Avaliação da massa muscular e da mioesteatose em pacientes com câncer incurável

Detalhes bibliográficos
Autor(a) principal: Lima, Larissa Calixto
Data de Publicação: 2020
Outros Autores: larissa_calixto@hotmail.com
Tipo de documento: Tese
Idioma: por
Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
Texto Completo: http://www.bdtd.uerj.br/handle/1/20844
Resumo: Over the last decade, studies on sarcopenia in individuals with cancer have increased considerably. In the oncologic setting, sarcopenia has been used as a synonym for severe muscle wasting, myopenia, or secondary sarcopenia. Computed tomography (CT) is considered a gold standard method due to its high accuracy and reproducibility for muscle mass assessment and good accuracy to infer muscle fat infiltration (i.e., myosteatosis). The aim of this study was to: (1) develop and validate an equation using anthropometric and handgrip strength (HGS) measurements to estimate skeletal muscle mass (SM) in incurable patients with cancer; (2) examine the factors associated with skeletal muscle radiodensity (SMD) evaluated by CT; and (3) investigate whether distinctive skeletal muscle phenotypes are associated with systemic inflammatory response, functional impairment, and survival in patients with incurable cancer. Three articles will be presented, each answering one of these objectives. For all articles, the inclusion criteria were patients aged 20 years or older, Karnofsky Performance Status (KPS) ≥30% and those who had abdominal or pelvic CT scans up to 30 days before the inclusion in the study. Article 1 developed and validated an equation for estimating SM in 272 patients (68.0% female; median age of 60 years) with incurable cancer. The predicted equation developed in this study included sex, race/skin color, body weight, corrected arm muscle area (CAMA) and HGS, with an adjusted R2 of 0.60 and the root mean square error of 5.82 The best predictive equation was muscle mass (cm2) = 57.37 + weight (kg) x 0.38 + CAMA (cm) x 1.17 + HGS (kg) x 0.65 + 7.75 (black race/skin color) – 22.96 (female). Article 2 was a cross-sectional study that analyzed the factors associated with SMD using linear regression models in 393 patients (median age 61 years, 69.7% female) with incurable cancer. The results showed that age, white race/skin color, adiposity markers and gynecological and BCT tumors were inversely associated with SMD, while HGS, SM index (SMI) and gastrointestinal tumor was directly associated with SMD. Article 3 comprised 326 patients with incurable cancer (median age 60 years, 67.5% female) and demonstrated that low SM index (SMI) and myostatosis phenotypes, particularly when combined, were associated with worse physical functional impairment and altered inflammatory response evaluated by different inflammation-based prognostic scores. Moreover, the presence of myosteatosis increased 90-day mortality risk. In conclusion, an equation was developed and validated using simple and low-cost measurements to be used as an alternative for assessing SM in patients with incurable cancer. Additionally, this work highlighted factors associated with SMD and with different muscle phenotypes.
