Muscle 2.0: Exploring muscle as an active player in cancer with Elise Hoffman, ND, FABNO
Worth 1.5 CE (of which .5 are pharm)
Most of us, the public included, recognize that fat mass and obesity are risk factors for a long list of cancers – these tissues are associated with a host of metabolic and endocrine changes implicated in cancer development including insulin resistance, systemic inflammation, and alterations in hormone levels and growth factors. We also have evidence that high body fat mass is associated with increased toxicities from cancer treatments and some research suggests that it is linked with worse survival.
Fat mass is generally measured by overall weight or BMI and in the medical field, the focus is on achieving a healthy weight or BMI for primary and secondary cancer prevention. All these metrics – fat mass, BMI and overall weight – however, are missing an evaluation of muscle mass, which the research is showing to be more and more valuable. Research has shown that low muscle mass is associated with higher: risk of recurrence, overall and cancer-specific mortality, surgical complications, and treatment-related toxicities. The impact of sarcopenia in cancer care is becoming more apparent and thus, we need to find ways to identify low muscle mass as well as treat it, to best help our patients.
Body weight and BMI are not good indicators of muscle mass or body fat as these metrics do not distinguish muscle from adipose tissue, nor describe their tissue distribution. A ‘normal’ BMI can mask excess body fat as well as sarcopenia. This makes measuring body composition in terms of fat, muscle, and water mass, important. At many hospitals, patients with cancer are weighed regularly and overall weight is given prognostic value and used to identify of cachexia. However, without a specific evaluation of muscle for all patients, we miss those who have lost muscle mass without obvious weight loss. Sarcopenia is not necessarily the same as cachexia, which is characterized by a continuous decline in muscle mass, with or without fat loss. It’s important to understand this difference in order to identify individuals who may be categorized as “healthy” or even “overweight” yet who have had a significant loss of muscle.
Muscle plays a role in cancer, and we should be measuring, monitoring, and supporting our patient’s muscle mass. We need to integrate muscle mass as a priority into clinical practice and the maintenance of muscle mass should be a treatment goal throughout the cancer process. If we are using body weight or BMI alone on our patients, we are missing a vital part of body composition that has prognostic value.
Nutrition and physical activity interventions are important components of cancer care, and they have a role in supporting muscle mass. Both the goal of maintaining muscle mass during treatment as well as building muscle to help improve survival following treatment, are important. During treatment, we want to ensure adequate protein intake, regular movement, as well as supplementation with: protein powder, branched chain amino acids, omega-3 fats, carnitine and zinc. Once treatment is finished, patients can begin to work on increasing muscle mass when indicated, with specific strength training, dietary recommendations as well as some supplements (carnitine, creatine, protein powder).
Learning Objectives
Understand the role that fat and muscle play in each phase of cancer care: prevention, during treatment, survivorship and on recurrence rates
Sarcopenia and cachexia do not necessarily occur together – recognizing these differences and identify patients who may have sarcopenia and not cachexia
Identify how to assess/measure fat and muscle mass in patients, including overall levels, as well as their distribution in the body
Discuss interventions on how to help increase overall muscle mass, maintain muscle mass during treatment with patients
Worth 1.5 CE (of which .5 are pharm)
Most of us, the public included, recognize that fat mass and obesity are risk factors for a long list of cancers – these tissues are associated with a host of metabolic and endocrine changes implicated in cancer development including insulin resistance, systemic inflammation, and alterations in hormone levels and growth factors. We also have evidence that high body fat mass is associated with increased toxicities from cancer treatments and some research suggests that it is linked with worse survival.
Fat mass is generally measured by overall weight or BMI and in the medical field, the focus is on achieving a healthy weight or BMI for primary and secondary cancer prevention. All these metrics – fat mass, BMI and overall weight – however, are missing an evaluation of muscle mass, which the research is showing to be more and more valuable. Research has shown that low muscle mass is associated with higher: risk of recurrence, overall and cancer-specific mortality, surgical complications, and treatment-related toxicities. The impact of sarcopenia in cancer care is becoming more apparent and thus, we need to find ways to identify low muscle mass as well as treat it, to best help our patients.
Body weight and BMI are not good indicators of muscle mass or body fat as these metrics do not distinguish muscle from adipose tissue, nor describe their tissue distribution. A ‘normal’ BMI can mask excess body fat as well as sarcopenia. This makes measuring body composition in terms of fat, muscle, and water mass, important. At many hospitals, patients with cancer are weighed regularly and overall weight is given prognostic value and used to identify of cachexia. However, without a specific evaluation of muscle for all patients, we miss those who have lost muscle mass without obvious weight loss. Sarcopenia is not necessarily the same as cachexia, which is characterized by a continuous decline in muscle mass, with or without fat loss. It’s important to understand this difference in order to identify individuals who may be categorized as “healthy” or even “overweight” yet who have had a significant loss of muscle.
