Current status and influencing factors of sarcopenia in abdominal surgery inpatients

doi:10.3877/cma.j.issn.1674-0793.2023.01.015

Abstract

Abstract:

Objective

To investigate the prevalence of sarcopenia in inpatients with abdominal surgery, and analyze its influencing factors, providing support for nutritional interventions in inpatients.

Methods

A cross-sectional study was conducted to investigate 1 131 inpatients after abdominal surgery who met the inclusion criteria in a tertiary hospital in Shandong Province from December 2019 to July 2021. General information was recorded, grip strength and 6-meter step time were measured, body composition analysis and serological indexes were performed, and nutritional risk screening was performed using the NRS2002 scale. The presence of sarcopenia was determined according to the Asian Working Group for Sarcopenia (AWGS) 2019 diagnostic criteria. The patients were divided into sarcopenia group and non-sarcopenia group, while relevant nutritional indicators of all patients, the length of hospital stay, and postoperative hospital stay of surgical patients were compared to screen the influencing factors of sarcopenia.

Results

A total of 165 patients were found with sarcopenia, with a prevalence of 14.59%. 305 cases (26.97%) had abnormal grip strength, 307 cases (27.14%) had abnormal skeletal muscle index (ASMI), and 272 cases (24.05%) had abnormal gait speed. There were significant differences in weight, body mass index, skeletal muscle mass, defatted weight, left upper arm muscle circumference, phase angle, albumin, hemoglobin, red blood cells, and lymphocytes between the two groups (all P<0.05). The length of hospital stay and postoperative hospital stay were significantly longer in the sarcopenia group than in the non-sarcopenia group among the surgical patients (P<0.05). Age, nutritional risk, and jaundice were independent influencing factors of sarcopenia (all P<0.05).

Conclusions

The prevalence of sarcopenia in inpatients of abdominal surgery is at a high level, which affects the length of hospital and postoperative hospital stay of surgical patients. Timely screening and intervention of sarcopenia may help improving the clinical outcome and disease prognosis of patients.

Key words: Abdominal surgery, Sarcopenia, Prevalence rate, Length of stay

Jindong Ma, Lei Wang, Tingting Cai, Xiangfei Jiao, Qiangpu Chen. Current status and influencing factors of sarcopenia in abdominal surgery inpatients[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(01): 69-74.

