Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Gastroenterol Hepatol. 2019 Jan;34(1):162-168. doi: 10.1111/jgh.14309. Epub 2018 Jun 25.
Sarcopenia is a pathological condition characterized by the progressive loss of muscle mass and increased amount of visceral fat. Recent evidence has revealed that sarcopenia is associated with certain diseases. However, the impact of sarcopenia on colorectal neoplasia has not been documented clearly. We studied the association between sarcopenia and advanced colorectal neoplasia in a large screening population.
This cross-sectional study included 14 024 asymptomatic adults who underwent first-time screening colonoscopy. Sarcopenia (class II) was defined as an appendicular skeletal muscle mass (ASM)/bodyweight (%) value more than two standard deviations below the mean for healthy young adults. ASM was estimated using bioelectrical impedance analysis.
In a multivariable model adjusted for age, sex, obesity (body mass index ≥ 25), smoking status, alcohol intake, regular exercise, and family history of colorectal cancer, the odds ratio (OR) for advanced colorectal neoplasia on comparing participants with sarcopenia (class II) to those without sarcopenia (class I + II) was 1.52 (95% confidence interval [CI], 1.23-1.86). Further adjustment for metabolic parameters attenuated this association, but the association was still significant (OR, 1.34; 95% CI, 1.07-1.68). Furthermore, the multivariable (traditional risk factors)-adjusted OR associated with a 1% decrease on the introduction of ASM/weight% as a continuous variable in regression models was 1.04 (95% CI, 1.01-1.07) for advanced colorectal neoplasia.
Our findings indicate that sarcopenia is significantly and progressively associated with the risk of advanced colorectal neoplasia. This association might be explained by metabolic factors that could be potential mediators of the effect of sarcopenia.
肌少症是一种以肌肉质量进行性丧失和内脏脂肪量增加为特征的病理状态。最近的证据表明，肌少症与某些疾病有关。然而，肌少症对结直肠肿瘤的影响尚未明确。我们在一个大型筛查人群中研究了肌少症与晚期结直肠肿瘤之间的关系。
本横断面研究纳入了 14024 名无症状成年人，他们接受了首次筛查性结肠镜检查。肌少症（Ⅱ级）定义为四肢骨骼肌质量（ASM）/体重（%）值低于健康年轻成年人平均值两个标准差以上。ASM 采用生物电阻抗分析进行评估。
在调整年龄、性别、肥胖（体重指数≥25）、吸烟状况、饮酒、定期运动和结直肠癌家族史的多变量模型中，与无肌少症（Ⅰ+Ⅱ级）相比，肌少症（Ⅱ级）患者患晚期结直肠肿瘤的比值比（OR）为 1.52（95%置信区间[CI]，1.23-1.86）。进一步调整代谢参数减弱了这种关联，但关联仍然显著（OR，1.34；95%CI，1.07-1.68）。此外，在多变量（传统危险因素）调整的回归模型中，当 ASM/体重%作为连续变量引入时，每降低 1%与晚期结直肠肿瘤相关的 OR 为 1.04（95%CI，1.01-1.07）。
我们的研究结果表明，肌少症与晚期结直肠肿瘤的风险显著且呈进行性相关。这种关联可能可以用代谢因素来解释，这些因素可能是肌少症影响的潜在中介因素。
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