Low muscle mass is associated with a higher risk of all-cause and cardiovascular disease-specific mortality in cancer survivors

Dongyu Zhang; Kori A Spiropoulos; Akemi Wijayabahu; Demetra D Christou; Shama D Karanth; Stephen D Anton; Christiaan Leeuwenburgh; Muxuan Liang; Meghann Wheeler; Danting Yang; Aduse-Poku Livingstone; Robert T Mankowski; Ting-Yuan David Cheng; Hanchao Zhang; Erin M Siegel; Frank J Penedo; Jonathan D Licht; Dejana Braithwaite

doi:10.1016/j.nut.2022.111934

Low muscle mass is associated with a higher risk of all-cause and cardiovascular disease-specific mortality in cancer survivors

Nutrition. 2023 Mar:107:111934. doi: 10.1016/j.nut.2022.111934. Epub 2022 Dec 10.

Authors

Dongyu Zhang¹, Kori A Spiropoulos², Akemi Wijayabahu², Demetra D Christou³, Shama D Karanth⁴, Stephen D Anton⁵, Christiaan Leeuwenburgh⁵, Muxuan Liang⁶, Meghann Wheeler², Danting Yang², Aduse-Poku Livingstone², Robert T Mankowski⁵, Ting-Yuan David Cheng⁷, Hanchao Zhang⁸, Erin M Siegel⁹, Frank J Penedo¹⁰, Jonathan D Licht¹¹, Dejana Braithwaite¹²

Affiliations

¹ Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA; University of Florida Health Cancer Center, Gainesville, Florida, USA. Electronic address: dzhang2@ufl.edu.
² Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA.
³ Department of Applied Physiology and Kinesiology, University of Florida College of Health & Human Performance, Gainesville, Florida, USA.
⁴ University of Florida Health Cancer Center, Gainesville, Florida, USA; Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida, USA.
⁵ Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida, USA.
⁶ Department of Biostatistics, University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA.
⁷ Division of Cancer Prevention and Control, The Ohio State University College of Medicine, Columbus, Ohio, USA.
⁸ Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York, New York, USA.
⁹ Department of Cancer Epidemology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.
¹⁰ Department of Psychology, University of Miami, Miami, Florida, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA.
¹¹ University of Florida Health Cancer Center, Gainesville, Florida, USA; Division of Hematology and Oncology, University of Florida Health Cancer Center, Gainesville, Florida, USA.
¹² Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA; University of Florida Health Cancer Center, Gainesville, Florida, USA; Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA.

Abstract

Objectives: Individuals with prior cancer diagnosis are more likely to have low muscle mass (LMM) than their cancer-free counterparts. Understanding the effects of LMM on the prognosis of cancer survivors can be clinically important. The aim of this study was to investigate whether risks for all-cause and cardiovascular disease (CVD)-specific mortality differ by status of LMM in cancer survivors and a matched cohort without cancer history.

Methods: We used cohort data from the 1999-2006 and 2011-2014 National Health and Nutrition Examination Survey. Participants included 946 adults surviving for ≥1 since cancer diagnosis and a matched cohort (by age, sex, and race) without cancer history (N = 1857). LMM was defined by appendicular lean mass and body height (men <7.26 kg/m², women <5.45 kg/m²). Death was ascertained via the National Death Index and cause of death was assessed via International Classification of Diseases, Tenth Revision. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratio (aHR) and 95% confidence interval (CI) of LMM.

Results: The mean age of cancer survivors and matched cohort was 60.6 y (SD 15) and 60.2 y (SD 14.9), respectively. The median follow-up was 10.5 y for survivors and 10.9 y for matched cohort. Overall, 22.2% of cancer survivors and 19.7% of the matched cohort had LMM, respectively. In all, 321 survivors (33.9%) and 495 participants (26.7%) in the matched cohort died during follow-up. CVD-specific deaths were identified in 58 survivors (6.1%) and 122 participants in the matched cohort (6.6%). The multivariable Cox model suggested that LMM was positively associated with all-cause (aHR, 1.73; 95% CI, 1.31-2.29) and CVD-specific (aHR, 2.13; 95% CI, 1.14-4.00) mortality in cancer survivors. The associations between LMM and risk for all-cause (aHR, 1.24; 95% CI, 0.98-1.56) and CVD-specific (aHR, 1.21; 95% CI, 0.75-1.93) mortality were not statistically significant in the matched cohort.

Conclusion: Cancer survivors with LMM have an increased risk for all-cause and CVD-specific mortality. This increase appears to be larger than that in counterparts without cancer history.

Keywords: Cancer survivorship; Epidemiology; Geriatric oncology; Low muscle mass; Nutrition.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cancer Survivors*
Cardiovascular Diseases* / diagnosis
Female
Humans
Male
Muscles
Neoplasms* / complications
Nutrition Surveys
Prognosis
Risk Factors

Grants and funding

R37 CA248371/CA/NCI NIH HHS/United States