Abstract

Objective: This study aimed to evaluate prevalence and clinical correlates of sarcopenia and sarcopenic obesity in breast cancer patients

Methods: A total of 50 female patients with histopathological diagnosis of breast cancer were included in this prospective 6-month observational study. Data on patient age, anthropometrics, bioelectrical impedance analysis, physical activity level and blood biochemistry were recorded. Sarcopenia was assessed using preoperative computed tomography (CT) findings, while obesity in sarcopenic patients was identified based on BMI (Body mass index) and fat percentage values.

Results: Obesity, sarcopenia and sarcopenic obesity was evident in 50%, 50% and 20% of patients, respectively. None of the parameters studied, including age, laboratory results, BIA (bioelectrical impedance analysis), or anthropometric findings, showed a significant correlation with the degree of sarcopenia in the overall study population, as well as in patients with sarcopenia and those with sarcopenic obesity.

Conclusion: The findings suggest that sarcopenia is prevalent in half of breast cancer patients before radiotherapy, with concomitant obesity in 40% of sarcopenic patients. Therefore, assessing body composition using CT imaging is essential to recognize sarcopenic obesity earlier and prevent the combined hazards of obesity and depleted muscle mass in breast cancer patients.

Keywords: Breast cancer, nutrition, obesity, sarcopenia, sarcopenic obesity

Copyright and license

Copyright © 2024 The author(s). This is an open-access article under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Kayalı İF, Habiboğlu R. Prevalence and presence of sarcopenia and sarcopenic obesity in female breast cancer patients. Clin Sci Nutr. 2024;6(1):1-10. doi:10.62210/ClinSciNutr.2024.81

