Nutrition in Clinical Practice http://ncp.sagepub.com/
Sarcopenia in Solid Organ Transplantation Elizabeth J. Carey Nutr Clin Pract 2014 29: 159 originally published online 14 February 2014 DOI: 10.1177/0884533613520619 The online version of this article can be found at: http://ncp.sagepub.com/content/29/2/159
Published by: http://www.sagepublications.com
On behalf of:
The American Society for Parenteral & Enteral Nutrition
Additional services and information for Nutrition in Clinical Practice can be found at: Email Alerts: http://ncp.sagepub.com/cgi/alerts Subscriptions: http://ncp.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
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520619
research-article2014
NCPXXX10.1177/0884533613520619Nutrition in Clinical PracticeCarey
Invited Review
Sarcopenia in Solid Organ Transplantation Elizabeth J. Carey, MD1
Nutrition in Clinical Practice Volume 29 Number 2 April 2014 159–170 © 2014 American Society for Parenteral and Enteral Nutrition DOI: 10.1177/0884533613520619 ncp.sagepub.com hosted at online.sagepub.com
Abstract Sarcopenia is a relatively new concept in the medical literature, initially intended to describe the loss of lean body mass that occurs with aging. More recently, sarcopenia has been described in various forms of chronic disease, including patients with end-stage organ disease awaiting transplantation. The presence of sarcopenia is an important marker in transplant patients, since it has been linked to poorer preand posttransplant outcomes compared with patients with preserved muscle mass. The mechanisms and natural history of sarcopenia in transplant patients are incompletely understood, and there are currently no therapies proven to mitigate or reverse the process. This article reviews the current understanding of the prevalence and clinical significance of sarcopenia in transplant patients and highlights important areas of future research. (Nutr Clin Pract. 2014;29:159-170)
Keywords organ transplantation; sarcopenia; malnutrition; nutrition assessment; nutrition
Poverty of Flesh The term sarcopenia was coined by Irwin Rosenberg1 in 1989, in a plea to clinicians and researchers to devote attention to the dramatic decrease in lean body mass that occurs with age. The word sarcopenia, derived from the Greek words for “poverty” and “flesh,” describes the changes in body composition, specifically loss of skeletal muscle mass, that occur with age.2-4 A precursor to poor outcomes such as falls, debility, disability, and death, sarcopenia is an emerging topic in the medical literature.5 The role of sarcopenia in disease states such as cancer, chronic obstructive pulmonary disease, cirrhosis, heart failure, and end-stage kidney disease is a topic of more recent interest. Sarcopenia has now drawn the attention of the transplant community, since muscle wasting is commonly found in candidates for solid organ transplant and has been associated with worse outcomes after transplantation. After its initial introduction, sarcopenia was further described by Evans and Campbell,4 who put muscle volume loss in context with age-related changes in muscle strength and activity level. The past 2 decades have brought an explosion of research on sarcopenia, primarily in the geriatric literature. In the past 5 years, the paradigm of sarcopenia has been applied to various disease states. Although far from a full understanding of the implications of sarcopenia in transplantation, it is clear that transplant professionals and patients will benefit from a better understanding of this process.
increased risk of disability and mortality.6 More recently, the presence of sarcopenia has been linked to worse medical and surgical outcomes in a wide range of diseases.7 In multiple types of cancer, including breast, hepatocellular, lung, renal, and colon cancer, sarcopenia is associated with an increased risk of toxicity during chemotherapy and is an independent predictor of mortality.8,9 Surgical outcomes are also decreased in cancer patients with sarcopenia, with higher rates of infection, postoperative complications, and need for inpatient rehabilitation.10 The field of solid organ transplantation is defined by the shortage of donor organs, mandating that clinicians strive to maximize the utility of scarce resources. There is increasing attention to non–organ-specific factors affecting transplant outcomes, and sarcopenia has recently been identified as a risk for worse outcomes after transplantation.11,12
Definition The lack of a consistent and widely accepted definition of sarcopenia is a challenge to transplant clinicians and researchers in this field. The absence of a standard definition has resulted
From the 1Division of Hepatology, Mayo Clinic in Arizona, Phoenix. Financial disclosure: None declared. This article originally appeared online on February 14, 2014.
Clinical Significance Sarcopenia was first noted to be of clinical significance in the elderly population, in whom it is strongly associated with an
Corresponding Author: Elizabeth J. Carey, MD, Division of Hepatology, Mayo Clinic in Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA. Email: [email protected]
Downloaded from ncp.sagepub.com at Gebze Yuksek Teknoloji Enstitu on May 4, 2014
160
Nutrition in Clinical Practice 29(2)
Table 1. Definitions of Sarcopenia. Group
Definition
Method
Functional Status 2
International Working Group on “age-associated loss of skeletal muscle DEXA (≤7.23 kg/m for Gait speed
Sarcopenia in Solid Organ Transplantation Elizabeth J. Carey Nutr Clin Pract 2014 29: 159 originally published online 14 February 2014 DOI: 10.1177/0884533613520619 The online version of this article can be found at: http://ncp.sagepub.com/content/29/2/159
Published by: http://www.sagepublications.com
On behalf of:
The American Society for Parenteral & Enteral Nutrition
Additional services and information for Nutrition in Clinical Practice can be found at: Email Alerts: http://ncp.sagepub.com/cgi/alerts Subscriptions: http://ncp.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - Mar 13, 2014 OnlineFirst Version of Record - Feb 14, 2014 What is This?
