Projects / Programmes
Burden of cachexia and sarcopenia in patients with chronic diseases: epidemiology, pathophysiology and outcomes
| Code |
Science |
Field |
Subfield |
| 3.08.00 |
Medical sciences |
Public health (occupational safety) |
|
| Code |
Science |
Field |
| B680 |
Biomedical sciences |
Public health, epidemiology |
| Code |
Science |
Field |
| 3.03 |
Medical and Health Sciences |
Health sciences |
cachexia, sarcopenia, epidemiology, patophysiology, chronic diseases, mortality
Researchers (6)
Organisations (2)
Abstract
In medicine, body habitus is most commonly described with the body mass index and both scientific and clinical community are primarily concerned with the issue of obesity. Whilst the causal relationship between obesity and incidence of chronic disease is established, the relationship is much more challenging in patients with existing chronic disease. Current state of the art knowledge in elderly and patients with chronic disease is that weight loss generally is not a good sign. One or several body compartments can be affected by wasting. The end stage is known as cachexia. If only skeletal muscle is affected, sarcopenia ensues, and clinical consequences are rather similar than in cachexia. Lack of good epidemiological data may be due to consensus based definitions and at least some of them can be argued as quite complicated for use in daily practice. In this context, it is less known that cachexia and since very recent also sarcopenia have a code in the International Classification of Disease, version 10.
In literature, epidemiological data is largely an estimate with various definitions applied to the populations that are mostly small or moderate in size. Along with that, the pathophysiological mechanisms that drive body wasting and those that prevent it are not well investigated. In studies, tissue and cellular levels usually are not our primary focus due to many reasons, including the invasive procedures to obtain biological samples.
In view of insufficient epidemiological, clinical and pathophysiological information, we propose a two-parallel tracks project. First track will primarily focus on epidemiological features in big hospitalization database. Primary end-point will be all-cause hospitalization; secondary end-points will be individual chronic disease related hospitalizations and all-cause mortality. Endpoints will be analyzed at 30 days and 1 year post discharge. Second track will apply the current definitions of body wasting to patients with selected chronic disease (heart failure, chronic obstructive pulmonary disease, chronic kidney disease, cancer) to investigate epidemiology; along with that, validation of several exercise tests and prospective biological sampling to address pathophysiological mechanisms will be performed. Primary end-point will be diagnosis of cachexia or sarcopenia; secondary end-points will include results of physical performance tests, hospitalization rate and all-cause mortality. Endpoints will be analyzed at baseline and every 6 months thereafter. For patients in both tracks, we will crosslink with Central Population Registry and National Hospitalization Database to record death and/or hospitalization(s).
Our findings will be relevant for current knowledge in the field and will also open new research avenues. This will be first comprehensive and nationwide experience with big data analysis; thereafter, our expertise can be transferred to other databases of its kind, either at national level or within international consortia. Validation and trans-disease comparison of exercise performance and other diagnostic tests will translate into suggestions for daily practice to make body wasting diagnosis more applicable and feasible for a busy clinician. Findings will also be relevant for the on-going process of cachexia definition revision under the auspices of the Society on Sarcopenia, Cachexia and Wasting Disorders. With biological samples stored and as based on findings of this project, further cellular and molecular as well as genetic experiments using our samples and samples from other patient series could be further explored. From patient perspective, we will be first to address the cachexia burden using semi-structured interview to suggest supportive strategies that are to be tested in prospective interventional studies.
Significance for science
Impact of our results should be manifold. One of primary goals is to generate good epidemiology data with the use of existing resources, i.e. the databases that are managed and maintained on a regular basis. Through that, a better estimate of body wasting impact on public health will be possible. This in the end should have implications for preventive and screening strategies; our exercise test validation and incidence study should generate very relevant data to address these topics. In other words, if we will be able to estimate patient risk for body wasting, preventive strategies as described in the literature could be imposed. Also, we need to improve our diagnostic ability and exercise test validation should identify test(s) that are best suited in different clinical scenarios, e.g. per chronic disease.
Pathophysiological insights will be important to study potential differences between chronic disease and to evaluate the effects of rehabilitation strategies on different mechanisms. The relevance of this project therefore is multidimensional as it overarches several medical disciplines and addresses the body wasting in a comprehensive and integrated manner, including the patient perception.
The literature is particularly scarce in the fields of epidemiology, diagnosis and exercise test validity, thus we anticipate to advance the field substantially.
Significance for the country
Impact of our results should be manifold. One of primary goals is to generate good epidemiology data with the use of existing resources, i.e. the databases that are managed and maintained on a regular basis. Through that, a better estimate of body wasting impact on public health will be possible. This in the end should have implications for preventive and screening strategies; our exercise test validation and incidence study should generate very relevant data to address these topics. In other words, if we will be able to estimate patient risk for body wasting, preventive strategies as described in the literature could be imposed. Also, we need to improve our diagnostic ability and exercise test validation should identify test(s) that are best suited in different clinical scenarios, e.g. per chronic disease.
Pathophysiological insights will be important to study potential differences between chronic disease and to evaluate the effects of rehabilitation strategies on different mechanisms. The relevance of this project therefore is multidimensional as it overarches several medical disciplines and addresses the body wasting in a comprehensive and integrated manner, including the patient perception.
The literature is particularly scarce in the fields of epidemiology, diagnosis and exercise test validity, thus we anticipate to advance the field substantially.
Most important scientific results
Interim report
Most important socioeconomically and culturally relevant results
Interim report
