Body Composition Research Articles

Prognostic implication of body composition changes in patients with borderline resectable/locally advanced pancreatic adenocarcinoma (PDAC) treated with mFOLFIRINOX.

783 Background: Although cachexia is a known prognostic factor in patients with advanced cancer, individual body composition changes during chemotherapy and their association with survival in PDAC warrant further investigation. We aimed to analyze the prognostic implication of comprehensive body composition, including areas and attenuation of muscle mass, body fat area and its distribution, and body mass index (BMI) during mFOLFIRINOX in patients with PDAC. Methods: Patients with borderline resectable or locally advanced PDAC, who were not able to undergo curative surgery and received first-line mFOLFIRINOX between January 2017 and December 2020 from Asan Medical Center, Seoul, Korea, were included in this retrospective study if they had paired CT scans of the abdomen at baseline and after 12 weeks of mFOLFIRINOX. Body composition was measured using artificial intelligence software (AID-UTM, iAID Inc.) from the CT images, and their association with overall survival (OS) were analyzed. Results: A total of 377 patients were included. Median age was 63 (range, 56–69) and 214 patients (56.8%) were males and 163 patients (43.2%) were females. During the first 12 weeks, significant changes in the body composition occurred as follows (median changes and interquartile range): skeletal muscle area, -5.8% [-11.1%–0.6%]; normal attenuation muscle area/total attenuation muscle area, -2.8% [-8.7%–3.2%]; visceral fat area (VFA), -6.1% [-23.7%–18.6%]; skeletal fat area (SFA), -12.2% [-27.8%–77.1%]; and BMI, -2.2% [-6.8%–1.5%]. Furthermore, changes in the VFA and BMI was associated with tumor response (Kruskal-Wallis test, p = 0.012 for VFA; p = 0.054 for BMI). There was no significant relationship between body composition abnormalities including sarcopenia, myosteatosis, or obesity at baseline and OS. However, patients who experienced the greatest decrease in SFA and BMI after 12 weeks of mFOLFIRINOX had poorer OS (tertile 1 [greatest decrease] vs 3 [smallest decrease]: HR 0.67 [95% CI, 0.52–0.87] for SFA, p = 0.003; 0.68 [95% CI, 0.49–0.83] for BMI, p = 0.001). Conclusions: In patients with borderline resectable/locally advanced PDAC, body composition significantly changes during the first 12 weeks. Decrease in the body fat and BMI from baseline were associated with poorer tumor response and OS.

Gender Different Impacts of Muscle Mass and Adipose Tissue on Patients With Hepatocellular Carcinoma Undergoing Surgical Resection.

Body composition is an objective assessment reflecting nutritional status and is highly gender different. Surgical resection, the standard treatment for early-stage hepatocellular carcinoma (HCC), is an energy-consuming major operation that would affect body composition. However, the impacts of body composition on the post-operative prognosis of HCC are still uncertain. In this study, we aimed to investigate surgery-related changes in body composition and the impacts on clinical outcomes of HCC after surgical resection distinguished by gender. From January 2013 to December 2018, 401 consecutive patients who received surgical resection for HCC in Taipei Veterans General Hospital were retrospectively reviewed. Cross areas of adipose and muscle mass were measured at L3 vertebral level from peri-operative computed tomography by Slice-O-matic software; body composition indices were thus calculated. Factors associated with survivals were analysed. Body composition indices did not change significantly after surgical resection of HCC in both males and females. Higher pre-operative intramuscular adipose tissue index (IMATI) (hazard ratio [HR]: 2.059, p = 0.002) and lower ratio of subcutaneous to visceral adipose tissue index (SATI/VATI) (HR: 1.681, p = 0.028) were independent predictors of worse overall survival (OS) in male patients. In females, higher pre-operative IMATI (HR: 3.053, p = 0.001) was the only body composition-related factor predicting OS. Surgical resection contributed minor changes in body composition in patients with early HCC. Myosteatosis and subcutaneous to visceral fat ratio were survival predictors in male patients, but myosteatosis was the only body composition-predictor of survival in females.

Effect of changes in body composition and sociodemographic factors on colon cancer survival.

296 Background: Muscle mass, muscle quality, and adipose tissue volumes have been shown to affect colon cancer survival. Further research is required to understand how change in body composition during treatment impacts colon cancer outcomes, and how covariables such mental health and socioeconomic status affect this relationship. The aim of this project was to examine how changes in body composition during chemotherapy for colon cancer impact the duration of disease-free survival (DFS) and how sociodemographic covariables (age, sex, social isolation, depression, anxiety, income, community size) influence this relationship. Methods: Computed tomography (CT) scans from the time of diagnosis and the end of chemotherapy were obtained from individuals treated for stage III colon cancer with oxaliplatin at BC Cancer between 2012 and 2016. Whole body tissue volumes were estimated based on CT images at the level of the third lumbar vertebra, analysed using DAFS Express (Voronoi Health Analytics Inc., Vancouver BC). Muscle quantity was measured as skeletal muscle index (SMI), and muscle quality was measured as skeletal muscle density (SMD) and skeletal muscle gauge (SMG). Quantity of visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intermuscular adipose tissue (IMAT), and total adipose tissue (TAT) were also measured. Social isolation, anxiety, and depression symptoms were measured using the validated Psychosocial Screen for Cancer–Revised. Neighbourhood income and community population were estimated using postal codes. Cox proportional hazard models were calculated for the effect of body composition variables on DFS, and interactions with sociodemographic variables. Results: Significant reductions in SMI, SMD, SMG, VAT, IMAT and TAT were observed between diagnosis and post-chemotherapy (n=282). Improved survival was associated with higher SMD and lower IMAT at diagnosis and post-chemotherapy, lower VAT at diagnosis, and an increase in VAT or TAT during chemotherapy. Body composition had a more significant effect on survival in individuals who were older, female, or lived in smaller communities. Conclusions: Significant reductions in SMI, SMD, SMG, VAT, IMAT and TAT were observed between diagnosis and post-chemotherapy (n=282). Improved survival was associated with higher SMD and lower IMAT at diagnosis and post-chemotherapy, lower VAT at diagnosis, and an increase in VAT or TAT during chemotherapy. Body composition had a more significant effect on survival in individuals who were older, female, or lived in smaller communities.

