men , and 0.909 with 95 % CI of 0.887 - 0.931 for women . We created a score chart for each sex based on the final model . When the sum of sensitivity and specificity was maximized , sensitivity , specificity , and positive and negative predictive values for sarcopenia were 84.9 % , 88.2 % , 54.4 % , and 97.2 % for men , 75.5 % , 92.0 % , 72.8 % , and 93.0 % for women , respectively . CONCLUSIONS The presence of sarcopenia could be detected using three easily obtainable variables with high accuracy . The screening test we developed could help identify functionally independent older adults with sarcopenia who are good c and i date s for intervention
target: Conclusion The prevalence of sarcopenia depends mostly on the diagnostic cut-off points of different criteria .
  Preoperative sarcopenia is a risk factor for both long-term and short-term outcomes
background: Background The impact of sarcopenia on the outcome of gastrointestinal ( GI ) oncological patients is still controversial .
  We aim to discuss the prevalence of sarcopenia and its relation to the oncological outcome .