Sarcopenia is an independent risk factor for depression in patients with advanced lung cancer

The bidirectional association of malnutrition with depression and anxiety in patients with cancer: a systematic review and meta-analysis of evidence

BACKGROUND

Anxiety and depression are common mental health problems in cancer patients. At the same time, cancer patients often suffer from disease-related catabolic dysregulation and malnutrition. Emerging evidence has suggested the potential link between mental disorders and nutritional status.

AIMS

This study summarised the evidence for the association of malnutrition with anxiety and depression in cancer patients.

METHODS

A systematic search of PubMed and EMBASE databases was performed for observational studies published up to December 2024.

RESULTS

Forty-one articles were found eligible for inclusion in the systematic review, and twenty-nine in the meta-analysis. Compared with the normally nourished cancer patients, malnourished patients had a more than threefold (relative risk (RR) = 3.23, 95% CI 2.39, 4.38) and nearly twofold (RR = 1.87, 95% CI 1.48, 2.37) increased risk of depression and anxiety, respectively. Considering the studies that identified lower emotional status as a cause rather than an effect of malnutrition, the inverse association was confirmed only for depression (RR = 2.01, 95% CI 1.62, 2.49), but not for anxiety (RR = 1.38, 95% CI 0.68, 2.80). Finally, the standardised mean differences of the psychological scores showed significantly higher values in individuals with nutritional impairment compared to those with normal nutritional status (SMD = 0.69, 95% CI 0.50, 0.88 for depression and SMD = 0.54, 95% CI 0.26, 0.82 for anxiety).

CONCLUSIONS

Mental health problems such as anxiety and depression are associated with malnutrition in cancer patients.

Bidirectional association between sarcopenia and depression: A systematic review and meta-analysis

PURPOSE

Recent research has reported a potential bidirectional association between sarcopenia and depression, yet systematic evidence supporting this relationship is still lacking. This study evaluated the bidirectional association of sarcopenia with depression to provide reliable evidence for the development of specific prevention and control strategies.

METHODS

Relevant articles were extracted from PubMed, Embase, Cochrane, and Web of Science from inception to July 4, 2024. Quality was assessed using the Newcastle-Ottawa Scale (NOS) for cohort and case-control studies, and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for cross-sectional studies. Changes in the association between sarcopenia and depression were compared across different study designs, sources of study subjects, and sarcopenia diagnostic criteria by subgroup analyses. Meta-analysis was conducted using R 4.4.1.

RESULTS

Thirty-three original studies involving 119,421 subjects were incorporated into this review. Pooled analysis revealed a significant reciprocal relationship between sarcopenia and depression in community populations. The risk of depression increased when sarcopenia was the exposure factor [OR = 2.40(95 % CI: 1.87, 3.08)]. Conversely, the risk of sarcopenia significantly increased when depression was the exposure factor [OR = 1.90(95 % CI: 1.44, 2.50)]. Additionally, there was a markedly increased risk of sarcopenia when depressive symptoms were the exposure factor [OR = 1.38(95 % CI: 1.25, 1.53)]. Similar conclusions were obtained in patients with other diseases.

CONCLUSIONS

The significant bidirectional association between sarcopenia and depression enhances the prevention, screening, diagnosis, and treatment of depression, thereby improving quality of life and outcomes.

Relationship Between Sarcopenia and the Trajectories of Depressive Symptoms Among Chinese Older Adults: The Mediating Effect of Social Participation

BACKGROUND

This study evaluated the relationship between sarcopenia and the trajectories of depressive symptoms among Chinese older adults and verified the mediating role of social participation.

METHOD

The sample included 1832 participants aged ≥ 60 years from five waves of the China Health and Retirement Longitudinal Study (CHARLS). The optimal trajectory class of depressive symptoms was identified using the latent growth mixture model (LGMM). The association between sarcopenia and the trajectories of depressive symptoms was assessed by multinomial logistic regression. The potential mediating effect of social participation was evaluated through mediation analysis. Subgroup and interaction analyses were also carried out.

