CT-Derived Body Composition and Diet Quality in Kidney Transplant Recipients: A Single-Center Retrospective Cross-Sectional Study.

This study analyzed the body composition of individuals with type 2 diabetes (T2DM). In this retrospective chart review study, body composition was measured through multifrequency bioelectrical impedance analysis (InBody 770). Body composition assessments were conducted in individuals with T2DM, who were aged ≥18 years. The parameters included body mass index (BMI), body fat mass (BFM), fat-free mass (FFM), visceral fat area, percent body fat (PBF), appendicular skeletal muscle mass (ASM), and skeletal muscle index (SMI). One-way ANOVA and independent t-tests were used to calculate differences in body composition distribution by age and sex. A total of 2404 participants were recruited. The prevalence of overall low muscle mass and sarcopenic obesity was 28.0% and 18.7%, respectively, which increased with age. The overall prevalence of obesity when PBF was used was 71.5%, which was higher than that when BMI was applied (32.4%). The normal BMI group exhibited a prevalence of low muscle mass of 55.6% and sarcopenic obesity of 34.8%. For both men and women, bodyweight, BFM, FFM, ASM, and SMI all decreased with age. The prevalence of low muscle mass and sarcopenic obesity was high in older adults and people with normal BMI. Using BMI to assess obesity and determine insufficient muscle mass underestimates the prevalence of obesity and neglects the problems of sarcopenia and high body fat in people with normal BMI.

BackgroundMyosteatosis, that is muscle fat infiltration, is an important marker of muscle quality, affecting quality of life and survival in patients with chronic kidney disease (CKD). However, the connection between myosteatosis, skeletal muscle index (SMI) and survival in kidney transplant (KTx) recipients remains unclear.MethodsThis retrospective observational study included a cohort of consecutive adult kidney recipients transplanted between 2010 and 2017 in Stockholm. Preoperative abdominal computed tomography (CT) images obtained after diagnosis of CKD 5 and within 36 months of transplantation were collected. Using established criteria, we measured muscle area at the third lumbar vertebra (L3 level) and identified low attenuation muscle, indicating myosteatosis. Each area was divided by height squared providing the SMI, and fatty muscle index (FMI). Given that there is no commonly accepted definition of sarcopenia, two cut‐offs for SMI were used to define low muscle mass, Cut‐off 1 (≤32.8 for women and ≤44.7 for men) and Cut‐off 2 (≤38.5 for women and ≤52.4 for men). Average radiodensity of skeletal muscle and Charlson comorbidity index were calculated for each patient. The influence on survival from SMI, FMI, SMI/FMI ratio, and radiodensity was analysed.ResultsOut of 582 KTx recipients, 266 (46%) had a pre‐transplant abdominal CT available. Applying SMI Cut‐off 1, 30 recipients (11%) had sarcopenia compared with 106 (40%) with Cut‐off 2. Neither SMI nor FMI was associated with survival. Yet there was an association between SMI/FMI ratio and survival, patients with the lowest quintile SMI/FMI ratio having a significantly lower survival when compared with the highest quintile, both in the crude model and when adjusted for age, gender, and comorbidity. Additionally, FMI, radiodensity, and SMI/FMI, but not SMI, were significantly associated with Charlson comorbidity index (P < 0.01).ConclusionsThe SMI/FMI ratio may be associated with both pre‐transplant comorbidity and post‐transplant survival even though the significance of SMI is unclear. This suggests that SMI/FMI ratio is a better indicator of muscular impairment than skeletal muscle quantity alone. The finding may reflect the complex interplay between muscle mass, muscular fat infiltration and metabolic health, all important determinants of wellness and longevity. In summary, our study underscores the potential of the SMI/FMI ratio as a predictor of outcome after KTx, a finding possibly transferable to other patient populations.