References

  1. Demark-Wahnefried W, Rimer BK, Winer EP. Weight gain in women diagnosed with breast cancer. J Am Diet Assoc. 1997;97:519-528. https://doi.org/10.1016/s0002-8223(97)00133-8
  2. McTiernan A. Weight, physical activity and breast cancer survival. Proc Nutr Soc. 2018;77:403-411. https://doi.org/10.1017/S0029665118000010
  3. Chlebowski RT, Aiello E, McTiernan A. Weight loss in breast cancer patient management. J Clin Oncol. 2002;20:1128-1143. https://doi.org/10.1200/JCO.2002.20.4.1128
  4. Sheean PM, Hoskins K, Stolley M. Body composition changes in females treated for breast cancer: a review of the evidence. Breast Cancer Res Treat. 2012;135:663-680. https://doi.org/10.1007/s10549-012-2200-8
  5. Cheney CL, Mahloch J, Freeny P. Computerized tomography assessment of women with weight changes associated with adjuvant treatment for breast cancer. Am J Clin Nutr. 1997;66:141-146. https://doi.org/10.1093/ajcn/66.1.141
  6. Demark-Wahnefried W, Kenyon AJ, Eberle P, Skye A, Kraus WE. Preventing sarcopenic obesity among breast cancer patients who receive adjuvant chemotherapy: results of a feasibility study. Clin Exerc Physiol. 2002;4:44-49.
  7. Del Fabbro E, Parsons H, Warneke CL, et al. The relationship between body composition and response to neoadjuvant chemotherapy in women with operable breast cancer. Oncologist. 2012;17:1240-1245. https://doi.org/10.1634/theoncologist.2012-0169
  8. Chemama S, Bayar MA, Lanoy E, et al. Sarcopenia is Associated with Chemotherapy Toxicity in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis from Colorectal Cancer. Ann Surg Oncol. 2016;23:3891-3898. https://doi.org/10.1245/s10434-016-5360-7
  9. Shachar SS, Williams GR, Muss HB, Nishijima TF. Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review. Eur J Cancer. 2016;57:58-67. https://doi.org/10.1016/j.ejca.2015.12.030
  10. Parsons HA, Baracos VE, Dhillon N, Hong DS, Kurzrock R. Body composition, symptoms, and survival in advanced cancer patients referred to a phase I service. PLoS One. 2012;7:e29330. https://doi.org/10.1371/journal.pone.0029330
  11. Caan BJ, Cespedes Feliciano EM, Prado CM, et al. Association of Muscle and Adiposity Measured by Computed Tomography With Survival in Patients With Nonmetastatic Breast Cancer. JAMA Oncol. 2018;4:798-804. https://doi.org/10.1001/jamaoncol.2018.0137
  12. Prado CM, Baracos VE, McCargar LJ, et al. Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res. 2009;15:2920-2926. https://doi.org/10.1158/1078-0432.CCR-08-2242
  13. Prado CM, Lima IS, Baracos VE, et al. An exploratory study of body composition as a determinant of epirubicin pharmacokinetics and toxicity. Cancer Chemother Pharmacol. 2011;67:93-101. https://doi.org/10.1007/s00280-010-1288-y
  14. Deluche E, Leobon S, Desport JC, Venat-Bouvet L, Usseglio J, Tubiana-Mathieu N. Impact of body composition on outcome in patients with early breast cancer. Support Care Cancer. 2018;26:861-868. https://doi.org/10.1007/s00520-017-3902-6
  15. Limon-Miro AT, Valencia ME, Lopez-Teros V, Guzman-Leon AE, Mendivil-Alvarado H, Astiazaran-Garcia H. Bioelectric Impedance Vector Analysis (BIVA) in Breast Cancer Patients: A Tool for Research and Clinical Practice. Medicina (Kaunas). 2019;55:663. https://doi.org/10.3390/medicina55100663
  16. Di Sebastiano KM, Mourtzakis M. A critical evaluation of body composition modalities used to assess adipose and skeletal muscle tissue in cancer. Appl Physiol Nutr Metab. 2012;37:811-821. https://doi.org/10.1139/h2012-079
  17. van der Werf A, Langius JAE, de van der Schueren MAE, et al. Percentiles for skeletal muscle index, area and radiation attenuation based on computed tomography imaging in a healthy Caucasian population. Eur J Clin Nutr. 2018;72:288-296. https://doi.org/10.1038/s41430-017-0034-5
  18. Prado CM, Birdsell LA, Baracos VE. The emerging role of computerized tomography in assessing cancer cachexia. Curr Opin Support Palliat Care. 2009;3:269-275. https://doi.org/10.1097/SPC.0b013e328331124a
  19. Bayar MA, Antoun S, Lanoy E. Statistical approaches for evaluating body composition markers in clinical cancer research. Expert Rev Anticancer Ther. 2017;17:311-318. https://doi.org/10.1080/14737140.2017.1298446
  20. Benavides-Rodríguez L, García-Hermoso A, Rodrigues-Bezerra D, Izquierdo M, Correa-Bautista JE, Ramírez-Vélez R. Relationship between Handgrip Strength and Muscle Mass in Female Survivors of Breast Cancer: A Mediation Analysis. Nutrients. 2017;9:695. https://doi.org/10.3390/nu9070695
