Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Nutrition in acute and chronic diseases

Absence of risk of sarcopenia protects cancer patients from fatigue

Abstract

Background

Cancer and its treatments often lead to sarcopenia and fatigue. However, whether these factors are associated remains unproven.

Objective

To evaluate whether the risk of sarcopenia predicts the presence of fatigue.

Methods

A cross-sectional study was completed and included 198 cancer patients of both sexes, undergoing in- and outpatient treatment. The Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F) and the Functional Assessment of Cancer Therapy Fatigue (FACT-F) were used to assess the risk of sarcopenia and the presence of fatigue, respectively. The cut-off values used to identify the risk of sarcopenia and the severity of fatigue scale were SARC-F ≥ 4 and Fatigue <34, respectively. Logistic regression analysis was performed to evaluate the association between SARC-F and the FACT-F.

Results

Out of 198 patients, 35% were at risk of sarcopenia and of these 87% had fatigue. Patients at risk of sarcopenia had lower scores in the FACT-F subscales, lower handgrip strength, lower performance status, were mostly hospitalized and were sedentary. Logistic regression analysis revealed that patients with SARC-F < 4 had a lower risk of fatigue in both models, crude (OR: 0.83; CI 95% [0.79–0.88], p < 0.0001) as well as adjusted for age, gender, BMI, physical activity, current use of alcoholic beverages, smoking, performance status, cancer type, clinical setting and use of supplements (OR: 0.87; CI 95% [0.81–0.92], p < 0.0001).

Conclusion

In patients with cancer, 35% presented risk of sarcopenia and of these 87% had fatigue. In addition, the absence of sarcopenia was considered protective against fatigue.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31.

    Article  Google Scholar 

  2. 2.

    Borges TC, Gomes TLN, Pimentel GD. Sarcopenia as a predictor of nutritional status and comorbidities in hospitalized patients with cancer: A cross-sectional study. Nutr. 2020;73:110703.

    Article  Google Scholar 

  3. 3.

    Pamoukdjian F, Bouillet T, Lévy V, Soussan M, Zelek L, Paillaud E. Prevalence and predictive value of pre-therapeutic sarcopenia in cancer patients: a systematic review. Clin Nutr. 2018;37:1101–13.

    Article  Google Scholar 

  4. 4.

    Soares JDP, Gomes TLN, Siqueira JM, Oliveira ICL, Mota JF, Laviano A, et al. Muscle function loss is associated with anxiety in patients with gastrointestinal cancer. Clin Nutr ESPEN. 2019;29:149–53.

    Article  Google Scholar 

  5. 5.

    Dela VegaMCM, Laviano A, Pimentel GD. Sarcopenia and chemotherapy-mediated toxicity. Einstein. 2016;14:580–4.

    Article  Google Scholar 

  6. 6.

    Malmstrom TK, Morley JE. SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc. 2013;14:531–2.

    Article  Google Scholar 

  7. 7.

    Barbosa-Silva TG, Menezes AMB, Bielemann RM, Malmstrom TK, Gonzalez MC. Enhancing SARC-F: Improving sarcopenia screening in the clinical practice. J Am Med Dir Assoc. 2016;17:1136–41.

    Article  Google Scholar 

  8. 8.

    Fu X, Tian Z, Thapa S, Sun H, Wen S, Xiong H. et al. Comparing SARC-F with SARC-CalF for screening sarcopenia in advanced cancer patients. Clin Nutr. 2020;39:3337–45.

    Article  Google Scholar 

  9. 9.

    Behne TEG, Dock-Nasimento DB, Sierra JC, Ro-Drigues HHNP, Palauro ML, Andreo FO. et al. Association between preoperative potential sarcopenia and survival of cancer patients undergoing major surgical procedures. Rev Col Bras Cir. 2020;47:1–10.

    Article  Google Scholar 

  10. 10.

    Berger AM, Mooney K, Alvarez-Perez A, Breitbart WS, Carpenter KM, Cella D, et al. Cancer-Related Fatigue, Version 2.2015: Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2015;13:1012–39.

  11. 11.

    O’Higgins CM, Brady B, O’Connor B, Walsh D, Reilly RB. The pathophysiology of cancer-related fatigue: current controversies. Support Care Cancer. 2018;26:3353–64.

    Article  Google Scholar 

  12. 12.

    Mock V, Atkinson A, Cella D, et al. National Comprehensive Cancer Network (NCCN) Practice Guidelines for Cancer-Related Fatigue. Oncology 2000;14:151–61.

    CAS  PubMed  Google Scholar 

  13. 13.

    Gomes TLN, Soares JDP, Borges TC, Pichard C, Pimentel GD. Phase angle is not associated with fatigue in cancer patients: the hydration impact. Eur J Clin Nutr. 2020;74:1369–73.

    CAS  Article  Google Scholar 

  14. 14.

    Ishikawa NM, Thuler LCS, Giglio AG, Da Rocha Baldotto CS, De Andrade CJC, Derchain SFM. Validation of the Portuguese version of Functional Assessment of Cancer Therapy-Fatigue (FACT-F) in Brazilian cancer patients. Support Care Cancer. 2010;18:481–90.

    Article  Google Scholar 

  15. 15.

    Van Belle S, Paridaens R, Evers G, Kerger J, Bron D, Foubert J, et al. Comparison of proposed diagnostic criteria with FACT-F and VAS for cancer-related fatigue: Proposal for use as a screening tool. Support Care Cancer. 2005;13:246–54.