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spelling Avesani, Carla Mariahttp://lattes.cnpq.br/3561058635341668Bezerra, Flávia Fiorucihttp://lattes.cnpq.br/1523963949057333Koury, Josely Correahttp://lattes.cnpq.br/9039270525512042Prado, CarlaGonzalez, Maria Cristinahttp://lattes.cnpq.br/2868331941630408Bergmann, Ankehttp://lattes.cnpq.br/8708733143383938http://lattes.cnpq.br/0393794340553483Lima, Larissa Calixtolarissa_calixto@hotmail.com2023-12-20T19:03:19Z2020-12-02LIMA, Larissa Calixto. Avaliação da massa muscular e da mioesteatose em pacientes com câncer incurável. 2020. 110 f. Tese (Doutorado em Alimentação, Nutrição e Saúde) – Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2020.http://www.bdtd.uerj.br/handle/1/20844Over the last decade, studies on sarcopenia in individuals with cancer have increased considerably. In the oncologic setting, sarcopenia has been used as a synonym for severe muscle wasting, myopenia, or secondary sarcopenia. Computed tomography (CT) is considered a gold standard method due to its high accuracy and reproducibility for muscle mass assessment and good accuracy to infer muscle fat infiltration (i.e., myosteatosis). The aim of this study was to: (1) develop and validate an equation using anthropometric and handgrip strength (HGS) measurements to estimate skeletal muscle mass (SM) in incurable patients with cancer; (2) examine the factors associated with skeletal muscle radiodensity (SMD) evaluated by CT; and (3) investigate whether distinctive skeletal muscle phenotypes are associated with systemic inflammatory response, functional impairment, and survival in patients with incurable cancer. Three articles will be presented, each answering one of these objectives. For all articles, the inclusion criteria were patients aged 20 years or older, Karnofsky Performance Status (KPS) ≥30% and those who had abdominal or pelvic CT scans up to 30 days before the inclusion in the study. Article 1 developed and validated an equation for estimating SM in 272 patients (68.0% female; median age of 60 years) with incurable cancer. The predicted equation developed in this study included sex, race/skin color, body weight, corrected arm muscle area (CAMA) and HGS, with an adjusted R2 of 0.60 and the root mean square error of 5.82 The best predictive equation was muscle mass (cm2) = 57.37 + weight (kg) x 0.38 + CAMA (cm) x 1.17 + HGS (kg) x 0.65 + 7.75 (black race/skin color) – 22.96 (female). Article 2 was a cross-sectional study that analyzed the factors associated with SMD using linear regression models in 393 patients (median age 61 years, 69.7% female) with incurable cancer. The results showed that age, white race/skin color, adiposity markers and gynecological and BCT tumors were inversely associated with SMD, while HGS, SM index (SMI) and gastrointestinal tumor was directly associated with SMD. Article 3 comprised 326 patients with incurable cancer (median age 60 years, 67.5% female) and demonstrated that low SM index (SMI) and myostatosis phenotypes, particularly when combined, were associated with worse physical functional impairment and altered inflammatory response evaluated by different inflammation-based prognostic scores. Moreover, the presence of myosteatosis increased 90-day mortality risk. In conclusion, an equation was developed and validated using simple and low-cost measurements to be used as an alternative for assessing SM in patients with incurable cancer. Additionally, this work highlighted factors associated with SMD and with different muscle phenotypes.Ao longo da última década, o número de estudos sobre sarcopenia em indivíduos com neoplasias malignas aumentaram consideravelmente. Nos pacientes com câncer a sarcopenia é definida como depleção muscular grave, miopenia ou sarcopenia secundária. A tomografia computadorizada (TC) é considerada método padrão-ouro para a avaliação da massa muscular, uma vez que, além de fazer a quantificação da massa muscular com precisão, permite a identificação