RESULTS

The results showed that the depressive symptom score trajectory of the sarcopenia group was higher than that of the normal group. The depressive symptoms of the general participants had three trajectories: "Anterior high level," "Posterior high level," and "Stable low level". Sarcopenia was related to the increased odds of adverse trajectory of depressive symptoms ("Anterior high level" trajectory) (adjusted OR = 1.53, 95% CI: 1.02-2.30). Social participation mediated 10.69% of the association between sarcopenia and adverse trajectory of depressive symptoms. Sex, education, marital status, chronic disease, self-rated health status, and self-rated standard of living were modifiable factors affecting the relationship of sarcopenia and adverse trajectory of depressive symptoms.

CONCLUSION

Comprehensive measures including early screening and treatment for sarcopenia, the strengthening of social participation levels, and formulating targeted intervention strategies are recommended to alleviate depressive symptoms and enhance mental health.

Systematic review of associations between anxiety, depression, and functional/biological aging among cancer survivors

BACKGROUND

Evidence suggests a mind-body component to aging through which psychological distress from anxiety and depression drives molecular changes that promote early decline (ie, accelerated aging). Cancer survivors experience particularly high rates of anxiety and depression. Some survivors also have accelerated aging, though the relationships between anxiety and depression and aging are not clear. A synthesis of evidence is needed to understand the state of the science and impending priorities.

METHODS

PubMed, Embase, CINAHL, Web of Science, and PsycNet databases were searched for studies that measured associations between depression, anxiety, and nonchronological aging in cancer survivors (2012-2022). Data were methodologically evaluated.

RESULTS

Survivorship studies were included if they were peer reviewed, published in English from 2012 to 2022, and measured associations between anxiety and depression and aging. In total, 51 studies were included. Just over half were cross-sectional (53%). Foci included functional (n = 35 [69%]) and biological (n = 16 [31%]). Functional aging measures included frailty, sarcopenia, geriatric assessment, and cognition. Biological aging measures included telomere length, telomerase, age-related inflammatory blood-based biomarkers, renal insufficiency, anemia, and DNA methylation. We tested 223 associations. Associations between anxiety, depression, and aging were generally positive, though with varying strengths. Most compelling were associations between functional aging and depression. There were concerns for selection and measurement biases.

CONCLUSIONS

Findings suggest positive associations between anxiety, depression, and aging among cancer survivors. Future work is needed to clarify temporality, develop a consensus on the measurement of aging, and diversify cohorts.

Effects of household solid fuel use on sarcopenia in middle-aged and older adults: evidence from a nationwide cohort study

Background

Household solid fuel use is common in global households and has been linked to changes in handgrip strength and muscle mass. However, whether household solid fuel use results in sarcopenia over time is not well elaborated.

Methods

This study employed data from the 2011-2015 China Health and Retirement Longitudinal Study (CHARLS) that recruited 4,932 participants ≥45 years. The Cox proportional hazards regression model was conducted to estimate the impact of household solid fuel use for cooking and heating on sarcopenia development. The analysis was further stratified based on geographic position. Mediation analysis was employed to estimate the potential mediating effects of cognitive function and depressive symptoms associated with household solid fuel use and sarcopenia.

Results

Over the 4-year follow-up, 476 cases of sarcopenia were reported (9.65%), with 254 in males (10.82%) and 222 in females (8.59%). Cooking and heating with solid fuels increased the risk of sarcopenia (Cooking: HR 1.401, 95% CI 1.138-1.724; Heating: HR 1.278, 95% CI 1.040-1.571). Crop residue/wood burning correlated with higher sarcopenia risk (Cooking: 1.420, 95% CI 1.147-1.758; Heating: 1.318, 95% CI 1.062-1.635). Switching to clean cooking fuels significantly reduced sarcopenia risk (HR 0.766, 95% CI 0.599-0.979). Heating with solid fuels was associated with higher sarcopenia risk only in southern China (HR 1.375, 95% CI 1.102-1.715). Additionally, cognitive function and depressive symptoms partially mediated the link between household solid fuel use and sarcopenia.

Conclusion

Household use of solid fuels is associated with an increased risk of sarcopenia. Restricting the use of solid fuels and focusing on cognitive function and depressive symptoms in solid fuel users can help decrease sarcopenia development.

