Changes in body composition in patients with malignant pleural mesothelioma and the relationship with activity levels and dietary intake

Our plain-English summary of Changes in body composition in patients with malignant pleural mesothelioma and the relationship with activity levels and dietary intake, by E. Jeffery, Y.C.G. Lee, R.U. Newton, et al (European Journal of Clinical Nutrition, 2022).

The study

• Authors: E. Jeffery, Y.C.G. Lee, R.U. Newton, P. Lyons-Wall, J. McVeigh, D.B. Fitzgerald, L. Straker, C.J. Peddle-McIntyre
• Journal: European Journal of Clinical Nutrition
• Published: 2022;76(7):979-986
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Skeletal muscle loss is common in advanced cancer and is associated with negative outcomes. In malignant pleural mesothelioma (MPM), no study has reported body composition changes or factors associated with these changes. This study aimed to describe changes in body composition over time and its relationship with activity levels, dietary intake and survival.

Methods: The study was a secondary analysis of data collected from a longitudinal observational study of patients with MPM. Participants completed 3-month assessments for up to 18 months. Participants with two dual-energy x-ray absorptiometry (DXA) scans were included. Changes in appendicular skeletal muscle mass (ASM) and total fat mass were used to categorise participants into phenotypes. Activity levels were measured with an ActiGraph GT3X+ accelerometer and energy and protein intake was measured with a 3-day food record and 24-h recall.

Results: Eighteen participants were included (89% men, mean age 68.9 ± 7.1 years). Median time between DXA was 91 [IQR 84-118] days. Compared to participants with ASM maintenance (n = 9), fewer participants with ASM loss (n = 9) survived ≥12 months from follow-up (p = 0.002). Participants with ASM loss increased sedentary time (p = 0.028) and decreased light activity (p = 0.028) and step count (p = 0.008). Activity levels did not change in participants with ASM maintenance (p > 0.05). Energy and protein intake did not change in either group (p > 0.05).

Conclusions: Muscle loss was associated with poorer survival and decreased activity levels. Interventions that improve physical activity or muscle mass could benefit patients with MPM.

© 2022. The Author(s).

In plain English

This study examined how body composition changed in people with malignant pleural mesothelioma (MPM) and how changes related to activity, diet and survival. It was a secondary analysis of an observational study at a pleural disease clinic in Perth, Western Australia: 18 of 36 recruited patients had two body scans a median of 91 days apart. Asbestos exposure was not studied. Nine participants lost arm and leg muscle and nine maintained it. Seven of the nine with muscle loss (78%) survived less than 12 months after the second scan, compared with none of the nine who maintained muscle (p = 0.002). In the muscle-loss group, daily steps fell and sedentary time rose; activity did not change significantly in the other group. Energy and protein intake did not change significantly within either group. The authors noted that participants may have been at different disease stages, which could have introduced bias, and that the sample was too small for further evaluation of such factors. They concluded that muscle loss was associated with poorer survival and decreased activity levels, and that interventions improving physical activity or muscle mass could benefit patients with MPM.

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: Secondary analysis of data from a longitudinal observational study, with assessments about every 3 months for up to 18 months
• Who was studied: Patients with cytologically or histologically confirmed malignant pleural mesothelioma recruited from a pleural disease clinic in Perth, Western Australia. 18 of 36 recruited patients had two consecutive DXA body composition scans and were included. They were 89% men, with a mean age of 68.9 (SD 7.1) years. Recruitment dates are not given.
• Exposure: No asbestos exposure data were collected for participants. The factor studied was change in body composition measured by DXA scan: loss versus maintenance or gain of appendicular (arm and leg) skeletal muscle mass and of total fat mass. This was examined against accelerometer-measured activity, dietary energy and protein intake, and survival.
• Main results:
  • 18 of the 36 patients recruited to the original study were included. The median time between the first and second scans was 91 [IQR 84–118] days.
  • 9 participants (50%) met the criteria for muscle loss and 9 (50%) for muscle maintenance.
  • Body composition patterns: 7 participants (39%) lost both appendicular muscle and fat mass, and 2 (11%) lost muscle but maintained fat mass. 4 (22%) maintained muscle and lost fat mass, and 5 (28%) maintained both.
  • In the whole group of 18, there were no significant changes in total, lean or fat mass.
  • Survival: 7 of 9 participants (78%) with muscle loss survived less than 12 months from the second scan, compared with 0 of 9 (0%) with muscle maintenance (p = 0.002).
  • In the muscle loss group, median daily step count fell (6013 to 4251; p = 0.008). The proportion of waking hours spent sedentary rose (67.0% to 73.7%; p = 0.028) and light activity fell (28.4% to 25.3%; p = 0.028). Moderate and vigorous activity did not change significantly (p = 0.260).
  • Activity levels did not change significantly in the muscle maintenance group (8 participants had activity data).
  • Change in step count differed between groups: median –1020 steps/day in the muscle loss group versus 1234 steps/day in the muscle maintenance group (p = 0.008).
  • Energy and protein intake did not change significantly within either group.
  • Change in protein intake differed between groups: median –0.29 g/kg/day in the muscle loss group versus 0.60 g/kg/day in the muscle maintenance group (p = 0.011). Change in energy intake did not differ significantly (p = 0.236).
• The authors' conclusion: The authors concluded that multiple patterns of body composition change exist in patients with MPM, and that muscle loss was associated with poorer survival and decreased activity levels. They stated that interventions improving physical activity or muscle mass could benefit these patients.
• Limitations the authors state:
  • Participants may have been at different stages of disease, so combining them could have introduced bias.
  • The sample was too small for further evaluation of factors such as disease progression and cancer treatment in relation to body composition change.
  • For some outcomes, such as cancer treatment status, the sample was too small for statistical analysis.
  • Diet was measured differently at baseline (3-day food record) and at follow-up (24-hour recall), which could have affected repeatability.

Topics

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

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

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