da infiltração de tecido adiposo muscular, denominada mioesteatose. Os objetivos deste estudo foram: (1) desenvolver e validar uma equação de predição de massa muscular esquelética (MME) baseada em variáveis antropométricas e na força de preensão manual (FPM); (2) investigar os fatores associados à radiodensidade do músculo esquelético (RME) avaliada por TC; e (3) investigar a associação entre diferentes fenótipos de músculo esquelético com resposta inflamatória sistêmica, capacidade funcional e sobrevida global. Três artigos serão apresentados, sendo que cada um responderá a um dos três objetivos propostos. Para todos os artigos, os critérios de inclusão adotados compreenderam idade maior que 20 anos, apresentar Karnofsky Performance Status (KPS) superior a 30% no momento da avaliação e possuir imagens de TC das regiões pélvica e abdominal no intervalo de até 30 dias da data de inclusão na pesquisa. O artigo 1 desenvolveu e validou uma equação de predição da MME usando como referência a MME avaliada por TC em 272 pacientes (68% do sexo feminino; mediana de idade de 60 anos) com câncer incurável. A equação de estimativa desenvolvida neste estudo incluiu as variáveis sexo, raça/cor da pele autorrelatada, peso corporal, área muscular do braço corrigida (AMAc) e FPM, apresentando R2 ajustado de 0,60 e raiz do erro quadrático médio de 5,82, cuja fórmula segue descrita: massa muscular (cm2) = 57,37 + peso (kg) x 0,38 + AMAc (cm) x 1,17 + FPM (kg) x 0,65 + 7,75 (se raça/cor da pele negra) – 22,96 (se sexo feminino). O artigo 2, de delineamento transversal, analisou os fatores associados à RME por meio de modelos de regressões lineares em uma amostra de 393 pacientes (mediana de idade de 61 anos, 69,7% do sexo feminino) com câncer incurável. Os modelos multivariados demostraram associação significativa e direta entre a RME e as variáveis albumina sérica, FPM, MME e câncer gastrintestinal e associação significativa e indireta entre RME e idade, raça/cor da pele branca, adiposidade corporal e diagnóstico de câncer ginecológico ou tecido ósseo e conectivo. O artigo 3 inclui 326 pacientes com câncer incurável (mediana de idade de 60 anos, 67,5% do sexo feminino) e demonstrou que fenótipos de baixa MME e mioesteatose, particularmente quando combinados, se associaram a pior desempenho de função física e maior resposta inflamatória sistêmica avaliada por meio de diferentes indicadores inflamatórios. Além disso, a presença de mioesteatose aumentou o risco de morte em um período de seguimento de 90 dias. Em conclusão, os três artigos apresentados na presente tese possibilitaram propor uma equação como alternativa simples e de baixo custo para a avaliação da MME de pacientes com câncer avançado. Ademais, mostraram os fatores associados à RME e aos diferentes fenótipos musculares.Submitted by Barbara Marques CEH/A (barbara_marques@id.uff.br) on 2023-12-20T19:03:19Z No. of bitstreams: 1 Tese - Larissa Calixto Lima - 2020 - Completa.pdf: 1813380 bytes, checksum: eeca32d4262510643539a0b304a9ca06 (MD5)Made available in DSpace on 2023-12-20T19:03:19Z (GMT). No. of bitstreams: 1 Tese - Larissa Calixto Lima - 2020 - Completa.pdf: 1813380 bytes, checksum: eeca32d4262510643539a0b304a9ca06 (MD5) Previous issue date: 2020-12-02application/pdfporUniversidade do Estado do Rio de JaneiroPrograma de Pós-Graduação em Alimentação, Nutrição e SaúdeUERJBrasilCentro Biomédico::Instituto de NutriçãoAdvanced cancerPalliative careMuscle massSarcopeniaMyosteatosisComputed tomographyAnthropometryCâncer avançadoCuidados paliativosMassa muscularSarcopeniaMioesteatoseTomografia computadorizadaAntropometriaCIENCIAS DA SAUDE::NUTRICAOAvaliação da massa muscular e da mioesteatose em pacientes com câncer incurávelEvaluation of muscle mass and myosteatosis in patients with incurable cancerinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UERJinstname:Universidade do Estado do Rio de Janeiro (UERJ)instacron:UERJORIGINALTese - Larissa Calixto Lima - 2020 - Completa.pdfTese - Larissa