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References 24

[1]	Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis[J]. Age Ageing, 2019, 48(1): 16-31.
[2]	蔡婷婷, 王蕾, 陈强谱. 肌肉减少症对老年患者术后并发症的影响及干预措施[J]. 中华老年医学杂志, 2021, 40(8): 971-975.
[3]	Bauer J, Morley JE, Schols A, et al. Sarcopenia: A time for action. An SCWD position paper[J]. J Cachexia Sarcopenia Muscle, 2019, 10(5): 956-961.
[4]	Petermann-Rocha F, Balntzi V, Gray SR, et al. Global prevalence of sarcopenia and severe sarcopenia: A systematic review and meta-analysis[J]. J Cachexia Sarcopenia Muscle, 2022, 13(1): 86-99.
[5]	Chen LK, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment[J]. J Am Med Dir Assoc, 2020, 21(3): 300-307.
[6]	Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002[J]. Clin Nutr, 2003, 22(4): 415-421.
[7]	Kyle UG, Genton L, Pichard C. Low phase angle determined by bioelectrical impedance analysis is associated with malnutrition and nutritional risk at hospital admission[J]. Clin Nutr, 2013, 32(2): 294-299.
[8]	Kitamura A, Seino S, Abe T, et al. Sarcopenia: prevalence, associated factors, and the risk of mortality and disability in Japanese older adults[J]. J Cachexia Sarcopenia Muscle, 2021, 12(1): 30-38.
[9]	Chen Z, Li WY, Ho M, et al. The prevalence of sarcopenia in Chinese older adults: meta-analysis and meta-regression[J]. Nutrients, 2021, 13(5): 1441.
[10]	de Blasio F, Di Gregorio A, de Blasio F, et al. Malnutrition and sarcopenia assessment in patients with chronic obstructive pulmonary disease according to international diagnostic criteria, and evaluation of raw BIA variables[J]. Respir Med, 2018, 134: 1-5.
[11]	梁学明, 陈媛媛, 温海滨, 等. 维持性血液透析老年患者患肌少症发病危险因素的多因素Logistic回归分析[J]. 内科, 2021, 16(3): 335-338.
[12]	Moreira VG, Perez M, Lourenço RA. Prevalence of sarcopenia and its associated factors: the impact of muscle mass, gait speed, and handgrip strength reference values on reported frequencies[J]. Clinics (Sao Paulo), 2019, 74: e477.
[13]	Li CW, Yu K, Shyh-Chang N, et al. Pathogenesis of sarcopenia and the relationship with fat mass: descriptive review[J]. J Cachexia Sarcopenia Muscle, 2022, 13(2): 781-794.
[14]	Prior SJ, Ryan AS, Blumenthal JB, et al. Sarcopenia is associated with lower skeletal muscle capillarization and exercise capacity in older adults[J]. J Gerontol A Biol Sci Med Sci, 2016, 71(8): 1096-1101.
[15]	Morley JE. Frailty and sarcopenia in elderly[J]. Wien Klin Wochenschr, 2016, 128(Suppl 7): 439-445.
[16]	Sieber CC. Malnutrition and sarcopenia[J]. Aging Clin Exp Res, 2019, 31(6): 793-798.
[17]	Michaud M, Balardy L, Moulis G, et al. Proinflammatory cytokines, aging, and age-related diseases[J]. J Am Med Dir Assoc, 2013, 14(12): 877-882.
[18]	Peixoto da Silva S, Santos J, Costa E Silva MP, et al. Cancer cachexia and its pathophysiology: links with sarcopenia, anorexia and asthenia[J]. J Cachexia Sarcopenia Muscle, 2020, 11(3): 619-635.
[19]	Cho MR, Lee S, Song SK. A review of sarcopenia pathophysiology, diagnosis, treatment and future direction[J]. J Korean Med Sci, 2022, 37(18): e146.
[20]	王蕾, 蔡婷婷, 胡凤爱, 等. 梗阻性黄疸合并肌肉减少症的相关影响因素[J]. 滨州医学院学报, 2022, 45(2): 130-133.
[21]	Padillo FJ, Andicoberry B, Muntane J, et al. Factors predicting nutritional derangements in patients with obstructive jaundice: multivariate analysis[J]. World J Surg, 2001, 25(4): 413-418.
[22]	高彩艳, 张树泽, 曹宏泰, 等. 肌少症在胃癌患者中的研究进展[J/CD]. 中华普通外科学文献（电子版）, 2022, 16(4): 302-307.
[23]	Zhang FM, Ma BW, Huang YY, et al. Laparoscopic colorectal cancer surgery reduces the adverse impacts of sarcopenia on postoperative outcomes: A propensity score-matched analysis[J]. Surg Endosc, 2020, 34(10): 4582-4592.
[24]	Xia L, Zhao R, Wan Q, et al. Sarcopenia and adverse health-related outcomes: An umbrella review of meta-analyses of observational studies[J]. Cancer Med, 2020, 9(21): 7964-7978.

