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. 2019 May 3:5:3.
doi: 10.1186/s40959-019-0038-5. eCollection 2019.

Increased skeletal intermuscular fat is associated with reduced exercise capacity in cancer survivors: a cross-sectional study

Kerryn W Reding  1   2 , Peter Brubaker  3 , Ralph D'Agostino Jr  4 , Dalane W Kitzman  5 , Barbara Nicklas  6 , Dale Langford  7 , Michael Grodesky  8 , W Gregory Hundley  5   9
Affiliations

Increased skeletal intermuscular fat is associated with reduced exercise capacity in cancer survivors: a cross-sectional study

Kerryn W Reding et al. Cardiooncology. .

Abstract

Background: Cancer survivors experience on average a 20% reduction in peak exercise capacity (VO2 peak) post-cancer treatment. Intermuscular fat (IMF) is a strong predictor of reduced exercise capacity in heart failure (HF) patients; however it is unknown whether increased IMF is related to reduced VO2 peak in cancer survivors.

Methods and results: Twenty eight individuals: 14 cancer survivors > 12-months post-cancer treatment and 14 individuals without cancer were matched on age, gender, and body mass index (BMI). Participants underwent magnetic resonance imaging (MRI) assessments of IMF within the paraspinal muscles, VO2 peak and exercise-associated measures of left ventricular ejection fraction (LVEF). Blinded analyses were performed. Associations between the ratio of IMF to skeletal muscle (SM) were estimated using Pearson's partial correlation coefficients. Individuals with cancer and non-cancer comparators were of similar age (54 ± 17 versus 54 ± 15 years; p = 1.0), gender (5 men and 9 women, both groups), and BMI (27 ± 4 versus 26 ± 4; p = 0.57). Peak VO2 was 22% lower in cancer survivors versus non-cancer comparators (26.9 vs 34.3 ml/kg/min; p = 0.005), and was correlated with IMF:SM in both cancer survivors and non-cancer individuals after accounting for exercise-associated LVEF, resting LVEF, BMI, other body fat depots, and cardiovascular disease (CVD) co-morbidities (p < 0.001 to 0.08 for all adjusted correlations).

Conclusion: Among cancer survivors that previously received anthracyclines, increased intermuscular fat is associated with reduced VO2 peak even after accounting for exercise-associated cardiac function. This suggests IMF is important in the development of exercise intolerance, an outcome experienced by a large number of cancer survivors.

Keywords: Cancer survivors; Exercise intolerance; Muscle composition.

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Conflict of interest statement

Competing interestsThe authors have the following disclosures to declare: Dr. Kitzman has been a consultant for Relypsa, Abbvie, GlaxoSmithKline, AstraZeneca, Merck, CinRx, St. Luke’s Medical Center, DCRI, and Corvia Medical; received grants from Novartis and St. Luke’s Medical Center; and owns stock in Gilead Sciences.

Figures

Fig. 1
Fig. 1
The intermuscular fat of paraspinal muscles, depicted from MRI images of increased IMF (green) relative to SM (red) in a cancer survivor with reduced exercise capacity (left) and a control participant with normal exercise capacity (right)
See this image and copyright information in PMC

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