Calixto Lima - 2020 - Completa.pdfapplication/pdf1813380http://www.bdtd.uerj.br/bitstream/1/20844/2/Tese+-+Larissa+Calixto+Lima+-+2020+-+Completa.pdfeeca32d4262510643539a0b304a9ca06MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82123http://www.bdtd.uerj.br/bitstream/1/20844/1/license.txte5502652da718045d7fcd832b79fca29MD511/208442024-02-23 16:15:32.937oai:www.bdtd.uerj.br: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Biblioteca Digital de Teses e Dissertaçõeshttp://www.bdtd.uerj.br/PUBhttps://www.bdtd.uerj.br:8443/oai/requestbdtd.suporte@uerj.bropendoar:29032024-02-23T19:15:32Biblioteca Digital de Teses e Dissertações da UERJ - Universidade do Estado do Rio de Janeiro (UERJ)false
dc.title.por.fl_str_mv Avaliação da massa muscular e da mioesteatose em pacientes com câncer incurável
dc.title.alternative.eng.fl_str_mv Evaluation of muscle mass and myosteatosis in patients with incurable cancer
title Avaliação da massa muscular e da mioesteatose em pacientes com câncer incurável
spellingShingle Avaliação da massa muscular e da mioesteatose em pacientes com câncer incurável
Lima, Larissa Calixto
Advanced cancer
Palliative care
Muscle mass
Sarcopenia
Myosteatosis
Computed tomography
Anthropometry
Câncer avançado
Cuidados paliativos
Massa muscular
Sarcopenia
Mioesteatose
Tomografia computadorizada
Antropometria
CIENCIAS DA SAUDE::NUTRICAO
title_short Avaliação da massa muscular e da mioesteatose em pacientes com câncer incurável
title_full Avaliação da massa muscular e da mioesteatose em pacientes com câncer incurável
title_fullStr Avaliação da massa muscular e da mioesteatose em pacientes com câncer incurável
title_full_unstemmed Avaliação da massa muscular e da mioesteatose em pacientes com câncer incurável
title_sort Avaliação da massa muscular e da mioesteatose em pacientes com câncer incurável
author Lima, Larissa Calixto
author_facet Lima, Larissa Calixto
larissa_calixto@hotmail.com
author_role author
author2 larissa_calixto@hotmail.com
author2_role author
dc.contributor.advisor1.fl_str_mv Avesani, Carla Maria
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/3561058635341668
dc.contributor.advisor-co1.fl_str_mv Bezerra, Flávia Fioruci
dc.contributor.advisor-co1Lattes.fl_str_mv http://lattes.cnpq.br/1523963949057333
dc.contributor.referee1.fl_str_mv Koury, Josely Correa
dc.contributor.referee1Lattes.fl_str_mv http://lattes.cnpq.br/9039270525512042
dc.contributor.referee2.fl_str_mv Prado, Carla
dc.contributor.referee3.fl_str_mv Gonzalez, Maria Cristina
dc.contributor.referee3Lattes.fl_str_mv http://lattes.cnpq.br/2868331941630408
dc.contributor.referee4.fl_str_mv Bergmann, Anke
dc.contributor.referee4Lattes.fl_str_mv http://lattes.cnpq.br/8708733143383938
dc.contributor.authorLattes.fl_str_mv http://lattes.cnpq.br/0393794340553483
dc.contributor.author.fl_str_mv Lima, Larissa Calixto
larissa_calixto@hotmail.com
contributor_str_mv Avesani, Carla Maria
Bezerra, Flávia Fioruci
Koury, Josely Correa
Prado, Carla
Gonzalez, Maria Cristina
Bergmann, Anke
dc.subject.eng.fl_str_mv Advanced cancer
Palliative care
Muscle mass
Sarcopenia
Myosteatosis
Computed tomography
Anthropometry
topic Advanced cancer
Palliative care
Muscle mass
Sarcopenia
Myosteatosis
Computed tomography
Anthropometry
Câncer avançado
Cuidados paliativos
Massa muscular
Sarcopenia
Mioesteatose
Tomografia computadorizada
Antropometria
CIENCIAS DA SAUDE::NUTRICAO
dc.subject.por.fl_str_mv Câncer avançado
Cuidados paliativos
Massa muscular
Sarcopenia
Mioesteatose
Tomografia computadorizada
Antropometria
dc.subject.cnpq.fl_str_mv CIENCIAS DA SAUDE::NUTRICAO