Background: A strong association between calf circumference (CC) and skeletal muscle index (SMI) has been established worldwide in the elderly, however, these data in the Thai population are lacking. Objective: To evaluate the relationship between CC and SMI, as well as to identify the important predictors of SMI among the community-dwelling Thai elderly. Materials and Methods: The present study was an analytic cross-sectional study performed in 110 community-dwelling adults aged 60 years and older who lived in Sriracha, Chonburi, Thailand. Weight, height, and the maximum CC were measured in standing position. Body composition was measured using the bioelectrical impedance analysis (BIA) and the SMI was calculated as the appendicular skeletal muscle mass (ASM) divided by the height squared (kg/m²). Pearson’s correlation was used to indicate the relationship between CC and SMI. Multiple linear regression was developed to predict SMI. Results: The prevalence of low muscle mass in men and women were 23.5% and 33.3%, respectively. CC had a positive correlation with SMI (r=0.75; p<0.001). The cut-off values for predicting low muscle mass using CC were 34.0 cm (sensitivity 85.5%, specificity 71.8%, AUC 0.895) in women, and 33.4 cm (sensitivity 75.0%, specificity 92.3%, AUC 0.925) in men. Multiple linear regression analysis revealed age, gender, weight, and CC as the key predictors for SMI with adjusted r² of the model equal to 0.80. CC and weight had a direct effect on SMI. On the other hand, age was inversely related to SMI. Women had lower SMI than men. Conclusion: CC was positively associated with SMI, and it could be used as a screening tool to identify the community-dwelling Thai elderly with low muscle mass in the field settings. Important predictors of SMI were age, gender, weight, and CC. Keywords: Calf circumference; Skeletal muscle index; Sarcopenia; Low muscle mass; Aging; Appendicular skeletal muscle mass

Introduction: Alterations in body composition (muscle and adipose tissue) can influence clinical outcomes of underlying diseases. Comprehensive assessment of body composition via instrumental diagnostics includes bioelectrical impedance analysis, dual-energy X-ray absorptiometry, computed tomography (CT), and magnetic resonance imaging (MRI). Although CT and MRI are considered gold-standard methods, their use is limited by challenges in manual segmentation and the lack of universally accepted diagnostic thresholds. Artificial intelligence (AI) can fully automate this process and facilitate the calculation of diagnostic threshold values in cross-sectional population studies. Objective: To obtain data on the sex and age distribution of morphometric parameters of muscle and adipose tissue, assessed using AI-based software on CT scans capturing the region of interest (L3 vertebra level), in a generally healthy population in Moscow. Materials and methods: A retrospective, observational, cross-sectional descriptive study was conducted across 65 medical institutions of the Moscow Department of Healthcare. CT data from generally healthy patients were selected through a multistage process, including assessment of anamnestic data. Participants were grouped by sex and age. Native CT images were analyzed using AI-based software for segmentation and calculation of the following parameters: skeletal muscle area (SMA), skeletal muscle index (SMI), radiological density of skeletal muscle (RDSM), subcutaneous adipose tissue area (SATA), visceral adipose tissue area (VATA), intramuscular adipose tissue area (IMATA), and its proportion (PIMAT). For each parameter, quantile regression models were constructed (5th, 25th, 50th, 75th, and 95th percentiles) with 95% confidence intervals. Statistics: Cut-off values for morphometric parameters were determined using a quantile regression model. T-test, one-way ANOVA, and Mann-Whitney tests were used for comparative analysis. Statistical analysis was performed using jamovi version 2.3.28 and RStudio 2024.12.1. Results: After multi-stage analysis of CT images, text of their corresponding reports and electronic medical records according to inclusion and exclusion criteria, the final sample consisted of 900 patients (579 women (64.3%) and 321 men (35.7%)). SMA and SMI showed similar trends: a gradual increase to peak values followed by a decline, with minima in the «80 years and older» group. SMA, SMI, and RDSM were statistically significantly higher in men (p<0.001) and differed across age groups (p<0.001). Median peak SMA values: men — 41 years (168.77 cm2), women — 41 years (115.17 cm2). Median peak SMI values: men — 47 years (53.66 cm2/m2), women — 48 years (41.95 cm2/m2). SATA and VATA increased to peak values, with minima in the «18–29 years» group. SATA, VATA, IMATA, and PIMAT differed statistically significantly by sex (p=0.001 for PIMAT, p<0.001 for others) and age (p<0.001). Median peak SATA values: men — 63 years (177.93 cm2), women — 62 years (226.97 cm2). Median peak VATA values: men — 71 years (233.97 cm2), women — 71 years (169.26 cm2). Discussion: Representative population data on the sex and age distribution of body composition morphometric parameters were obtained for conditionally healthy men and women in Moscow using AI-based software. These results enable further research on body composition changes in various pathologies and the diagnosis of sarcopenia through opportunistic analysis of previously performed CT scans including the region of interest. The observed distribution patterns of both muscle and adipose tissue parameters align with data from similar population studies in the literature. However, SMI values in the Moscow population were lower than those reported for american and dutch cohorts (statistically significant for women). These identified differences underscore the value of the obtained results for the specific population. Conclusion: This study presents the first population data on the sex and age distribution of body composition morphometric parameters from CT images for Moscow, obtained using AI-based software. All parameters showed statistically significant differences across sex and age groups, with higher values of muscle and visceral adipose tissue in men, and higher subcutaneous and intramuscular adipose tissue in women. The lower SMI in the Moscow population compared to American and Dutch cohorts highlights the relevance of these data for CT-based sarcopenia diagnostics in the European part of Russia.

