CT assessment of nutritional status and lean body mass in gastric and esophageal cancer

Abstract

BackgroundMalnutrition is common in patients with gastric and esophageal tumors, and is predominantly associated with loss of lean body mass. Adequate assessment of preoperative nutritional status is essential for prognostication and multidisciplinary treatment planning. The aim of this study was to ascertain whether anthropometric nutritional assessment correlates with computed tomography (CT) measured lean body mass in patients with gastric and/or esophageal cancer.MethodsThis was a retrospective analysis of abdominal CT images and anthropometric nutritional assessments. The anthropometric parameters of interest were weight, height, body mass index, mid-upper arm circumference, triceps skinfold thickness, mid-arm muscle circumference, and nutritional diagnosis. The lean muscle mass area was calculated from axial-view CT images of the abdomen at the level of L3 and corrected by height for calculation of the lean mass index. Values below 55.4 cm2/m2 for males and 38.9 cm2/m2 for females were defined as low lean body mass.ResultsThe sample included 70 patients, of whom 67.1% were men. The mean lean body mass index assessed by computed tomography was 47.8 cm2/m2 (range, 29.2–78.6cm2/m2), with 54.3% of patients being classified as having low lean body mass. When classified by mid-arm muscle circumference, 74.2% of patients classified as undernourished had low lean body mass on CT, compared to 40.0% of patients classified as well-nourished (sensitivity 62.2%, specificity 72.4%, accuracy 66.7%).ConclusionsA substantial portion of patients with gastric and/or esophageal cancer exhibited low lean body mass on computed tomography. Anthropometric evaluation has limited capacity to identify these patients. Among the tested anthropometric parameter, mid-arm muscle circumference showed the best agreement with CT-measured lean body mass.