The mechanism of cancer-depression comorbidity

Cancer and depression are closely interrelated, particularly in patients with advanced cancer, who often present with comorbid anxiety and depression for various reasons. Recently, there has been a growing interest in the study of depression in cancer patients, with the aim of assessing the possible triggers, predictors, adverse events, and possible treatment options for depression in several common cancers. The objective of this narrative review is to synthesize the extant literature on the relationship between the occurrence and progression of depression in several common patient categories. The authors conducted a comprehensive review of 75 articles published in PubMed over the past five years. This review was further evaluated in the present paper. Ultimately, it was determined that depression is a prevalent and detrimental phenomenon among cancer patients, particularly those with advanced disease. Consequently, there is a pressing need to prioritize research and interventions aimed at improving the quality of life and psychosocial well-being of cancer patients, including those with advanced disease. The relationship between cancer and depression has been evolving dynamically in recent times. The current research findings indicate a strong association between cancer and depression. However, the direction of causality remains unclear. Focusing on depression in cancer patients may, therefore, be beneficial for these patients.

Early Changes in Nutritional Status of Elderly Patients with Lung Cancer Undergoing Chemotherapy Are Positively Related with Symptoms of Depression: A Prospective Follow-Up Study

This study aims to assess early effects of chemotherapy on symptom alleviation, nutritional status, and mental health in elderly patients with advanced non-small-cell lung cancer (NSCLC). This prospective study included 45 NSCLC patients (32 males, 13 females) aged 65-82 years (mean age 70.0 ± 4.5 years) with good performance status. Assessments were conducted immediately after diagnosis and after two chemotherapy cycles, focusing on nutritional status (assessed with MNA questionnaire), quality of life (QoL, based on FACT-L and FACT-TOI questionnaires), lung cancer-related symptoms (based on LCSS), and mental health (based on PHQ-9 questionnaire). Despite significant alleviation of symptoms like cough, dyspnea, and body weight loss, there was no significant correlation between changes in symptoms burden and changes in nutritional status (r2 = 0.122, P = 0.427), and change of patients' mental condition (r2 = -0.141, P = 0.255). No significant QoL changes were noted, but a decrease in severe depression frequency was observed. The improvement of patients' mental condition was related strictly to the improvement of nutritional status (r2 = -0.589, P < 0.001). The study highlights the vital link between nutritional status and mental health in elderly NSCLC patients, emphasizing the need for integrated care approaches that address both aspects to enhance treatment effectiveness and patient well-being.

Associations of nutrition impact symptoms with depression in patients with advanced cancer

PURPOSE

Advanced cancer patients have nutrition impact symptoms (NISs), while many of them have depressive moods. This study aimed to determine the associations of NISs with depression.

METHODS

This study was a secondary analysis. The dietary intake and 19 NISs in patients receiving palliative care were evaluated using 10-point scales, and the patients were categorized into two groups (non-depression and depression groups) using the cutoff based on the Patient Health Questionnaire-9 (PHQ-9). To determine associations between depression and the number of NISs with a score of ≥ 4, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the logistic regression model were calculated.

RESULTS

A total of 225 participants were divided into the non-depression group (n = 148) and the depression group (n = 77). The prevalence of depression was 34.2%. Dietary intake was lower, and the number of NISs with a score of ≥ 4 was higher in the depression group (both p < 0.001). All NISs were more severe in the depression group. Significant differences were observed in 15 of the 19 NISs. In the logistic regression model, significantly higher adjusted ORs were observed in the groups with 4-6 NISs and 7 or more NISs with a score of ≥ 4 (10.76 [95% CI, 2.07-55.91], p = 0.016; 17.02 [95% CI, 3.08-94.22], p < 0.001) than in the group with no NISs with a score of ≥ 4.

CONCLUSION

Having four or more NISs with a score ≥ 4 was associated with depression.

Analysis of factors affecting intraoperative hemorrhage during percutaneous nephrolithotomy and establishment of nomogram model

