Lean body mass and muscle function in head and neck cancer patients and healthy individuals – results from the DAHANCA 25 study

Figures & data

Table I. Characteristics of HNSCC patients and healthy individuals.

	HNSCC patients (n = 66)	Healthy individuals (n = 24)
Median age (range), years	56 ± 8 (27–72)	59 ± 9 (25–69)
Body weight, (at time of inclusion), kg	71.7 ± 12.4	79.5 ± 13.7
Weight loss during treatment (range), kg	−8.5 ± 6.5 (−30.0–8.0)	–
Weight loss during treatment (range),%	−9.6 ± 6.4 (−26.1–11.9)	–
Height (m)	1.76 ± 0.08	1.77 ± 0.08
Body mass index	23.0 ± 3.4	25.5 ± 3.6
Relative weight loss
> 8.5% < 8.5%	34 (52%) 31 (48%)	– –
Gender
Female Male	12 (18%) 54 (82%)	7 (29%) 17 (71%)
Physical activity level (leisure time)
I II III IV	6 (17%) 21 (60%) 8 (23%) 0 (0%)	1 (5%) 7 (35%) 9 (45%) 3 (15%)

Values presented as mean ± SD unless stated otherwise. *Group difference (unpaired t-test, p < 0.05). Physical activity level measured by the Saltin and Grimby questionnaire [18]: Level I (almost completely inactive, 0–2 hours of light PA per week), II (at least 4 hours of light PA per week), III (light PA of > 4 hours per week or 2–4 hours of vigorous PA per week) and IV (vigorous PA > 4 hours per week or strenuous exercise several times per week).

Figure 1. Associations between lean body mass, muscle strength and functional performance. Left: Association between lean body mass, isometric knee extension (KE, Newton-meters) in HNSCC patients and healthy individuals. Right: Association between isometric KE adjusted for body weight (Newton-meters/kg) and 10 m max gait speed (m/s) in HNSCC patients and healthy individuals.

Table II. Associations between lean body mass, maximal muscle strength and functional performance.

	HNSCC patients				Healthy individuals
	Crude model		Adjusted model		Crude model		Adjusted model
Dependent and ndependent variable	R^2	Coefficient [95% CI]	R^2	Coefficient [95% CI]	R^2	Coefficient [95% CI]	R^2	Coefficient [95% CI]
Isometric KE
Body weight	0.30 p < 0.0001*	2.5 [0.5;3.4]	0.50 p < 0.0001*	2.4 [1.0;3.7]	0.31 p = 0.004	2.5 [0.9;4.2]	0.71 P < 0.0001*	1.3 [0.4;2.9]
Isokinetic KE
Body weight	0.32 p < 0.0001*	2.1 [1.3;2.9]	0.57 p < 0.0001*	2.3 [1.3;3.2]	0.43 p = 0.0005*	2.3 [1.1;3.4]	0.71 p = 0.0001*	1.6 [0.4;2.9]
Isometric KE
Lean body mass	0.58 p < 0.0001*	5.0 [3.9;6.1]	0.63 p < 0.0001*	5.5 [3.6;7.4]	0.68 p < 0.0001*	4.2 [2.9;5.5]	0.75 P < 0.0001*	2.5 [0.2;4.7]
Isokinetic KE
Lean body mass	0.56 p < 0.0001*	4.0 [3.1;4.9]	0.67 p < 0.0001*	4.8 [3.4;6.2]	0.70 p < 0.0001*	3.3 [2.4;4.3]	0.80 p < 0.0001*	3.0 [1.5;4.5]
Isometric KF
Lean body mass	0.50 p < 0.0001*	2.4 [1.8;3.1]	0.59 p < 0.0001*	2.0 [0.9;3.0]	0.66 p < 0.0001*	2.4 [1.7;3.2]	0.71 p = 0.0001*	1.6 [0.2;2.9]
Isokinetic KF
Lean body mass	0.49 p < 0.0001*	2.2 [1.6;2.8]	0.61 p < 0.0001*	2.2 [1.3;3.1]	0.68 p < 0.0001*	2.2 [1.5;2.8]	0.78 p < 0.0001*	1.7 [0.5;2.7]
10 m max gait speed
Isometric KE /bodyweight	0.27 p < 0.0001*	0.26 [0.1;0.4]	0.31 p = 0.0001*	0.2 [0.1;0.4]	0.38 p = 0.001	0.3 [0.1;2.0]	0.43 p = 0.03	0.2 [−0.1;0.5]
30 s arm curl
Isometric KE	0.34 p < 0.0001*	0.04 [0.03;0.06]	0.44 p < 0.0001*	0.05 [0.03;0.07]	0.29 p = 0.006	0.05 [0.01;0.08]	0.34 p = 0.08	0.1 [0.0;0.12]
30 s chair rise
Isometric KE/ Bodyweight	0.26 p < 0.0001*	3.6 [2.0;5.2]	0.34 p < 0.0001*	3.8 [1.7;5.9]	0.28 p = 0.008	3.8 [1.1;6.6]	0.33 p = 0.09	2.4 [−2.6;7.5]
Stair climb
Isometric KE/ Bodyweight	0.13 p = 0.004	0.3 [0.1;0.5]	0.21 p = 0.007	0.2 [0.1;0.5]	0.30 p = 0.005	0.4 [0.1;0.7]	0.32 p = 0.1	0.4 [−0.1;0.9]
Physical function
10 m max gait speed	0.14 p = 0.003	17 [6;28]			0.001 p = 0.88	−0.5 [−7.8;6.7]
Physical function
30 s arm curl	0.06 p = 0.046	0.9 [0.02;1.7]			0.29 p = 0.006	0.2 [−0.1;0.6]
Physical function
30 s chair rise	0.16 p = 0.001	1.2 [0.5;2.0]			0.22 p = 0.03	0.4 [0.03;0.8]
Physical function
Stair climb	0.10 p = 0.015	−2.5 [−4.0;20.5]			0.13 p = 0.11	−1.1 [−2.4;0.3]