    Article  Google Scholar 

  16. 16.

    Feng LR, Regan J, Shrader JA, Liwang J, Ross A, Kumar S, et al. Cognitive and motor aspects of cancer-related fatigue. Cancer Med. 2019;8:5840–9.

    Article  Google Scholar 

  17. 17.

    Wang B, Thapa S, Zhou T, Liu H, Li L, Peng GYS. Cancer-related fatigue and biochemical parameters among cancer patients with different stages of sarcopenia. Support Care Cancer. 2019;28:581–8.

    Article  Google Scholar 

  18. 18.

    Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: Reliability, validity, and guidelines. J Clin Oncol. 1984;2:187–93.

    CAS  Article  Google Scholar 

  19. 19.

    Yang M, Huang Z, Chen J, Jiang J, Zuo Y, Hao Q. Applications of the new ESPEN definition of malnutrition and SARC-F in Chinese nursing home residents. Sci Rep. 2018;8:1–9.

    Google Scholar 

  20. 20.

    Chauhan NS, Samuel SR, Meenar N, Saxena PP, Keogh JWL. Sarcopenia in male patients with head and neck cancer receiving chemoradiotherapy: a longitudinal pilot study. PeerJ 2020;8:e8617.

    Article  Google Scholar 

  21. 21.

    Noronha Barrére AP, Guimarães Lopes G, de Assis T, Fraga Piovacari SM, Toledo DO. Identification of Sarcopenia Risk in Oncology Outpatients using the SARC-F Method. J Nutr Heal Food Sci. 2018;6:1–5.

    Google Scholar 

  22. 22.

    Kilgour RD, Vigano A, Trutschnigg B, Hornby L, Lucar E, Bacon SL, et al. Cancer-related fatigue: the impact of skeletal muscle mass and strength in patients with advanced cancer. J Cachexia Sarcopenia Muscle. 2010;1:177–85.

    Article  Google Scholar 

  23. 23.

    Neefjes ECW, van den Hurk RM, Blauwhoff-Buskermolen S, van der Vorst MJDL, Becker-Commissaris A, de van der Schueren MAE, et al. Muscle mass as a target to reduce fatigue in patients with advanced cancer. J Cachexia Sarcopenia Muscle. 2017;8:623–9.

    Article  Google Scholar 

  24. 24.

    Ohashi K, Ishikawa T, Hoshi A, Suzuki M, Mitobe Y, Yamada E, et al. Relationship Between Sarcopenia and Both Physical Activity and Lifestyle in Patients With Chronic Liver Disease. J Clin Med Res. 2018;10:920–7.

    CAS  Article  Google Scholar 

  25. 25.

    Queiroz M dos SC, Wiegert EVM, Lima LC, Oliveira LC de. Associação entre Sarcopenia, Estado Nutricional e Qualidade de Vida em Pacientes com Câncer Avançado em Cuidados Paliativos. Rev Bras Cancerol. 2018;64:69–75.

  26. 26.

    Nipp RD, Fuchs G, El‐Jawahri A, Mario J, Troschel FM, Greer JA, et al. Sarcopenia Is Associated with Quality of Life and Depression in Patients with Advanced Cancer. Oncologist 2018;23:97–104.

    Article  Google Scholar 

  27. 27.

    Papadopoulou SK. Sarcopenia: A contemporary health problem among older adult populations. Nutrients. 2020;12:1293.

    Article  Google Scholar 

  28. 28.

    Martone AM, Bianchi L, Abete P, Bellelli G, Bo M, Cherubini A, et al. The incidence of sarcopenia among hospitalized older patients: results from the Glisten study. J Cachexia Sarcopenia Muscle. 2017;8:907–14.

    Article  Google Scholar 

  29. 29.

    Pimentel GD, Pichard C, Laviano A, Fernandes RC. High protein diet improves the overall survival in older adults with advanced gastrointestinal cancer. Clin Nutr. 2021;40:1376–80.

    Article  Google Scholar 

  30. 30.

    Prado CM, Purcell SA, Laviano A. Nutrition interventions to treat low muscle mass in cancer. J Cachexia Sarcopenia Muscle. 2020;11:366–80.

    Article  Google Scholar 

  31. 31.

    Soares JDP, Howell SL, Teixeira FJPG. Dietary Amino Acids and Immunonutrition Supplementation in Cancer-Induced Skeletal Muscle Mass Depletion: A Mini-Review. Curr Pharm Des. 2020;9:970–8.

    Article  Google Scholar 

Download references

Acknowledgements

TCB, JDP, JSM, and TLNG would like to thank the Capes, Brazil. GDP would like to The Brazilian National Council for Scientific and Technological Development (CNPq, Brazil, 312252/2019–6).

Author information

Affiliations

Authors

Contributions

CSB, TCB, and GDP contributed to study design. CSB, TCB, NPV, TLNG, JDPS, JMS collected the data. CSB, TCB, and GDP performed the statistical analyses. CSB, TCB, and GDP drafted the manuscript. CP, AL, and GDP contributed of critical discussion of data and revised the paper. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Gustavo D. Pimentel.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Barreto, C.S., Borges, T.C., Valentino, N.P. et al. Absence of risk of sarcopenia protects cancer patients from fatigue. Eur J Clin Nutr (2021). https://doi.org/10.1038/s41430-021-00931-4

Download citation

Search

Quick links