Downloaded from ncp.sagepub.com at Gebze Yuksek Teknoloji Enstitu on May 4, 2014
520619
research-article2014
NCPXXX10.1177/0884533613520619Nutrition in Clinical PracticeCarey
Invited Review
Sarcopenia in Solid Organ Transplantation Elizabeth J. Carey, MD1
Nutrition in Clinical Practice Volume 29 Number 2 April 2014 159–170 © 2014 American Society for Parenteral and Enteral Nutrition DOI: 10.1177/0884533613520619 ncp.sagepub.com hosted at online.sagepub.com
Abstract Sarcopenia is a relatively new concept in the medical literature, initially intended to describe the loss of lean body mass that occurs with aging. More recently, sarcopenia has been described in various forms of chronic disease, including patients with end-stage organ disease awaiting transplantation. The presence of sarcopenia is an important marker in transplant patients, since it has been linked to poorer preand posttransplant outcomes compared with patients with preserved muscle mass. The mechanisms and natural history of sarcopenia in transplant patients are incompletely understood, and there are currently no therapies proven to mitigate or reverse the process. This article reviews the current understanding of the prevalence and clinical significance of sarcopenia in transplant patients and highlights important areas of future research. (Nutr Clin Pract. 2014;29:159-170)
Keywords organ transplantation; sarcopenia; malnutrition; nutrition assessment; nutrition
Poverty of Flesh The term sarcopenia was coined by Irwin Rosenberg1 in 1989, in a plea to clinicians and researchers to devote attention to the dramatic decrease in lean body mass that occurs with age. The word sarcopenia, derived from the Greek words for “poverty” and “flesh,” describes the changes in body composition, specifically loss of skeletal muscle mass, that occur with age.2-4 A precursor to poor outcomes such as falls, debility, disability, and death, sarcopenia is an emerging topic in the medical literature.5 The role of sarcopenia in disease states such as cancer, chronic obstructive pulmonary disease, cirrhosis, heart failure, and end-stage kidney disease is a topic of more recent interest. Sarcopenia has now drawn the attention of the transplant community, since muscle wasting is commonly found in candidates for solid organ transplant and has been associated with worse outcomes after transplantation. After its initial introduction, sarcopenia was further described by Evans and Campbell,4 who put muscle volume loss in context with age-related changes in muscle strength and activity level. The past 2 decades have brought an explosion of research on sarcopenia, primarily in the geriatric literature. In the past 5 years, the paradigm of sarcopenia has been applied to various disease states. Although far from a full understanding of the implications of sarcopenia in transplantation, it is clear that transplant professionals and patients will benefit from a better understanding of this process.
increased risk of disability and mortality.6 More recently, the presence of sarcopenia has been linked to worse medical and surgical outcomes in a wide range of diseases.7 In multiple types of cancer, including breast, hepatocellular, lung, renal, and colon cancer, sarcopenia is associated with an increased risk of toxicity during chemotherapy and is an independent predictor of mortality.8,9 Surgical outcomes are also decreased in cancer patients with sarcopenia, with higher rates of infection, postoperative complications, and need for inpatient rehabilitation.10 The field of solid organ transplantation is defined by the shortage of donor organs, mandating that clinicians strive to maximize the utility of scarce resources. There is increasing attention to non–organ-specific factors affecting transplant outcomes, and sarcopenia has recently been identified as a risk for worse outcomes after transplantation.11,12
Definition The lack of a consistent and widely accepted definition of sarcopenia is a challenge to transplant clinicians and researchers in this field. The absence of a standard definition has resulted
From the 1Division of Hepatology, Mayo Clinic in Arizona, Phoenix. Financial disclosure: None declared. This article originally appeared online on February 14, 2014.
Clinical Significance Sarcopenia was first noted to be of clinical significance in the elderly population, in whom it is strongly associated with an
Corresponding Author: Elizabeth J. Carey, MD, Division of Hepatology, Mayo Clinic in Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA. Email: [email protected]
Downloaded from ncp.sagepub.com at Gebze Yuksek Teknoloji Enstitu on May 4, 2014
160
Nutrition in Clinical Practice 29(2)
Table 1. Definitions of Sarcopenia. Group
Definition
Method
Functional Status 2
International Working Group on “age-associated loss of skeletal muscle DEXA (≤7.23 kg/m for Gait speed
