Muscle attenuation, not skeletal muscle index, is an independent prognostic factor for survival in gastric cancer patients with overweight and obesity

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 122; p. 112391
• Main Authors: Zhuang, Cheng-Le, Wu, Hao-Fan, Jiang, Hao-Jie, Zhang, Feng-Min, Shi, Han-Ping, Yu, Zhen, Shen, Xian, Chen, Xiao-Lei, Wang, Su-Lin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2024; Elsevier Limited
• Subjects: Attenuation; Body fat; Body mass index; Body size; Body weight; Cancer; Chemotherapy; Computed tomography; death; Gastrectomy; Gastric cancer; Gastrointestinal surgery; hazard ratio; Humans; Medical imaging; Medical prognosis; Muscle attenuation; Muscle, Skeletal - diagnostic imaging; Muscle, Skeletal - pathology; Muscles; Musculoskeletal system; nutrition; Obesity; Obesity - complications; Obesity - pathology; Older people; Overweight; Overweight - complications; Overweight - pathology; Population; Prognosis; Regression analysis; Retrospective Studies; Sarcopenia; Sarcopenia - complications; Skeletal muscle; Skeletal muscle index; stomach neoplasms; Stomach Neoplasms - complications; Stomach Neoplasms - surgery; Survival; Thinness - complications; Underweight; visceral fat; Women; Working groups; China; Skeletal muscle index; Obesity; Sarcopenia; Gastric cancer; Muscle attenuation; Overweight
• ISSN: 0899-9007; 1873-1244; 1873-1244
• DOI: 10.1016/j.nut.2024.112391

•Muscle attenuation was inversely associated with body mass index and visceral fat area.•Muscle attenuation predicts survival better than mass in patients with cancer who are overweight.•Visceral fat mediates effects on muscle attenuation in survival in patients with cancer. [Display omitted] Skeletal muscle index (SMI) is insufficient for evaluating muscle in obesity, and muscle attenuation (MA) may be a preferred indicator. This study aimed to investigate whether MA has greater prognostic value than SMI in gastric cancer patients with overweight and obesity. Clinical parameters of 1312 patients with gastric cancer who underwent radical gastrectomy were prospectively collected between 2013 and 2019. MA and SMI were analyzed by computed tomography scan. Overweight/obesity was defined as body mass index (BMI) ≥24 kg/m2. The hazard ratio (HR) for death was calculated using Cox regression analysis. Among all patients, 405 were identified as overweight and obese, and 907 were identified as normal and underweight. MA was inversely associated with BMI and visceral fat area. Among the 405 patients with overweight and obesity, 212 patients (52%) were diagnosed with low MA. In the overweight/obese group, MA was an independent predictor for overall survival (HR, 1.610; P = 0.021) in multivariate Cox regression analyses, whereas SMI did not remain in the model. In the normal/underweight group, both low MA (HR, 1.283; P = 0.039) and low SMI (HR, 1.369; P = 0.008) were independent factors of overall survival. Additionally, 318 patients were identified as having visceral obesity in the overweight/obese group, and low MA was also an independent prognostic factor for survival in these patients (HR, 1.765; P = 0.013). MA had a higher prognostic value than SMI in overweight and obese patients with gastric cancer after radical gastrectomy.