PurposeIncreased visceral adiposity (visceral obesity) and muscle wasting (sarcopenia) at colorectal cancer (CRC) diagnosis, quantified by computed tomography (CT) image analysis, have been unfavorably associated with short-term clinical outcomes and survival, but associations with long-term health-related quality of life (HRQoL) have not been investigated. We studied associations of visceral adiposity, muscle fat infiltration, muscle mass, and sarcopenia at CRC diagnosis with HRQoL 2–10 years post-diagnosis.MethodsA cross-sectional study was conducted in 104 stage I‒III CRC survivors, diagnosed at Maastricht University Medical Center+, the Netherlands (2002–2010). Diagnostic CT images at the level of the third lumbar vertebra were analyzed to retrospectively determine visceral adipose tissue area (cm2); intermuscular adipose tissue area (cm2) and mean muscle attenuation (Hounsfield units) as measures of muscle fat infiltration; and skeletal muscle index (SMI, cm2/m2) as measure of muscle mass and for determining sarcopenia.ResultsParticipants showed a large variation in body composition parameters at CRC diagnosis with a mean visceral adipose tissue area of 136.1 cm2 (standard deviation: 93.4) and SMI of 47.8 cm2/m2 (7.2); 47% was classified as being viscerally obese, and 32% as sarcopenic. In multivariable linear regression models, associations of the body composition parameters with long-term global quality of life, physical, role and social functioning, disability, fatigue, and distress were not significant, and observed mean differences were below predefined minimal important differences.ConclusionsAlthough visceral obesity and sarcopenia are relatively common at CRC diagnosis, we found no significant associations of these parameters with long-term HRQoL in stage I–III CRC survivors.

Sarcopenia, intramuscular fat deposition, and visceral adiposity independently predict the outcomes of hepatocellular carcinoma

Comment on 'Allograft function and muscle mass evolution after kidney transplantation' by Gaillard et al.

Within colorectal cancer, the systemic inflammatory response (SIR) and CT-derived body composition, particularly the loss of lean muscle mass, are independently associated with oncological outcomes; however, no study has included both non-metastatic and metastatic disease. The present study analyses the association between body composition, mode of presentation, SIR and survival in patients with TNM I-IV colon cancer. Patients diagnosed with colon cancer from 2011 to 2014 were identified. The SIR was stratified using systemic inflammatory grade (SIG). Staging CT scans were used to define body composition: subcutaneous fat index (SFI), visceral fat area (VFA), skeletal muscle index (SMI) and skeletal muscle density (SMD). The effect of SIG and body composition on mode of presentation and 3-year overall survival (3-yr OS) was analysed. One thousand one hundred forty-six patients were identified; 14%/38%/40%/8% had TNM Stage I/II/III/IV colon cancer, respectively. Patients were predominantly aged 65+(63%), male (52%) and BMI>25 (62%). 79%74% had a high SFI/VFA, and 56%/62% had a low SMI/SMD, respectively. Abnormal body composition was prevalent across all disease stages and associated with TNM stage-high SFI in 87%/76%/81%/68% (P<0.001), high VFA in 79%/73%/75%/67% (P=0.189), low SMI in 43%/60%/55%/68% (P<0.001) and low SMD in 55%/65%/61%/67% (P=0.094) of TNM I/II/III/IV disease, respectively. Body composition was associated with SIG-high SFI in 83%/80%/77%/78%/66% (P=0.004), high VFA in 78%/78%/70%/63%/61% (P=0.002), low SMI in 48%/52%/62%/62%/79% (P<0.001) and low SMD in 56%/60%/62%/70%/76% (P<0.001) of patients with SIG 0/1/2/3/4, respectively. After adjustment for other factors, increased SIG (OR 1.95), visceral obesity (OR 0.65) and low SMI (OR 1.61) were associated with emergency presentation. In TNM Stage II colon cancer, low SMI and low SMD were associated with worse 3-yr OS (92% vs 87%, P<0.001 and 96% vs 85%, P<0.001, respectively). In TNM Stage III, a trend was seen between low SMI and SMD and 3-yr OS (77% vs 73%, P=0.091 and 76% vs 75%, P=0.034, respectively). In TNM Stage IV disease, low SMI was associated with 3-yr OS (43% vs 16%, P<0.001). A trend, albeit not of significance, was seen between low SMD and 3-yr OS (32% vs 21%, P=0.366). The present results show that abnormal body composition is prevalent across TNM I-IV colon cancer and associated with TNM stage and SIG. Body composition is independently associated with emergency presentation and long-term survival. Further research is required to analyse whether interventions including structured exercise programmes or attenuation of the SIR have an effect on CT-derived body composition and oncological outcomes.

