Associations of Total Body Fat Mass and Skeletal Muscle Index with All-Cause and Cancer-Specific Mortality in Cancer Survivors

Livingstone Aduse-Poku; Shama D Karanth; Meghann Wheeler; Danting Yang; Caretia Washington; Young-Rock Hong; Todd M Manini; Jesus C Fabregas; Ting-Yuan David Cheng; Dejana Braithwaite

doi:10.3390/cancers15041081

Associations of Total Body Fat Mass and Skeletal Muscle Index with All-Cause and Cancer-Specific Mortality in Cancer Survivors

Cancers (Basel). 2023 Feb 8;15(4):1081. doi: 10.3390/cancers15041081.

Authors

Affiliations

¹ Department of Epidemiology, University of Florida, 2004 Mowry Rd., Gainesville, FL 32610, USA.
² University of Florida Health Cancer Center, University of Florida, 2004 Mowry Rd., Gainesville, FL 32610, USA.
³ Aging & Geriatric Research, Institute on Aging, 2004 Mowry Rd., Gainesville, FL 32610, USA.
⁴ Department of Health Services Research, Management, & Policy, 1225 Center Dr., Gainesville, FL 32610, USA.
⁵ Department Health Outcomes & Biomedical Informatics, Institute on Aging, 2004 Mowry Rd., Gainesville, FL 32611, USA.
⁶ Division of Hematology & Oncology, College of Medicine, University of Florida, 2000 SW Archer Rd., Gainesville, FL 32608, USA.
⁷ Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA.
⁸ Department of Surgery, University of Florida, 1600 SW Archer Rd., Gainesville, FL 32608, USA.

Abstract

Purpose: The importance of body composition on cancer outcomes is of great clinical interest. Measures of body composition that differentiate fat mass from skeletal muscle mass can help redefine our understanding of body composition for cancer survival. We investigated whether the risk of all-cause and cancer-specific mortality differ by levels of total fat mass and sarcopenia status in cancer survivors. Our secondary aim was a subgroup analysis assessing the role of race within these associations. Methods: Participants included 1682 adult cancer survivors who had undergone a dual-energy X-ray absorptiometry (DXA) examination to measure body composition, from the 1999-2006 and 2011-2018 National Health and Nutrition Examination Survey (NHANES). Total fat mass was categorized into tertiles (we assessed high vs. low tertiles), and sarcopenia was considered as having an appendicular skeletal muscle mass index less than 7.26 kg/m² for males and less than 5.45 kg/m² for females. Multivariable Cox proportional hazard models estimated the adjusted hazard ratio (aHR) and 95% confidence interval (CI). Results: The mean age of study participants was 61.9 years, and they were followed up for an average of 9.67 years. The prevalence of sarcopenia was 25.0% (N = 304), and 33.4% (N = 561) had a high total fat mass. Participants with a higher fat mass (aHR = 1.30, 95% CI = 1.06-1.61) and with sarcopenia (aHR = 1.51, 95% CI = 1.22-1.88) had a 30% and 51% increased risk of all-cause mortality compared to participants with a low fat mass and with no sarcopenia, respectively. Further, sarcopenia (aHR = 1.74, 95% CI = 1.23-2.29) was associated with a higher risk of cancer-specific mortality in cancer survivors. The association between sarcopenia and all-cause mortality was twice as strong in Black people (aHR = 2.99, 95% CI = 1.39-6.06) compared to White people (aHR = 1.53, 95% CI = 1.19-1.95). Conclusions: Our findings show the opposing relations of fat mass and appendicular skeletal muscle mass index with mortality in a national sample of cancer survivors, and that the relationships may differ by race. These results emphasize the importance of maintaining a healthy body composition among cancer survivors.

Keywords: all-cause mortality; and race; sarcopenia; skeletal muscle index; total fat mass.

Abstract

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