项目		例数	肌肉减少症患病率	握力异常率	ASMI异常率	步速异常率
性别
	男	619(54.73)	91(14.70)	168(27.14)	165(26.66)	138(22.29)
	女	512(45.27)	74(14.45)	137(26.76)	142(27.73)	134(26.17)
年龄(岁)
	<60	525(46.42)	22(4.19)	53(10.10)	67(12.76)	40(7.62)
	≥60	606(53.58)	143(23.60)	252(41.58)	240(39.60)	232(38.28)
体质指数(kg/m²)
	<18.5	56(4.95)	33(58.93)	34(60.71)	52(92.86)	25(44.64)
	18.5~<24	478(42.26)	112(23.43)	168(35.15)	206(43.10)	135(28.24)
	≥24	597(52.79)	20(3.35)	103(17.25)	49(8.21)	112(18.76)
相位角
	低	291(25.73)	114(39.18)	175(60.14)	165(56.70)	146(50.17)
	正常	840(74.27)	51(6.07)	130(15.48)	142(16.90)	126(15.00)
营养风险(NRS2002评分)
	无(<3分)	803(71.00)	76(9.46)	161(20.05)	173(21.54)	137(17.06)
	有(≥3分)	328(29.00)	89(27.13)	144(43.90)	134(40.85)	135(41.16)
主要疾病
	肝脏恶性肿瘤	166(14.68)	11(6.63)	30(18.07)	34(20.48)	32(19.28)
	胆系恶性肿瘤	116(10.26)	36(31.03)	56(48.28)	49(42.24)	54(46.55)
	胰腺恶性肿瘤	74(6.54)	20(27.03)	28(37.84)	37(50.00)	33(44.59)
	胃肠道恶性肿瘤	61(5.39)	20(32.79)	32(52.46)	25(40.98)	26(42.62)
	肝脏良性疾病	124(10.96)	5(4.03)	16(12.90)	22(17.74)	13(10.48)
	胆系良性疾病	513(45.36)	66(12.87)	128(24.95)	124(24.17)	99(19.30)
	胰腺良性疾病	12(1.06)	2(16.67)	4(33.33)	4(33.33)	4(33.33)
	其他	65(5.75)	5(7.69)	11(16.92)	12(18.46)	11(16.92)
黄疸程度
	正常	547(48.36)	67(12.25)	123(22.49)	145(26.51)	107(19.56)
	隐形黄疸	306(27.06)	40(13.07)	79(25.82)	77(25.16)	62(20.26)
	轻度黄疸	192(16.98)	30(15.63)	59(30.73)	48(25.00)	50(26.04)
	中度黄疸	57(5.04)	20(35.09)	30(52.63)	27(47.37)	36(63.16)
	重度黄疸	29(2.56)	8(27.59)	14(48.28)	10(34.48)	17(58.62)

项目		例数	肌肉减少症患病率	握力异常率	ASMI异常率	步速异常率
性别
	男	619(54.73)	91(14.70)	168(27.14)	165(26.66)	138(22.29)
	女	512(45.27)	74(14.45)	137(26.76)	142(27.73)	134(26.17)
年龄(岁)
	<60	525(46.42)	22(4.19)	53(10.10)	67(12.76)	40(7.62)
	≥60	606(53.58)	143(23.60)	252(41.58)	240(39.60)	232(38.28)
体质指数(kg/m²)
	<18.5	56(4.95)	33(58.93)	34(60.71)	52(92.86)	25(44.64)
	18.5~<24	478(42.26)	112(23.43)	168(35.15)	206(43.10)	135(28.24)
	≥24	597(52.79)	20(3.35)	103(17.25)	49(8.21)	112(18.76)
相位角
	低	291(25.73)	114(39.18)	175(60.14)	165(56.70)	146(50.17)
	正常	840(74.27)	51(6.07)	130(15.48)	142(16.90)	126(15.00)
营养风险(NRS2002评分)
	无(<3分)	803(71.00)	76(9.46)	161(20.05)	173(21.54)	137(17.06)
	有(≥3分)	328(29.00)	89(27.13)	144(43.90)	134(40.85)	135(41.16)
主要疾病
	肝脏恶性肿瘤	166(14.68)	11(6.63)	30(18.07)	34(20.48)	32(19.28)
	胆系恶性肿瘤	116(10.26)	36(31.03)	56(48.28)	49(42.24)	54(46.55)
	胰腺恶性肿瘤	74(6.54)	20(27.03)	28(37.84)	37(50.00)	33(44.59)
	胃肠道恶性肿瘤	61(5.39)	20(32.79)	32(52.46)	25(40.98)	26(42.62)
	肝脏良性疾病	124(10.96)	5(4.03)	16(12.90)	22(17.74)	13(10.48)
	胆系良性疾病	513(45.36)	66(12.87)	128(24.95)	124(24.17)	99(19.30)
	胰腺良性疾病	12(1.06)	2(16.67)	4(33.33)	4(33.33)	4(33.33)
	其他	65(5.75)	5(7.69)	11(16.92)	12(18.46)	11(16.92)
黄疸程度
	正常	547(48.36)	67(12.25)	123(22.49)	145(26.51)	107(19.56)
	隐形黄疸	306(27.06)	40(13.07)	79(25.82)	77(25.16)	62(20.26)
	轻度黄疸	192(16.98)	30(15.63)	59(30.73)	48(25.00)	50(26.04)
	中度黄疸	57(5.04)	20(35.09)	30(52.63)	27(47.37)	36(63.16)
	重度黄疸	29(2.56)	8(27.59)	14(48.28)	10(34.48)	17(58.62)

