3: Energy Balance, Body Comp, Activity

Question 1

Percentage of overweight/obese in Adults and Kids

Answer 1

Adults - 32.5% overweight, 37.7% obese
Kids/adolescents - 17% overweight/obese

Question 2

Cancers with sufficient/probable evidence that body fatness is a risk factor

Answer 2

Breast(Post)
Endometrial
Esophagus
Colorectal
corpus uteri
gallbladder
gastric cardia
kidney (renal cell)
liver
meningioma
mouth/pharynx/larnyx
multiple myeloma
ovary
pancreas
prostate
thyroid

Question 3

CT Images can be useful for evaluating what?

What is this linked to?

How underrecognized is it?

Answer 3

skeletal muscle mass vs adipose tissue. This can help with diagnosing cachexia (looking at visceral, subcutaneous, and inter-muscular fat).

Muscle depletion is linked to cancer outcomes, including chemo response/toxicity, increased postsurgical compilations, LOS inpatient, and mortality

Sarcopenia is underrecognized in 34% of nonmet breast and 42% of nonmet colorectal.

Question 4

Visceral adiposity is strongly associated with what?

Answer 4

Metabolic syndrome. Increased production of adipokines like leptin, adiponectin, tumor necrosis factor alpha and interleukin-6 (IL-6) that contribute to insulin resistance and inflammatory state

Question 5

Define Cachexia

Answer 5

a metabolic syndrome driven by inflammation and characterized by loss of muscle with or without loss of fat mass. It’s a multfactorial syndrome that can’t be fully reversed with conventional nutrition support

Question 6

What cancers is cachexia most prevalent in?

Answer 6

gastric, pancreatic, esophageal, head and neck, lung, colorectal, and prostate cancers.

Question 7

Diagnosis criteria for cancer cachexia

Answer 7

wt loss of more than 5% over past 6 months in absence of simple starvation

OR BMI less than 20 and any degree of wt loss >2%

OR appendicular skeletal muscle index consistent with sarcopenia (men <7.26; women <5.45) and any degree of wt loss >2%

Question 8

What are the 3 stages of cachexia? Define each one

Answer 8

Precachexia (wt loss, anorexia, progression depends on cancer type/stage and factors like inflammation, low intake, lack of response to anticancer therapy)

Cachexia (wt loss >5% in 6 months, BMI <20 + >2% wt loss, Sarcopenia + >2% wt loss, reduced food intake, presence of systemic inflammation)

Refractory Cachexia (active catabolism, management of wt loss not possible, very advanced or rapidly progressive cancer unresponsive to anticancer therapy)

Question 9

What’s the rate of sarcopenia in health adults compared to newly diagnosed cancer patients?

Answer 9

Healthy = 15%
Cancer = 40-50%

Question 10

Recommendations for wt management in survivors

Answer 10

Those that need to lose weight should get a comprehensive intervention lasting at least 6 months that encompass diet, physical activity and behavior modification. Ideally on-site, high intensity sessions (14 in 6 months) provided in group or individualized for a year or more

Question 11

Recommendations for activity during treatment? What type need special care?

Answer 11

Any risks with activity during treatment are low when contraindications to activity are screened for. Special care should be taken for peripheral neuropathy, lymphedema, or serious comorbidities.

Question 12

Lansky and Karnofsky Performance Scale

Answer 12

Normal: 80-100
Able to live at home with some/no assistance: 50-70
Unable to provide self-care/disabled: 30-40
Hospice/fatal processes progressing: 10-20
Death: 0

Question 13

ECOG Scale

Answer 13

0 = fully active
1 = restrictive in physically strenuous activity only
2 = ambulatory and capable of self care; OOB over 50% of time
3 = limited self care, in bed/chair over 50% of time
4 = disabled, incapable of self care
5= death