Body composition and nutritional status in malignant pleural mesothelioma: implications for activity levels and quality of life

Our plain-English summary of Body composition and nutritional status in malignant pleural mesothelioma: implications for activity levels and quality of life, by E. Jeffery, Y.C.G. Lee, R.U. Newton, et al (European Journal of Clinical Nutrition, 2019).

The study

• Authors: E. Jeffery, Y.C.G. Lee, R.U. Newton, P. Lyons-Wall, J. McVeigh, A.K. Nowak, H.M. Cheah, B. Nguyen, D.B. Fitzgerald, J. Creaney, L. Straker, C.J. Peddle-McIntyre
• Journal: European Journal of Clinical Nutrition
• Published: 2019;73(10):1412-1421
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background/objectives: Malignant pleural mesothelioma (MPM) is an incurable cancer and optimizing daily physical activity and quality of life are key goals of patient management. Little is known about the prevalence of pre-sarcopenia and malnutrition in MPM or their associations with patient outcomes. This study aimed to determine the prevalence of pre-sarcopenia and malnutrition in MPM and investigate if activity levels and quality of life differed according to body composition and nutritional status.

Subjects/methods: Patients with a diagnosis of MPM were recruited. Pre-sarcopenia was defined as low appendicular skeletal muscle mass (≤ 7.26 kg/m2 for men and ≤ 5.45 kg/m2 for women), measured by dual energy X-ray absorptiometry. Malnutrition was defined as a rating of B or C on the Patient-Generated Subjective Global Assessment. Outcome measures included objective activity levels (Actigraph GT3X) and health-related quality of life (HRQoL; Functional Assessment of Cancer Therapy General).

Results: Sixty-one people participated (79% male, median age 69 [IQR 62-74] years and median BMI 25.8 [IQR 24.3-28.4] kg/m2). Fifty-four percent were pre-sarcopenic and 38% were malnourished. Percent of time spent in light activity/day was lower in participants with pre-sarcopenia compared with non-sarcopenic participants (median 25.4 [IQR 19.8-32.1]% vs. 32.3 [27.1-35.6]%; p = 0.008). Participants with malnutrition had poorer HRQoL than well-nourished participants (mean 69.0 (16.3) vs. 84.4 (13.3); p < 0.001).

Conclusion: Participants with MPM had high rates of pre-sarcopenia and malnutrition. Pre-sarcopenia was associated with poorer activity levels, whilst malnutrition was associated with poorer quality of life. Interventions that aim to address reduced muscle mass and weight loss, should be tested in MPM to assess their impact on patient outcomes.

In plain English

This study looked at muscle mass and nutrition in 61 people with malignant pleural mesothelioma recruited from a specialist clinic in Western Australia between August 2015 and May 2017. It was a cross-sectional analysis of starting data from two small pilot studies. Asbestos exposure was not studied. Low muscle mass (called pre-sarcopenia) was measured with a DXA body scan, and malnutrition with a standard assessment. Of those with a usable scan, 28 (54%) had pre-sarcopenia. Of all 61, 23 (38%) were malnourished, although no participant was underweight. Participants with pre-sarcopenia spent less of their waking day in light activity than those without (median 25.4% vs 32.3%) and more time sedentary. Their cancer-related quality-of-life scores did not differ significantly. Malnourished participants had lower quality-of-life scores (mean 69.0 vs 84.4) and worse fatigue scores than well-nourished participants. The authors concluded that pre-sarcopenia was associated with lower activity and malnutrition with poorer quality of life. They noted the study was small, could not show cause and effect, and may have included healthier patients.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional analysis of baseline data from two prospective pilot studies (an observational study and a 6-week resistance exercise intervention)
• Who was studied: 61 patients with cytologically or histologically confirmed malignant pleural mesothelioma (79% male, median age 69), recruited from a tertiary specialist pleural disease and medical oncology clinic in Western Australia, August 2015 to May 2017
• Exposure: No asbestos exposure was measured. The factors compared were pre-sarcopenia (low appendicular skeletal muscle mass on DXA: 7.26 kg/m2 or less for men, 5.45 kg/m2 or less for women) and malnutrition (PG-SGA rating B or C)
• Main results:
  • 28 participants (54%) of those who had a DXA scan had pre-sarcopenia
  • 23 of the 61 participants (38%) were classified as malnourished
  • No participants were underweight by BMI
  • Participants with pre-sarcopenia spent a lower proportion of awake time in light activity than non-sarcopenic participants (median 25.4% [IQR 19.8 to 32.1] vs 32.3% [27.1 to 35.6]; p = 0.008)
  • Participants with pre-sarcopenia spent a higher proportion of time sedentary than non-sarcopenic participants (mean 72.8% vs 63.5%; p = 0.001)
  • Cancer-specific quality of life did not differ significantly between pre-sarcopenic and non-sarcopenic participants (mean 78.5 vs 82.2; p = 0.414)
  • Malnourished participants scored lower than well-nourished participants on cancer-specific quality of life (mean 69.0 vs 84.4; p less than 0.001)
  • Malnourished participants had lower fatigue-scale scores than well-nourished participants (mean 27.4 vs 40.2; p less than 0.001). On this scale a score of 34 or less indicates clinically meaningful fatigue
  • Malnourished and well-nourished participants did not differ in time spent in light activity (median 26.6% vs 29.7%; p = 0.380)
  • Energy and protein intake did not differ between malnourished and well-nourished participants
  • Compared with well-nourished participants, malnourished participants had higher IL-6 (p = 0.002) and lower myostatin (p = 0.032)
• The authors' conclusion: The authors concluded that participants with malignant pleural mesothelioma had high rates of pre-sarcopenia and malnutrition. Pre-sarcopenia was associated with lower activity levels and malnutrition with poorer quality of life. They also concluded that interventions addressing reduced muscle mass and weight loss should be tested.
• Limitations the authors state:
  • The study was cross-sectional, so it cannot show cause and effect
  • The sample was small, and the study was underpowered to detect differences in quality-of-life scores
  • Participants differed in time since diagnosis and treatments received
  • Healthier patients may have been included, so the sample may not represent the wider mesothelioma population
  • Body composition data were missing for 15% of participants
  • Gait speed was not measured, so participants could not be classified as sarcopenic or severely sarcopenic

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Quality of Life.

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