影响因素			肌肉减少症组	非肌肉减少症组	χ²值	P值
例数			165	966
性别					0.014	0.906
	男		91(55.15)	528(54.66)
	女		74(44.85)	438(46.34)
年龄(岁)					85.025	<0.001
	<60		22(13.33)	503(52.07)
	≥60		143(86.67)	463(47.93)
体质指数(kg/m²)					178.865	<0.001
	<18.5		33(20.00)	23(2.38)
	18.5~<24		112(67.88)	366(37.89)
	≥24		20(12.12)	577(59.73)
饮酒					0.492	0.483
	是		29(17.58)	149(15.42)
	否		136(82.42)	817(84.58)
营养风险(NRS2002评分)					58.351	<0.001
	无(<3分)		76(46.06)	727(75.26)
	有(≥3分)		89(59.94)	239(24.74)
疾病性质					20.870	<0.001
	恶性疾病		87(52.73)	330(34.16)
		肝脏恶性肿瘤	11(6.67)	155(16.05)
		胆系恶性肿瘤	36(21.82)	80(8.28)
		胰腺恶性肿瘤	20(12.12)	54(5.59)
		胃肠道恶性肿瘤	20(12.12)	41(4.24)
	良性疾病		78(47.27)	636(65.84)
		肝脏良性疾病	5(3.03)	119(12.32)
		胆系良性疾病	66(40.00)	447(46.27)
		胰腺良性疾病	2(1.21)	10(1.04)
		其他	5(3.03)	60(6.21)
黄疸程度					26.288	<0.001
	正常		67(40.61)	480(46.69)
	隐形黄疸		40(24.24)	266(27.54)
	轻度黄疸		30(18.18)	162(16.77)
	中度黄疸		20(12.12)	37(3.83)
	重度黄疸		8(4.85)	21(2.17)

影响因素			肌肉减少症组	非肌肉减少症组	χ²值	P值
例数			165	966
性别					0.014	0.906
	男		91(55.15)	528(54.66)
	女		74(44.85)	438(46.34)
年龄(岁)					85.025	<0.001
	<60		22(13.33)	503(52.07)
	≥60		143(86.67)	463(47.93)
体质指数(kg/m²)					178.865	<0.001
	<18.5		33(20.00)	23(2.38)
	18.5~<24		112(67.88)	366(37.89)
	≥24		20(12.12)	577(59.73)
饮酒					0.492	0.483
	是		29(17.58)	149(15.42)
	否		136(82.42)	817(84.58)
营养风险(NRS2002评分)					58.351	<0.001
	无(<3分)		76(46.06)	727(75.26)
	有(≥3分)		89(59.94)	239(24.74)
疾病性质					20.870	<0.001
	恶性疾病		87(52.73)	330(34.16)
		肝脏恶性肿瘤	11(6.67)	155(16.05)
		胆系恶性肿瘤	36(21.82)	80(8.28)
		胰腺恶性肿瘤	20(12.12)	54(5.59)
		胃肠道恶性肿瘤	20(12.12)	41(4.24)
	良性疾病		78(47.27)	636(65.84)
		肝脏良性疾病	5(3.03)	119(12.32)
		胆系良性疾病	66(40.00)	447(46.27)
		胰腺良性疾病	2(1.21)	10(1.04)
		其他	5(3.03)	60(6.21)
黄疸程度					26.288	<0.001
	正常		67(40.61)	480(46.69)
	隐形黄疸		40(24.24)	266(27.54)
	轻度黄疸		30(18.18)	162(16.77)
	中度黄疸		20(12.12)	37(3.83)
	重度黄疸		8(4.85)	21(2.17)

变量	赋值
肌肉减少症	无肌肉减少症=0，有肌肉减少症=1
年龄	<60岁=0，≥60岁=1
体质指数	<18.5 kg/m²=0,18.5~<24 kg/m²=1，≥24 kg/m²=2
疾病性质	良性疾病=0，恶性疾病=1
营养风险	无(NRS2002 <3分)=0，有(NRS2002 ≥3分)=1
黄疸程度	正常=0，隐形黄疸=1，轻度黄疸=2，中度黄疸=3，重度黄疸=4

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