Muscle plays a role in cancer, and we should be measuring, monitoring, and supporting our patient’s muscle mass. We need to integrate muscle mass as a priority into clinical practice and the maintenance of muscle mass should be a treatment goal throughout the cancer process. If we are using body weight or BMI alone on our patients, we are missing a vital part of body composition that has prognostic value.
Nutrition and physical activity interventions are important components of cancer care, and they have a role in supporting muscle mass. Both the goal of maintaining muscle mass during treatment as well as building muscle to help improve survival following treatment, are important. During treatment, we want to ensure adequate protein intake, regular movement, as well as supplementation with: protein powder, branched chain amino acids, omega-3 fats, carnitine and zinc. Once treatment is finished, patients can begin to work on increasing muscle mass when indicated, with specific strength training, dietary recommendations as well as some supplements (carnitine, creatine, protein powder).
Learning Objectives
Understand the role that fat and muscle play in each phase of cancer care: prevention, during treatment, survivorship and on recurrence rates
Sarcopenia and cachexia do not necessarily occur together – recognizing these differences and identify patients who may have sarcopenia and not cachexia
Identify how to assess/measure fat and muscle mass in patients, including overall levels, as well as their distribution in the body
Discuss interventions on how to help increase overall muscle mass, maintain muscle mass during treatment with patients
Worth 1.5 CE (of which .5 are pharm)
Most of us, the public included, recognize that fat mass and obesity are risk factors for a long list of cancers – these tissues are associated with a host of metabolic and endocrine changes implicated in cancer development including insulin resistance, systemic inflammation, and alterations in hormone levels and growth factors. We also have evidence that high body fat mass is associated with increased toxicities from cancer treatments and some research suggests that it is linked with worse survival.
Fat mass is generally measured by overall weight or BMI and in the medical field, the focus is on achieving a healthy weight or BMI for primary and secondary cancer prevention. All these metrics – fat mass, BMI and overall weight – however, are missing an evaluation of muscle mass, which the research is showing to be more and more valuable. Research has shown that low muscle mass is associated with higher: risk of recurrence, overall and cancer-specific mortality, surgical complications, and treatment-related toxicities. The impact of sarcopenia in cancer care is becoming more apparent and thus, we need to find ways to identify low muscle mass as well as treat it, to best help our patients.
Body weight and BMI are not good indicators of muscle mass or body fat as these metrics do not distinguish muscle from adipose tissue, nor describe their tissue distribution. A ‘normal’ BMI can mask excess body fat as well as sarcopenia. This makes measuring body composition in terms of fat, muscle, and water mass, important. At many hospitals, patients with cancer are weighed regularly and overall weight is given prognostic value and used to identify of cachexia. However, without a specific evaluation of muscle for all patients, we miss those who have lost muscle mass without obvious weight loss. Sarcopenia is not necessarily the same as cachexia, which is characterized by a continuous decline in muscle mass, with or without fat loss. It’s important to understand this difference in order to identify individuals who may be categorized as “healthy” or even “overweight” yet who have had a significant loss of muscle.
Muscle plays a role in cancer, and we should be measuring, monitoring, and supporting our patient’s muscle mass. We need to integrate muscle mass as a priority into clinical practice and the maintenance of muscle mass should be a treatment goal throughout the cancer process. If we are using body weight or BMI alone on our patients, we are missing a vital part of body composition that has prognostic value.
Nutrition and physical activity interventions are important components of cancer care, and they have a role in supporting muscle mass. Both the goal of maintaining muscle mass during treatment as well as building muscle to help improve survival following treatment, are important. During treatment, we want to ensure adequate protein intake, regular movement, as well as supplementation with: protein powder, branched chain amino acids, omega-3 fats, carnitine and zinc. Once treatment is finished, patients can begin to work on increasing muscle mass when indicated, with specific strength training, dietary recommendations as well as some supplements (carnitine, creatine, protein powder).
Learning Objectives
Understand the role that fat and muscle play in each phase of cancer care: prevention, during treatment, survivorship and on recurrence rates
Sarcopenia and cachexia do not necessarily occur together – recognizing these differences and identify patients who may have sarcopenia and not cachexia
Identify how to assess/measure fat and muscle mass in patients, including overall levels, as well as their distribution in the body
Discuss interventions on how to help increase overall muscle mass, maintain muscle mass during treatment with patients