151751-Najiba-Chargi

414 CHAPTER 20 To our knowledge, this is the first study that examined the association between sarcopenia, as defined by low MF and low SMI, and frailty, as determined by CGA, in HNC patients. With the aging of the global population the incidence of frail and sarcopenic patients with HNC will increase. Understandings of the underlying interrelationship of sarcopenia and frailty are of great importance as they are both associated with adverse health outcome. 7,29 Frailty and sarcopenia are important concepts in preventing physical dependence, as geriatrics are shifting towards identification of early stage of disability. Definitions of both sarcopenia and frailty are still developing, and both concepts clearly overlap in their physical aspects. 12,30 Frail - ty is a pre-disability syndrome where an older person can be identified as being at risk when exposed to stressors associated with high risk for disability or needing to be hospitalized 31 . Two major frailty definitions exist. The physical phenotype of frailty (Fried) 26 and the multiple deficit model (Rockwood). 32 An CGA is the most appropriate way to detect frailty. Frailty is predisposed by advancing age in combination with physiological deterioration, especially a loss of muscle mass. So, sarcopenia is a major driver of frailty, because of decline of MF with low SMM. This increases the risk of falls, which can lead to loss of independence and disability. And low SMM increases the risk of comorbidity’s like diabetes mellitus and cardiovascular diseases by changing the body fat composition. 31 Studies using “physical” frailty as definition in examining the interrelationship with sarcopenia are suggested to have more overlap. 30 In this study sarcopenic patient were more likely to be frail, according to the Fried criteria. Moreover, the Fried criteria were an independent predictor for sarcopenia. GFI was not associated with sarcopenia. Presumably because GFI uses also social, and psychological domains rather than only physically items like the Fried criteria. This confirms that “physical” frailty, like the Fried criteria, are more associated with sarcopenia than definitions based upon the multiple deficit model (Rockwood). A previous retrospective study found a significant association between sarcopenia and frailty based on the G8 questionnaire (OR 0.76, 95% CI 0.6-0.89, P < 0.001). 11 In that study sarcopenia was based only on low SMI, so according to the EWGSOP-criteria insufficient as sarcopenia which include muscle function as well. Also, frailty screening was based on different screening questionnaires, i.e., G8, Timed Up and Go test, and Malnutrition Universal Screening Tool. In our study SMI, but not the combination of low MF and low SMI (defined as sarcopenia by the EWGSOP), was independently associated with frailty based on CGA (OR 0.89, 95%CI 0.82-0.96, P=0.003). The suggestion that SMI could possibly be able to predict frailty, in particularly the physical part of frailty, in patients with HNC and is easier to use and implement then a CGA or questionnaires to diagnose frailty is in accordance with the study of Zwart et al, although in our study SMI was directly associated with CGA instead of the G8 frailty screening questionnaire. 11 Our study has some limitations. It was designed as a retrospective single-center study, with a limited number of included patients. Only patients with the available data on MF and SMI were included in the study. As it is more likely that MF parameters were examined for frail patients