  21. Anandavadivelan P, Brismar TB, Nilsson M, Johar AM, Martin L. Sarcopenic obesity: A probable risk factor for dose limiting toxicity during neo-adjuvant chemotherapy in oesophageal cancer patients. Clin Nutr. 2016;35:724-730. https://doi.org/10.1016/j.clnu.2015.05.011
  22. Villaseñor A, Ballard-Barbash R, Baumgartner K, et al. Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study. J Cancer Surviv. 2012;6:398-406. https://doi.org/10.1007/s11764-012-0234-x
  23. Yip C, Goh V, Davies A, et al. Assessment of sarcopenia and changes in body composition after neoadjuvant chemotherapy and associations with clinical outcomes in oesophageal cancer. Eur Radiol. 2014;24:998-1005. https://doi.org/10.1007/s00330-014-3110-4
  24. Prado CM, Lieffers JR, McCargar LJ, et al. Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008;9:629-635. https://doi.org/10.1016/S1470-2045(08)70153-0
  25. Pamoukdjian F, Bouillet T, Lévy V, Soussan M, Zelek L, Paillaud E. Prevalence and predictive value of pre-therapeutic sarcopenia in cancer patients: A systematic review. Clin Nutr. 2018;37:1101-1113. https://doi.org/10.1016/j.clnu.2017.07.010
  26. Batsis JA, Mackenzie TA, Jones JD, Lopez-Jimenez F, Bartels SJ. Sarcopenia, sarcopenic obesity and inflammation: Results from the 1999-2004 National Health and Nutrition Examination Survey. Clin Nutr. 2016;35:1472-1483. https://doi.org/10.1016/j.clnu.2016.03.028
  27. Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, et al. Effects of Aerobic and Resistance Exercise on Metabolic Syndrome, Sarcopenic Obesity, and Circulating Biomarkers in Overweight or Obese Survivors of Breast Cancer: A Randomized Controlled Trial [published correction appears in J Clin Oncol. 2020;38(12):1370] [published correction appears in J Clin Oncol. 2020;38(18):2115]. J Clin Oncol. 2018;36:875-883. https://doi.org/10.1200/JCO.2017.75.7526
  28. Tan BH, Birdsell LA, Martin L, Baracos VE, Fearon KC. Sarcopenia in an overweight or obese patient is an adverse prognostic factor in pancreatic cancer. Clin Cancer Res. 2009;15:6973-6979. https://doi.org/10.1158/1078-0432.CCR-09-1525
  29. Antoun S, Baracos VE, Birdsell L, Escudier B, Sawyer MB. Low body mass index and sarcopenia associated with dose-limiting toxicity of sorafenib in patients with renal cell carcinoma. Ann Oncol. 2010;21:1594-1598. https://doi.org/10.1093/annonc/mdp605
  30. Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12:489-495. https://doi.org/10.1016/S1470-2045(10)70218-7
  31. Broughman JR, Williams GR, Deal AM, et al. Prevalence of sarcopenia in older patients with colorectal cancer. J Geriatr Oncol. 2015;6:442-445. https://doi.org/10.1016/j.jgo.2015.08.005
  32. Limon-Miro AT, Lopez-Teros V, Astiazaran-Garcia H. Dietary Guidelines for Breast Cancer Patients: A Critical Review. Adv Nutr. 2017;8:613-623. https://doi.org/10.3945/an.116.014423
  33. Rier HN, Jager A, Sleijfer S, van Rosmalen J, Kock MCJM, Levin MD. Low muscle attenuation is a prognostic factor for survival in metastatic breast cancer patients treated with first line palliative chemotherapy. Breast. 2017;31:9-15. https://doi.org/10.1016/j.breast.2016.10.014
  34. Thomson CA, Stopeck AT, Bea JW, et al. Changes in body weight and metabolic indexes in overweight breast cancer survivors enrolled in a randomized trial of low-fat vs. reduced carbohydrate diets. Nutr Cancer. 2010;62:1142-1152. https://doi.org/10.1080/01635581.2010.513803
  35. Aloia JF, McGowan DM, Vaswani AN, Ross P, Cohn SH. Relationship of menopause to skeletal and muscle mass. Am J Clin Nutr. 1991;53:1378-1383. https://doi.org/10.1093/ajcn/53.6.1378
  36. Friedmann JM, Elasy T, Jensen GL. The relationship between body mass index and self-reported functional limitation among older adults: a gender difference. J Am Geriatr Soc. 2001;49:398-403. https://doi.org/10.1046/j.1532-5415.2001.49082.x
  37. Adams SC, Segal RJ, McKenzie DC, et al. Impact of resistance and aerobic exercise on sarcopenia and dynapenia in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Breast Cancer Res Treat. 2016;158:497-507. https://doi.org/10.1007/s10549-016-3900-2
  38. Brown JC, Schmitz KH. Weight lifting and appendicular skeletal muscle mass among breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat. 2015;151:385-392. https://doi.org/10.1007/s10549-015-3409-0