Intraoperative hemorrhage is an important factor affecting intraoperative safety and postoperative patient recovery in percutaneous nephrolithotomy (PCNL). This study aimed to identify the factors that influence intraoperative hemorrhage during PCNL and develop a predictive nomogram model based on these factors.A total of 118 patients who underwent PCNL at the Department of Urology, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University from January 2021 to September 2023 was included in this study. The patients were divided into a hemorrhage group (58 cases) and a control group (60 cases) based on the decrease in hemoglobin levels after surgery. The clinical data of all patients were collected, and both univariate analysis and multivariate logistic regression analysis were conducted to identify the independent risk factors for intraoperative hemorrhage during PCNL. The independent risk factors were used to construct a nomogram model using R software. Additionally, receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA) were utilized to evaluate the model.Multivariate logistic regression analysis revealed that diabetes, long operation time and low psoas muscle mass index (PMI) were independent risk factors for intraoperative hemorrhage during PCNL (P < 0.05). A nomogram model was developed incorporating these factors, and the areas under the ROC curve (AUCs) in the training set and validation set were 0.740 (95% CI: 0.637-0.843) and 0.742 (95% CI: 0.554-0.931), respectively. The calibration curve and Hosmer-Lemeshow test (P = 0.719) of the model proved that the model was well fitted and calibrated. The results of the DCA showed that the model had high value for clinical application.Diabetes, long operation time and low PMI were found to be independent risk factors for intraoperative hemorrhage during PCNL. The nomogram model based on these factors can be used to predict the risk of intraoperative hemorrhage, which is beneficial for perioperative intervention in high-risk groups to improve the safety of surgery and reduce the incidence of postoperative complications.

Genetically Proxied Sarcopenia-Related Muscle Traits and Depression: Evidence from the FinnGen Cohort

BACKGROUND

Sarcopenia and depression are common and often coexist in the elderly. This study aims to determine the impact of sarcopenia-related muscle traits on depression.

METHODS

A two-sample Mendelian randomization (MR) study was performed on the summary-level data from the FinnGen cohort to estimate the causal association of appendicular lean mass (ALM), walking pace, or low hand grip strength with depression. Additionally, multivariable MR (MVMR) was performed to assess the dependence of each muscle trait in the causality and adjust the effect of body mass index (BMI). Supplementary backward MR analyses were performed to estimate the effect of depression on sarcopenia-related muscle traits.

RESULTS

Univariable MR analyses demonstrated that there were causal associations of ALM (odds ratio [OR]: 0.94; 95% confidence interval [CI]: 0.88-0.99), walking pace (OR: 0.53; 95% CI: 0.32-0.88), and low hand grip strength (OR: 1.20; 95% CI: 1.05-1.38) with depression. MVMR analyses showed that ALM was the only trait that had a significant causal relationship with depression (OR: 0.91; 95% CI: 0.85-0.98) after accounting for the other two muscle traits. Moreover, the independent association of ALM with depression remained (OR: 0.92; 95% CI: 0.85-0.99) after being adjusted by BMI. The backward MR analyses showed no causal associations of depression with any sarcopenia-related muscle traits.

CONCLUSION

Low muscle mass independently increases the risk of depression. This study determined the muscle-related risk factors of depression, which may help establish the causality between sarcopenia and depression and provide evidence-based recommendations for improving mental health in the elderly.

Depression and risk of sarcopenia: a national cohort and Mendelian randomization study

Background

Depression and the increased risk of sarcopenia are prevalent among the elderly population. However, the causal associations between these factors remain unclear. To investigate the potential association between depression and the risk of sarcopenia in older adults, this study was performed.

Methods

In the baseline survey, a total of 14,258 individuals aged 40 and above from the China Health and Retirement Longitudinal Study (2015) participated. We initially described the baseline prevalence of the disease. Then, logistic regression and restricted cubic spline (RCS) regression were conducted to assess the relationship between depression and sarcopenia. Subgroup analysis was performed to validate the robustness of the findings. Additionally, we conducted Mendelian randomization analysis using the inverse variance weighting estimator to assess the causal relationship between depression and sarcopenia. Furthermore, we adopted six methods, including MR-Egger, simple median, weighted median, maximum likelihood, robust adjusted profile score (RAPS), and MR Pleiotropy Residual Sum and Outlier (MR-PRESSO), for sensitivity analyses.

Results

Depression patients exhibited higher risks of sarcopenia in all five models adjusting for different covariates (P < 0.05). The RCS analysis demonstrated a linear relationship between depression and sarcopenia (P < 0.05). In the subgroup analysis, increased risk was observed among participants aged 60-70, married or cohabiting individuals, non-smokers, non-drinkers, those with less than 8 h of sleep, BMI below 24, and individuals with hypertension (all P < 0.05). Mendelian randomization results revealed that genetically proxied depression led to a reduction in appendicular skeletal muscle mass (all P < 0.05).

Conclusion

Our study provides observational and causal evidences that depression can lead to sarcopenia. This finding emphasizes the importance of timely identification and management of depression, as well as implementing targeted educational programs as part of comprehensive strategies to prevent sarcopenia.