<h3>Background</h3> We investigated the associations of poor oral health with dietary quality and intake in older people. We also examined whether changes in dietary quality can influence the risk of oral health problems. <h3>Methods</h3> Data come from the British Regional Heart Study (BRHS) and the Health, Aging and Body Composition (HABC) Study. The BRHS included older men from 24 British towns aged 71–92 years in 2010–12 (n=2,147). The HABC Study, included 3,075 American men and women aged 71–80. In both studies, measures of oral health included tooth loss, periodontal disease, dry mouth, and self-rated oral health. Dietary data included dietary quality (Elderly Dietary Index in the BRHS, and Healthy Eating Score in the HABC Study) and intake (processed meat, calories from fat, protein and fruits and vegetables). Additionally in the BRHS, change in dietary quality was assessed over 10 years from 1998–2000 (age 60–79 years) to 2010–2012 (71–92 years). <h3>Results</h3> In the BRHS, tooth loss, fair/poor self-rated oral health and accumulation of oral health problems were associated with poor dietary quality, after adjustment for age, social class, smoking, alcohol, history of cardiovascular disease (CVD) and diabetes, body mass index (BMI) and energy intake. Similar associations were observed for high intake of processed meat. Accumulation of oral health problems and self-rated oral health were associated with being in the top quartile of percentage of calories from saturated fat (fair/poor self-rated oral health, odds ratio (OR)=1.34, 95% CI 1.02–1.77) after adjustment for confounders. In the HABC study, no significant associations were observed between poor oral health and dietary quality after full adjustment. In the fully-adjusted model (age, gender, race, education, smoking, alcohol, history of CVD and diabetes, BMI and energy intake), periodontal disease was associated with the top quartile of percentage of calories from saturated fat (OR=1.48, 95%CI 1.09–2.01). In the BRHS, persistent low dietary quality over 10 years (from age 60–79 to 71–92 years), was associated with higher risk of tooth loss and accumulation of oral health problems at 71–92 years. <h3>Conclusion</h3> Older individuals with oral health problems had poorer diets and consumed fewer nutrient-rich foods. Moreover, persistent poor dietary quality in older ages was associated with oral health problems later in life, suggesting bi-directional associations between oral health and dietary intake in older age. Improved management of nutrition and oral health are both important aspects of the health of older populations.

Performance of CT-based low skeletal muscle index, low mean muscle attenuation, and bioelectric impedance derived low phase angle in the detection of an increased risk of nutrition related mortality

Association between CT-based body composition assessment and patient outcomes during neoadjuvant chemotherapy for epithelial ovarian cancer

Changes in Visceral and Subcutaneous Adipose Tissue and Body Composition in Kidney Transplant Recipients at 1, 3, and 5 Years After Kidney Transplant

