Comparison of pre-intestinal transplant and posttransplant sarcopenia and visceral adiposity measurements using computed tomography in the diagnosis of malnutrition during a nutrition-focused physical examination.

Abstract

Registered dietitian nutritionists subjectively assess muscle loss as part of the nutrition-focused physical examination (NFPE), using guidelines to standardize malnutrition diagnosis. Computed tomography (CT) scans provide an objective measure of skeletal muscle mass and abdominal wall and visceral adipose tissue and can be used to determine skeletal muscle loss. In this retrospective review, our team compared muscle measurements including the psoas, paraspinal muscles, and abdominal wall muscle area at the level of the third lumbar vertebral body (using CT)-as well as visceral and subcutaneous adipose tissue measurements-before and after gut transplant with the malnutrition diagnosis found on the NFPE. We also examined the association between CT measurements and postoperative infection, length of stay, and mortality. Forty-two patients were included in the study. Adipose tissue measurements on CT analysis were significantly lower in the malnutrition group compared with those without malnutrition (P ≤ 0.05) in both the pretransplant and posttransplant groups. Skeletal muscle size measurements were not significantly associated with malnutrition, but when adjusted for patients' height by calculating skeletal muscle index, an association between low skeletal muscle index scores and malnutrition diagnosis was found (P = 0.026). Pretransplant malnutrition diagnosis did not predict infection, length of stay, or mortality. Objective assessment of subcutaneous adipose tissue by CT analysis was significantly correlated with the subjective assessment of malnutrition by NFPE in both pretransplant and posttransplant patients. Skeletal muscle index scores were significantly lower in pretransplant patients who were diagnosed with malnutrition.