Elsevier

Clinical Nutrition

Volume 40, Issue 3, March 2021, Pages 890-894
Clinical Nutrition

Short Communication
SARC-F has low correlation and reliability with skeletal muscle mass index in older gastrointestinal cancer patients

https://doi.org/10.1016/j.clnu.2020.08.018Get rights and content

Summary

Background & aims

The evaluation of function and muscle mass in older cancer patients is essential to reduce comorbidities. We hypothesized that Simple Questionnaire to Rapidly Diagnose Sarcopenia (SARC-F) questionnaire is useful to assessment the muscle function, but not muscle mass. Thus, the purpose of this study was to evaluate the correlation and reliability between the SARC-F and skeletal muscle mass index (SMI) in older gastrointestinal cancer patients.

Methods

A cross-sectional observational study enrolled 108 (63.55 ± 8.9 y) gastrointestinal cancer patients. The patients were evaluated using the SARC-F questionnaire and the muscle mass index (SMI). SMI was calculated using Lee's equation: the appendicular muscle mass (ASM) was divided by height. Pearson's correlation was used to examine the correlation between SARC-F and SMI. The Bland–Altman plot and Cohen's kappa coefficient were used to determine the concordance and reliability between them. Statistical difference was set at p < 0.05.

Results

The Bland–Altman plot showed that the difference between methods were within agreement (±1.96; p = 0.001). However, SARC-F has low concordance (κ = 0.20; standard error = 0.14) and correlation (r = −0.303; p = 0.0014) with SMI.

Conclusion

In older cancer outpatients, we found that SARC-F has low correlation and reliability with SMI.

Introduction

Cancer results from an irregular increase in malignant cells and is one of the leading causes of morbidity and mortality [1,2]. Metabolic alterations and malnutrition are often associated with an exacerbated inflammatory response, decompensated proteolysis, negative nitrogenous balance and weight loss, particularly of the muscle mass [[3], [4], [5]]. This common condition among cancer patients is associated with worse prognosis. Additionality, the loss of muscle mass promotes imbalance and damage in functional capacity [6,7].

Thus, assessment of function and muscle mass is crucial to reduce comorbidities in cancer patients. Clinical routines use practical and fast screening tools to measure muscle mass. One of these tools is the Simple Questionnaire to Rapidly Diagnose Sarcopenia (SARC-F) that assesses muscle function [5,8,9]. Besides, evaluation of the skeletal muscle mass may be estimated using Lee's equation [10]. However, there are no studies that analyzed these two methods in the evaluation of loss muscle mass and function risk in gastrointestinal cancer patients. We hypothesized that SARC-F is useful to assessment the muscle function, but not muscle mass. Therefore, this study aimed to evaluate the correlation and reliability between SARC-F and the skeletal muscle mass index (SMI) in older gastrointestinal cancer patients.

Section snippets

Study design and patients

A cross-sectional study was conducted between December 2017 and October 2018 at the Public Hospital. We screened 114 older patients (63.55 ± 8.9 years) of both sexes with a diagnosis of gastrointestinal tract cancer who were currently undergoing anticancer therapy (chemotherapy, radiotherapy, or surgery). Of these, six patients were excluded from the study due to incomplete data, and 108 (80.5% male) patients were enrolled (Fig. 1). The patients were informed of the study and signed the written

Results

We found that 18.5% of patients presented normal muscle function. The most of patients was male (80.5%). We observed a high rate of thinness (BMI = 23.5 kg/m2) and low skeletal muscle mass (SMI = 81.5%). The primary diagnosis was colorectal cancer (48.1%) and 21.3% of the cases were liver metastasis. In addition, the most commonly treatment between these patients was neoadjuvant therapy (chemotherapy before surgery; 43.5%) and the least frequent was radiotherapy (0.9%) (Table 1).

Although, the

Discussion

In our study, 81.5% of patients presented low muscle function and mass. Although we observed that most of the values obtained from Lee's equation and the SARC-F were within the agreement limit, there was low correlation and reliability between them.

The muscle mass loss was identified by Lee's equation and can be found into acute (cachexia) or chronic (sarcopenia) forms [16]. Cancer patients may develop cachexia, which is sustained by an inflammatory state, insulin resistance and muscle loss due

Funding sources

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Statement of authorship

JDPS and GDP are responsible for conception of study. JDPS, JMS and ICLO performed data acquisition. JDPS, JMS, ICLO and GDP interpreted data, statistical analysis, contributed to manuscript revision and wrote the manuscript. All authors have read and approved the final version of the manuscript.

Conflict of interest

The authors declare no funding sources or conflicts of interest.

Acknowledgement

JMS and JDPS would like to thank the Capes, Brazil. GDP would like to thank The Brazilian National Council for Scientific and Technological Development (CNPq, Brazil, 312252/2019-6). We would like to thank the patients.

References (32)

  • M.J. Thun et al.

    The global burden of cancer: priorities for prevention

    Carcinogenesis

    (2009)
  • R.D. Nipp et al.

    Sarcopenia is associated with quality of life and depression in patients with advanced cancer

    Oncologist

    (2018)
  • S.S. Shachar et al.

    Skeletal muscle measures as predictors of toxicity, hospitalization, and survival in patients with metastatic breast cancer receiving taxane based chemotherapy

    Clin Cancer Res

    (2017)
  • J.D.P. Soares et al.

    Muscle function loss is associated with anxiety in patients with gastrointestinal cancer

    Clin Nutr ESPEN

    (2018)
  • A.J. Cruz-Jentoft et al.

    Sarcopenia: revised European consensus on definition and diagnosis

    Age Ageing

    (2019 Jul 1)
  • T.K. Malmstrom et al.

    SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes

    J Cachexia Sarcopenia Muscle

    (2016)
  • Cited by (12)

    • MSRA has low concordance with skeletal muscle mass index in mixed cancer patients: A preliminary and feasibility study

      2022, Clinical Nutrition ESPEN
      Citation Excerpt :

      Subsequently, Body Mass Index (BMI) was calculated (kg/m2). Appendicular muscle mass (ASM) was calculated using the LEE formula: ASM = 0.244 × Body weight + 7.80 × Height - 0.098 × Age + 6.6 × Sex + Race - 3.3 [6], for sex, 0 was used for women and 1 for men, and for race, 0 was used for whites, 1.4 for blacks, and 1.2 for Asians. Next, ASM was divided by height squared to obtain SMI values (skeletal muscle index).

    • High Charlson comorbidity index value is not associated with muscle strength in unselected cancer patients

      2022, Clinical Nutrition ESPEN
      Citation Excerpt :

      This condition is associated with the risk of morbidity and mortality among oncologic patients [6]. Likewise, Charlson Comorbidity Index (CCI) is an easy-to-use tool [7] commonly used to found that patients with risk for sarcopenia, when assessed by strength, assistance in walking, rise from a chair, climb stairs and falls (SARC-F), which is a good indicator of low strength and functional capacity [8,9], had more comorbidities, when evaluated by the ICC questionnaire [10]. In other study, Borges, Gomes, and Pimentel [11] found that 40% of cancer patients had risk of sarcopenia and its presence could predict the risk of comorbidities by 29%.

    View all citing articles on Scopus
    View full text