Results from the linear regression models on associations between body weight, lean body mass, maximal muscle strength - isokinetic knee extension (KE) and knee flexion (KF), functional performance and self-reported physical function in radiotherapy-treated HNSCC patients and healthy individuals. Results from the crude and adjusted models are presented. The dependent variable in the linear regression analyses are expressed in bold letters with the independent below. The results from the crude and adjusted linear regression models are presented as R² indicating how well the variation of the dependent variable can be explained by the variation of the independent variable. In addition, the regression coefficients describe the magnitude of change in the dependent variable when the independent variable changes. In both models asterisks indicate statistical significance of association. After Bonferroni correction a p-value < 0.0006 was considered statistically significant (denoted *).

Table III. Body composition, maximal muscle strength and functional performance values in HNSCC patients and healthy individuals.

	HNSCC patients			HNSCC patients (baseline) versus healthy individuals		HNSCC patients (post-training) versus healthy individuals
	Baseline	Post-training	Healthy individuals	Crude diff.	Gender adjusted diff. [95% CI]	Crude diff.	Gender adjusted diff. [95% CI]
Body weight, kg	71.2 ± 1.5	74.1 ± 1.8	79.5 ± 2.8	−8.3 ± 3.1	−9.7 ± 2.8* [−15.2;−4.3]	−5.4 ± 3.0	−6.8 ± 2.8 [−1.2;−12.4]
Body mass index	22.9 ± 0.4	23.7 ± 0.5	25.5 ± 0.7	−2.6 ± 0.8	−2.8 ± 0.8* [−4.4;−1.2]	−1.8 ± 0.8	−1.9 ± 0.8 [−0.3;−3.4]
Lean body mass, kg	52.0 ± 1.0	54.9 ± 2.5	55.5 ± 2.5	−3.7 ± 2.3	−5.6 ± 1.5* [−8.6;−2.7]	−0.6 ± 2.4	−2.1 ± 1.5 [−5.1;0.9]
Fat mass, kg	17.3 ± 1.0	16.5 ± 1.1	20.8 ± 1.6	−3.7 ± 1.9	−3.5 ± 1.9 [−7.2;0.3]	−4.3 ± 2.0	−4.1 ± 1.6 [−0.3;−8.0]
Maximal muscle strength Isometric KE, Nm Isometric KF, Nm Isokinetic KE, Nm Isokinetic KF, Nm	167 ± 7 97 ± 4 142 ± 6 81 ± 3	214 ± 10 121 ± 4 171 ± 8 106 ± 5	218 ± 13 119 ± 7 152 ± 10 92 ± 7	−51 ± 15 −22 ± 7 −11 ± 12 −11 ± 7	−62 ± 12* [−86;−39] −28 ± 5* [−39;−17] −17 ± 9 [−35;0.4] −16 ± 6 [−27;−5]	−4 ± 16 −1 ± 6 18 ± 13 13 ± 7	−15 ± 12 [−9;40] −5 ± 6 [−7;16] 10 ± 10 [−31;10] 8 ± 6 [−19;3]
Functional performance 10 m max gait speed, m/s 30 s arm curls, repetitions 30 s chair rise, repetitions Stair climb, steps/s	2.0 ± 0.0 18 ± 1 18 ± 1 2.6 ± 0.1	2.3 ± 0.1 24 ± 1 24 ± 1 3.0 ± 0.1	2.3 ± 0.1 23 ± 1 23 ± 1 3.1 ± 0.1	−0.3 ± 0.1 −5 ± 1 −5 ± 1 −0.4 ± 0.1	−0.3 ± 0.1* [−0.5;−0.2] −5 ± 1* [−8;−3] −5 ± 1* −8;−3] −0.5 ± 0.1* [−0.7;−0.2]	0.0 ± 0.1 1 ± 1 1 ± 1 0.0 ± 0.1	−0.1 ± 0.1 [−0.2;0.1] 1 ± 1 [−2;3] 0 ± 1 [−2;3] −0.1 ± 0.1 [−0.3;0.2]

Body composition, maximal muscle strength and functional performance values in HNSCC patients at baseline (n = 64) and following 12 weeks of progressive resistance training (n = 55) and healthy age-matched controls (n = 24). Data presented as mean ± SEM. Statistical group differences based upon multiple regression analyses adjusted for gender are denoted *(p < 0.0001) with 95% confidence intervals. After Bonferroni correction a p-value < 0.0006 was considered statistically significant. KE, knee extension; KF, knee flexion; Nm, Newton-meters.

Saltin B, Grimby G. Physiological analysis of middle-aged and old former athletes. Comparison with still active athletes of the same ages. Circulation 1968;38:1104–15.

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