Diet and Exercise Are not Associated with Skeletal Muscle Mass and Sarcopenia in Patients with Bladder Cancer
Diet and Exercise Are not Associated with Skeletal Muscle Mass and Sarcopenia in Patients with Bladder Cancer
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DOI：
10.1016/j.euo.2019.04.012
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发表时间：
2021-04-12
影响因子：
8.2
通讯作者：
Inman, Brant A.
中科院分区：
文献类型：
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作者：
Wang, Yingqi;Chang, Andrew;Inman, Brant A.
背景：关于为什么膀胱癌中会发生肌肉减少症，以及哪些可改变和不可改变的患者水平因素影响其发生的了解有限。目的：目的是确定不可改变的危险因素、可改变的生活方式危险因素或癌症相关因素在多大程度上决定膀胱癌幸存者的身体成分变化和肌肉减少症。设计、环境和参与者：年龄在18岁以上，经组织学证实诊断为膀胱癌，并在1996年1月1日至2017年6月30日期间在杜克大学医学中心接受过治疗的患者被纳入本研究。结果测量和统计分析：利用饮食史问卷II （DHQ-II）和国际体育活动问卷（IPAQ-L）工具评估我院膀胱癌幸存者的饮食摄入模式。健康饮食指数2010 （HEI2010）得分根据DHQ-II结果计算。采用L3水平的Slice-O-Matic计算机断层扫描图像分析和三个独立评分者计算的骨骼肌指数（SMI）来评估身体成分。结果与局限性：本研究共评估了285例患者，评分者间平滑肌面积的类内相关性为0.97（95%可信区间：0.94-0.98）。符合肌肉减少症定义的患者比例男性为72%，女性为55%。单变量线性回归分析表明，年龄、男性性别和黑人种族是重度精神分裂症的高度显著预测因子，而肿瘤分期和分级、化疗和手术方式不是重度精神分裂症的预测因子。多元线性回归分析显示，可改变的生活方式因素，包括总体力活动（p = 0.830）、体力活动强度（高、中、低）（p = 0.874）、个人营养成分（每日卡路里，p = 0.739；脂肪，p = 0.259；碳水化合物，p = 0.983；蛋白质，p = 0.341）和HEI2010饮食质量（p = 0.822）与重度精神分裂症无关。结论：包括饮食质量和体力活动在内的生活方式因素与重度精神分裂症无关，因此对肌肉减少症的影响有限。肌少症很大程度上受不可改变的危险因素影响。患者总结：在本报告中，我们旨在确定生活方式因素（如饮食和体育活动）是否是膀胱癌幸存者身体成分变化和肌肉减少症的主要驱动因素。我们发现，包括饮食习惯、个人营养成分和身体活动在内的生活方式因素与骨骼肌质量没有关联，因此对肌肉减少症的影响可能有限。(c) 2019年欧洲泌尿外科协会。Elsevier B.V.版权所有。
Background: There is limited understanding about why sarcopenia is happening in bladder cancer, and which modifiable and nonmodifiable patient-level factors affect its occurrence. Objective: The objective is to determine the extent to which nonmodifiable risk factors, modifiable lifestyle risk factors, or cancer-related factors are determining body composition changes and sarcopenia in bladder cancer survivors. Design, setting, and participants: Patients above 18 yr of age with a histologically confirmed diagnosis of bladder cancer and a history of receiving care at Duke University Medical Center between January 1, 1996 and June 30, 2017 were included in this study. Outcome measurements and statistical analysis: Bladder cancer survivors from our institution were assessed for their dietary intake patterns utilizing the Diet History Questionnaire II (DHQ-II) and physical activity utilizing the International Physical Activity Questionnaire long form (IPAQ-L) tools. Healthy Eating Index 2010 (HEI2010) scores were calculated from DHQ-II results. Body composition was evaluated using Slice-O-Matic computed tomography scan image analysis at L3 level and the skeletal muscle index (SMI) calculated by three independent raters. Results and limitations: A total of 285 patients were evaluated in the study, and the intraclass correlation for smooth muscle area was 0.97 (95% confidence interval: 0.94-0.98) between raters. The proportions of patients who met the definition of sarcopenia were 72% for men and 55% of women. Univariate linear regression analysis demonstrated that older age, male gender, and black race were highly significant predictors of SMI, whereas tumor stage and grade, chemotherapy, and surgical procedures were not predictors of SMI. Multivariate linear regression analysis demonstrated that modifiable lifestyle factors, including total physical activity (p = 0.830), strenuousness (high, moderate, and low) of physical activity (p = 0.874), individual nutritional components (daily calories, p = 0.739; fat, p = 0.259; carbohydrates, p = 0.983; and protein, p = 0.341), and HEI2010 diet quality (p = 0.822) were not associated with SMI. Conclusions: Lifestyle factors including diet quality and physical activity are not associated with SMI and therefore appear to have limited impact on sarcopenia. Sarcopenia may largely be affected by nonmodifiable risk factors. Patient summary: In this report, we aim to determine whether lifestyle factors such as diet and physical activity were the primary drivers of body composition changes and sarcopenia in bladder cancer survivors. We found that lifestyle factors including dietary habits, individual nutritional components, and physical activity do not demonstrate an association with skeletal muscle mass, and therefore may have limited impact on sarcopenia. (c) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.