description Over the last decade, studies on sarcopenia in individuals with cancer have increased considerably. In the oncologic setting, sarcopenia has been used as a synonym for severe muscle wasting, myopenia, or secondary sarcopenia. Computed tomography (CT) is considered a gold standard method due to its high accuracy and reproducibility for muscle mass assessment and good accuracy to infer muscle fat infiltration (i.e., myosteatosis). The aim of this study was to: (1) develop and validate an equation using anthropometric and handgrip strength (HGS) measurements to estimate skeletal muscle mass (SM) in incurable patients with cancer; (2) examine the factors associated with skeletal muscle radiodensity (SMD) evaluated by CT; and (3) investigate whether distinctive skeletal muscle phenotypes are associated with systemic inflammatory response, functional impairment, and survival in patients with incurable cancer. Three articles will be presented, each answering one of these objectives. For all articles, the inclusion criteria were patients aged 20 years or older, Karnofsky Performance Status (KPS) ≥30% and those who had abdominal or pelvic CT scans up to 30 days before the inclusion in the study. Article 1 developed and validated an equation for estimating SM in 272 patients (68.0% female; median age of 60 years) with incurable cancer. The predicted equation developed in this study included sex, race/skin color, body weight, corrected arm muscle area (CAMA) and HGS, with an adjusted R2 of 0.60 and the root mean square error of 5.82 The best predictive equation was muscle mass (cm2) = 57.37 + weight (kg) x 0.38 + CAMA (cm) x 1.17 + HGS (kg) x 0.65 + 7.75 (black race/skin color) – 22.96 (female). Article 2 was a cross-sectional study that analyzed the factors associated with SMD using linear regression models in 393 patients (median age 61 years, 69.7% female) with incurable cancer. The results showed that age, white race/skin color, adiposity markers and gynecological and BCT tumors were inversely associated with SMD, while HGS, SM index (SMI) and gastrointestinal tumor was directly associated with SMD. Article 3 comprised 326 patients with incurable cancer (median age 60 years, 67.5% female) and demonstrated that low SM index (SMI) and myostatosis phenotypes, particularly when combined, were associated with worse physical functional impairment and altered inflammatory response evaluated by different inflammation-based prognostic scores. Moreover, the presence of myosteatosis increased 90-day mortality risk. In conclusion, an equation was developed and validated using simple and low-cost measurements to be used as an alternative for assessing SM in patients with incurable cancer. Additionally, this work highlighted factors associated with SMD and with different muscle phenotypes.
publishDate 2020
dc.date.issued.fl_str_mv 2020-12-02
dc.date.accessioned.fl_str_mv 2023-12-20T19:03:19Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
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dc.identifier.citation.fl_str_mv LIMA, Larissa Calixto. Avaliação da massa muscular e da mioesteatose em pacientes com câncer incurável. 2020. 110 f. Tese (Doutorado em Alimentação, Nutrição e Saúde) – Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2020.
dc.identifier.uri.fl_str_mv http://www.bdtd.uerj.br/handle/1/20844
identifier_str_mv LIMA, Larissa Calixto. Avaliação da massa muscular e da mioesteatose em pacientes com câncer incurável. 2020. 110 f. Tese (Doutorado em Alimentação, Nutrição e Saúde) – Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2020.
url http://www.bdtd.uerj.br/handle/1/20844
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language por
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dc.publisher.none.fl_str_mv Universidade do Estado do Rio de Janeiro
dc.publisher.program.fl_str_mv Programa de Pós-Graduação em Alimentação, Nutrição e Saúde
dc.publisher.initials.fl_str_mv UERJ
dc.publisher.country.fl_str_mv Brasil
dc.publisher.department.fl_str_mv Centro Biomédico::Instituto de Nutrição
publisher.none.fl_str_mv Universidade do Estado do Rio de Janeiro
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repository.name.fl_str_mv Biblioteca Digital de Teses e Dissertações da UERJ - Universidade do Estado do Rio de Janeiro (UERJ)
repository.mail.fl_str_mv bdtd.suporte@uerj.br
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