Sarcopenic obesity: hidden muscle wasting and its impact for survival and complications of cancer therapy
Open accessAbstract
Body composition, defined as the proportions and distribution of lean and fat tissues in the human body, is an emergent theme in clinical oncology. Severe muscle depletion (sarcopenia) is most easily overlooked in obese patients; the advent of secondary analysis of oncologic images provides a precise and specific assessment of sarcopenia. Here, we review the definitions, prevalence and clinical implications of sarcopenic obesity (SO) in medical and surgical oncology. Reported prevalence of SO varies due to the heterogeneity in the definitions and the variability in the cut points used to define low muscle mass and high fat mass. Prevalence of SO in advanced solid tumor patient populations average 9% (range 2.3%-14.6%) overall, and one in four (24.7%, range 5.9%-39.2%) patients with body mass index ≥ 30 kg/m2 are sarcopenic. SO is independently associated with higher mortality and higher rate of complications in systemic and surgical cancer treatment, across multiple cancer sites and treatment plans. These associations remain unexplained, however, it has been hypothesized that patients with sarcopenia are generally unfit and unable to tolerate stress. Another proposed mechanism relates to increased exposure to antineoplastic therapy, i.e. a large fat mass would be expected to inflate drug dose in BSA-based treatments, causing an increased rate of dose-limiting toxicity. Pharmacokinetic data are needed to confirm or refute this hypothesis. Old age, deconditioning, cancer progression, acute or chronic nonmalignant disease and drug side-effects are suggested causes of muscle loss, and it is unknown the degree to which this can be reversed. Sarcopenia can be readily detected before start of cancer treatment, however, clinical management protocols for SO patients require development. Studies of cancer treatment dose-modulation are in progress.
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Adverse clinical cancer outcomes are reported to be relevant to sarcopenic obesity, especially with respect to dose-limiting toxicity, surgical complications, physical disability, and shorter survival.
“Moreover, adverse clinical cancer outcomes reported to be relevant to SO, especially with respect to dose-limiting toxicity, surgical complications, physical disability, and shorter survival (59–61).”
From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [59]
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- Authors
- Baracos, V. E., & Arribas, L.
- Affiliations
- University of Alberta (CA)
- Institut d'Investigació Biomédica de Bellvitge (ES)
- Corresponding author
- Baracos, V.E.
- Venue
- Annals of Oncology
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 29
- Issue
- suppl_2
- Pages
- ii1-ii9
- ISSN
- 0923-7534 (ISSN-L)
- OpenAlex
- W2794311213
- Cited by
- 362
- References
- 51
- Citations by year
- 2026: 36 · 2025: 41 · 2024: 41 · 2023: 55 · 2022: 54 · 2021: 56 · 2020: 41 · 2019: 25 · 2018: 13
- FWCI
- 23.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Annals of Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Sarcoma Diagnosis and Treatment
- Keywords
- sarcopenic obesity, sarcopenia, obesity, muscle atrophy, body composition, cancer treatment complications, survival, dose-limiting toxicity, antineoplastic therapy, body mass index, pharmacokinetics, surgical oncology, medical oncology
- MeSH terms
- Antineoplastic Agents, Body Composition, Clinical Trials as Topic, Humans, Neoplasms, Obesity, Postoperative Complications, Surgical Procedures, Operative, Body Mass Index, Prevalence, Survival Analysis, Muscle, Skeletal, Neoadjuvant Therapy, Sarcopenia, Chemoradiotherapy
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