Hand Grip Strength and Body Composition According to the Sarcopenic Obesity Guidelines: Impact on Postoperative Complications in Patients With Gastric Cancer

Abstract

Background: The diagnosis of sarcopenic obesity (SO) in patients with gastric cancer has been inconsistent among studies examining postoperative complications because diagnostic methods have not been standardized. This study aimed to clarify the differences in the prevalence of obesity with and without low hand grip strength (HGS) according to the diagnostic criteria proposed using the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) and identify the optimal model for predicting postoperative complications.

Methods: Patients who underwent radical gastrectomy for gastric cancer between April 2015 and March 2023 were included. According to the ESPEN/EASO diagnostic criteria, patients with a body mass index ≥ 25 kg/m² who met the screening criteria were assessed for percent body fat (PBF) and skeletal muscle mass (SMM) adjusted by weight (SMM/W) and HGS. Depending on the respective cutoff values, six models of low SMM-obesity without HGS and six models of low HGS-obesity with HGS were set. The incidence of postoperative complication with the Clavien-Dindo classification grade 2 or higher was compared across models. Multivariate logistic regression analysis was performed to determine the risk model for postoperative complications, with significance set at p < 0.05.

Results: The analysis included 1762 patients with a median age of 67.0 years; 1123 were men (63.7%). The prevalence of low SMM-obesity was significantly higher (5.4%-17.3%) than that of low HGS-obesity (1.2%-2.3%). Among those with low SMM-obesity, PBF > 20.2% for men and > 31.7% for women as well as SMM/W ≤ 42.9% for men and ≤ 35.6% for women had the highest postoperative complication incidence number of cases. This model was an independent risk factor for postoperative complications in the multivariate analysis (odds ratio: 1.671, 95% confidence interval: 1.204-2.299, and p = 0.002).

Conclusions: In obese patients with gastric cancer, the preoperative prevalence of low HGS-obesity or low SMM-obesity differed significantly. One of the low SMM-obesity model was associated with postoperative complication after gastrectomy.

Keywords: body composition; gastric neoplasms; postoperative complications; risk factors; sarcopenic obesity.