BackgroundThe association between body composition and survival in rectal cancer patients is still unclear. Therefore, we aimed to evaluate the impact of computed tomography (CT)-measured body composition on survival in rectal cancer patients, stratifying our analyses by sex, tumour location, tumour stage and radiotherapy.MethodsThis retrospective cohort study included 173 patients with rectal adenocarcinoma. CT colonography scans at the time of diagnosis were used to assess the skeletal muscle index (SMI) and the visceral adipose tissue area (VAT). The patients were divided into a low or high SMI group and a low or high VAT group according to previously defined cutoff values. Endpoints included cancer-specific survival (CSS) and overall survival (OS).ResultsIn all patients, low SMI was associated with worse CSS (HR, 2.63; 95% CI, 1.35–5.12; P = 0.004) and OS (HR, 3.57; 95% CI, 2.01–6.34; P < 0.001) compared to high SMI. The differences remained significant after adjusting for potential confounders (CSS: adjusted HR, 2.28; 95% CI, 1.13–4.58; P = 0.021; OS: adjusted HR, 3.17; 95% CI, 1.73–5.82; P < 0.001). Low SMI was still related to a poor prognosis after stratifying by sex, tumour location, stage and radiotherapy (P < 0.05). High VAT was associated with better CSS (HR, 0.31; 95% CI, 0.11–0.84; P = 0.022) and OS (HR, 0.40; 95% CI, 0.17–0.97; P = 0.044) compared to low VAT among men with rectal cancer ≤ 10 cm from the anal verge. High VAT was associated with worse CSS (HR, 4.15; 95% CI, 1.10–15.66; P = 0.036) in women with rectal cancer ≤ 10 cm from the anal verge.ConclusionsLow SMI was associated with worse survival. High VAT predicted better survival in men but worse survival in women. The results suggest that CT-measured body composition is a useful tool for evaluating the prognosis of rectal cancer patients and demonstrate the need to include the sex and the tumour location in the analyses.

Body Composition in Relation to Clinical Outcomes in Renal Cell Cancer: A Systematic Review and Meta-analysis

Background CT-derived measures of body composition have been shown to have prognostic value in patients with cancer. However, few studies have compared these observations across tumor types and stages of disease. The aim of the present study was to compare body composition measures between two types of cancers, i.e. colorectal cancer (CRC), which is less inflammatory and patients maintain body composition over a longitudinal study period, whereas lung cancer (LC) is proinflammatory and patients lose more fat and muscle mass using a standard methodology. Methods Clinicopathological characteristics, including those pertaining to nutritional risk/status and systemic inflammation in patients with colorectal cancer (CRC, n = 1047) and lung cancer (LC, n = 662), were compared. The CT image at L3 was used to assess body composition. Comparison of these cohorts was carried out using the chi-square test. Binary logistic regression analysis was performed to assess the impact of clinico-pathological variables on body composition, and scatter plots were used to examine the relationship between body mass index (BMI) and CT-derived measures of body composition. Results According to CT-derived body composition, high subcutaneous (SFI) and visceral fat index (VFI) were common (>70%) in both CRC and LC. Also, low skeletal muscle index (SMI) and density (SMD) were approximately 40–50% and 60–70% in both CRC and LC. Compared with CRC, patients with LC had a higher American Society of Anaesthesia (ASA) (P < 0.001), Malnutrition Universal Screening Tool (MUST) (P < 0.001), modified frailty index (mFI) (P < 0.001), modified Glasgow Prognostic Score (mGPS) (P < 0.001), and neutrophil lymphocyte ratio (NLR) (P < 0.001) scores. On binary logistic regression analysis, MUST, mFI, and NLR were predictors of subcutaneous adiposity (P < 0.05); type of cancer, MUST, and mFI were predictors of visceral obesity (P < 0.001); age, type of cancer, MUST, and mGPS were predictors of low SMI (P < 0.001); and age, type of cancer, mFI, and mGPS were predictors of low SMD (P < 0.05). There was a similar relationship between BMI and other measures of CT-derived body composition across two types of cancers. Conclusion Obesity and low skeletal muscle mass were common in both CRC and LC cohorts despite large differences in comorbidity, nutritional risk, systemic inflammation, and survival, even when normalized for TNM stage. These observations would support the hypothesis that, although prognostic, CT derived body composition analysis primarily reflects patient constitution rather than the effect of tumor stage in patients with cancer. The systemic inflammatory response, as evidenced by mGPS, can be considered as an important therapeutic target and loss of muscle mass in patients with advanced cancer is related to the systemic inflammatory response.