Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact
Sarcopenia and cachexia in the era of obesity: clinical and nutritional impact
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DOI：
10.1017/s0029665115004279
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发表时间：
2016-05-01
影响因子：
7
通讯作者：
Ryan, A. M.
中科院分区：
文献类型：
--
作者：
Prado, C. M.;Cushen, S. J.;Ryan, A. M.
随着成像技术的使用，我们对当代人群中身体成分（BC）变异性的了解显著增加。异常BC，如肌肉减少症（低肌肉质量）和肥胖症（过量脂肪组织）是各种条件或临床情况下预后较差的预测因子。作为一种分解代谢疾病，癌症的一个定义特征是肌肉损失。虽然癌症中消耗的概念模型通常被认为是非自愿的体重减轻导致体重降低，但最近的研究表明，肌肉减少症和恶病质都可以与肥胖一起出现。低肌肉和高脂肪组织的组合（肌肉减少性肥胖症）是在整个体重中普遍存在的新出现的异常BC表型，并且因此是BMI谱。在大多数情况下，癌症中的肌肉减少症和肌肉减少性肥胖症是隐匿性疾病，与化疗毒性发生率较高、肿瘤进展时间较短、手术结局较差、身体损害和生存期较短独立相关。虽然机制尚未完全理解，但与临床结局较差的相关性强调了营养评估的价值以及制定适当干预措施以应对异常BC的必要性。肌肉减少症和肌肉减少性肥胖症产生不同的营养需求，突出了迫切需要更全面和差异化的理解，在这个异质性的人群中的能量和蛋白质的需求。
Our understanding of body composition (BC) variability in contemporary populations has significantly increased with the use of imaging techniques. Abnormal BC such as sarcopenia (low muscle mass) and obesity (excess adipose tissue) are predictors of poorer prognosis in a variety of conditions or clinical situations. As a catabolic illness, a defining feature of cancer is muscle loss. Although the conceptual model of wasting in cancer is typically conceived as involuntary weight loss leading to low body weight, recent studies have shown that both sarcopenia and cachexia can be present with obesity. The combination of low muscle and high adipose tissue (sarcopenic obesity) is an emerging abnormal BC phenotype prevalent across the body weight, and hence BMI spectra. Sarcopenia and sarcopenic obesity in cancer are in most instances occult conditions, which have been independently associated with higher incidence of chemotherapy toxicity, shorter time to tumour progression, poorer outcomes of surgery, physical impairment and shorter survival. Although the mechanisms are yet to be fully understood, the associations with poorer clinical outcomes emphasise the value of nutritional assessment as well as the need to develop appropriate interventions to countermeasure abnormal BC. Sarcopenia and sarcopenic obesity create diverse nutritional requirements, highlighting the compelling need for a more comprehensive and differentiated understanding of energy and protein requirements in this heterogeneous population.