Muscle Strength, Sarcopenia Indicators of Nutritional Risk With Gastrointestinal Tumors

Indications of nutritional risk arise from low grip/muscle strength and skeletal muscle attenuation in older adults with gastrointestinal tumors.

Risk factors for nutritional risk in older adults with gastrointestinal (GI) tumors are decreased muscle/grip strength and presence of sarcopenia. These results were published in the Journal of Geriatric Oncology.

To investigate risk factors for nutritional risk in older adults with GI tumors, a research team identified 170 hospitalized older adults who met selection criteria. Clinical data collected were sex, age, medical history, pathologic diagnosis, tumor stage, and abdominal computed tomography (CT)-based skeletal muscle index at the third lumbar vertebral level (L3 SMI).

Nutritional status was assessed using the Nutrition Risk Screening (NRS) 2002 Nutritional Risk Screening Form, which includes a disease-related score, a nutritional status-related score, and an age score, with a score of 3 or higher indicating nutritional risk. After assessment for nutritional risks, the participants were assigned to a nutritional risk group or a non-nutritional risk group.

The observation indicators for the study were muscle mass, muscle strength, calf circumference, and body mass index (BMI). The researchers analyzed the risk factors first by comparing the indicators that had significant changes between the 2 groups, then by multivariate logistic regression analysis.

Low grip/muscle strength and skeletal muscle attenuation are independent risk factors for nutritional risk in older adults with gastrointestinal tumors.

Muscle mass was assessed with CT-based measurements of L3 SMI. Values lower than 40.8 cm2/m2 in males and 34.9 cm2/m2 in females indicated decreased muscle mass. Grip strength, using a spring device with the elbow extended, was used to measure muscle strength in the dominant hand or maximum strength of both hands. Values lower than 28.0 kg and 18.0 kg indicated a decline in strength in male and female participants, respectively.

Physical function was measured via 6-minute walking speed. A speed of less than 1.0 meters/second indicated a decline.

Calf circumference was measured at the thickest part of the calf. Cutoff values for male and female patients were 34 cm and 33 cm, respectively. The formula for BMI was body mass divided by height2. Body mass and height measurements were taken with consistent instruments by uniformly trained medical staff.

Of 170 participants, 64.7% were male, average age was 71.2±2.8 years, 102 (60.0%) had gastric cancer, and 68 (40.0%) had colorectal cancer. NRS 2002 criteria placed 88 (51.8%) of participants in the nutritional risk group. The general clinical characteristics of this group, compared with the non-nutritional risk group, were higher number of female participants, higher tumor stage, older age, and prevalence of sarcopenia; and lower BMI, calf circumference, L3 SMI, muscle/grip strength, and 6-minute walking speed. A statistically significant difference (P <.05).

Age and cancer type tend to increase nutritional risk for patients with GI tumors more than patients with other malignant tumors. The prospect of muscle loss for these patients is “correspondingly more serious than it is for other people,” explained the researchers.

Sarcopenia aggravates the occurrence of nutritional risk in older patients with GI tumors, and has become a major public health concern recently due its serious adverse effects for older adults, noted the researchers.

They recommend screening this patient population for nutritional risk and sarcopenia. “Low grip/muscle strength and skeletal muscle attenuation are independent risk factors for nutritional risk in older adults with gastrointestinal tumors. For these patients, guidelines should encourage an intervention method of nutrition combined with exercise in order to ameliorate muscle loss and improve nutritional status,” the researchers concluded.

This article originally appeared on Oncology Nurse Advisor


Qiu J, Xu Y, Xie H, Cai Z, Yang B, Yan Z. An analysis of nutritional risk factors in older adults with gastrointestinal tumours. Journal of Geriatric Oncology. Published online April 29, 2023. doi:10.1016/j.jgo.2023.101499