Association between serum copper concentration and body composition in children with spinal muscular atrophy: a cross-sectional study.

The role of serum copper in modulating body composition in patients with spinal muscular atrophy (SMA) remains uncertain. This study aimed to illustrate the correlation between serum copper concentration and body composition in children with SMA. This study was conducted at a pediatric medical center in China from July 2019 to August 2022. The study included anthropometric measurements, serum analysis for copper, magnesium, zinc, and iron, as well as comprehensive body composition assessments. Multivariate analysis was utilized to assess the connection between serum copper concentration and body composition metrics. This cross-sectional analysis included 87 patients [median (IQR) age: 7 years (5-10), 57.5% male] diagnosed with SMA receiving comprehensive multi-disciplinary management. The results revealed a positive association between serum copper concentration and both fat mass percentage (β = 0.50, 95% confidence interval (CI): 0.07 to 0.92, p = 0.025) and fat-muscle ratio (β = 0.02, 95% CI: 0.01 to 0.03, p = 0.009). Conversely, a negative correlation was found between serum copper concentration and muscle mass percentage (β = -0.70, 95% CI: -1.11 to -0.29, p = 0.001). These findings suggest a correlation between copper concentration and body composition in SMA, offering valuable insights for addressing metabolic dysregulation in these patients.

Abdominal myosteatosis measured with computed tomography predicts poor outcomes in patients with glioblastoma.

Alterations in cellular metabolism affect cancer survival and can manifest in metrics of body composition. We investigated the effects of various body composition metrics on survival in patients with glioblastoma (GBM). We retrospectively analyzed patients who had an abdominal and pelvic computed tomography (CT) scan performed within 1 month of diagnosis of GBM (178 participants, 102 males, 76 females, median age: 62.1 years). Volumetric body composition metrics were derived using automated CT segmentation of adipose tissue, skeletal muscle, and aortic calcification from L1 to L5. Univariable and multivariable Cox proportional hazards models were performed separately in males and females using known predictors of GBM overall survival (OS) as covariates. A sex-specific composite score of predisposing and protective factors was constructed using the relative importance of each metric in GBM OS. Higher skeletal muscle volume and lower skeletal muscle fat fraction were associated with better OS in the entire dataset. A robust and independent effect on GBM OS was seen specifically for fraction of inter/intramuscular adipose tissue to total adipose tissue after correction for known survival predictors and comorbidities. Worse OS was observed with increased abdominal aortic calcification volume in both sexes. There was a significant difference in GBM OS among participants stratified into quartiles based on sex-specific composite predisposing and protective scores. The relationship between body composition and GBM OS provides an actionable advancement toward precision medicine in GBM management, as lifestyle and dietary regimens can alter body composition and metabolism and from there GBM survival.

Comprehensive treatment with dapagliflozin in elderly chronic kidney disease patients: Clinical efficacy and impact on body composition.

Dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, is widely used for treating heart failure and chronic kidney disease (CKD). While its renoprotective effects are well established, concerns remain regarding its impact on muscle mass and function, especially in elderly patients. To assess the effects of dapagliflozin on renal function, body composition, and muscle strength in elderly CKD patients. Twelve elderly CKD patients (75.6±1.4years) were treated with dapagliflozin for 12months. Body composition, serum parameters, and muscle function were evaluated at baseline, 6months, and 12months. Measurements included changes in eGFR, liver function, HbA1c, and muscle strength. Dapagliflozin treatment stabilized eGFR without significant improvement, but proteinuria was notably reduced in most patients, indicating a positive renal effect. AST and ALT levels showed significant reduction after 12months, suggesting improved liver function. No significant changes were observed in body weight, BMI, or muscle mass. Muscle function, as measured by the 5-sit-to-stand test, improved significantly, while grip strength remained stable. No serious adverse events were reported. Dapagliflozin is a safe and effective treatment for CKD in elderly patients, demonstrating renal protection and improved liver function without adversely affecting muscle mass or strength. The study supports the use of dapagliflozin as part of a comprehensive approach, combining pharmacotherapy, lifestyle modification, and exercise to optimize patient outcomes in CKD management.

Ergogenic Benefits of β-Hydroxy-β-Methyl Butyrate (HMB) Supplementation on Body Composition and Muscle Strength: An Umbrella Review of Meta-Analyses.

β-Hydroxy-β-methyl butyrate (HMB) is a metabolite of the amino acid leucine, known for its ergogenic effects on body composition and strength. Despite these benefits, the magnitude of these effects remains unclear due to variability among studies. This umbrella review aims to synthesize meta-analyses investigating the effects of HMB on body composition and muscle strength in adults. A comprehensive literature search was conducted in Scopus, PubMed and Web of Science without date or language restrictions until August 2024. The study protocol was registered at Prospero (No. CRD42023402740). Included studies evaluated the effects of HMB supplementation on body mass, fat mass (FM), fat-free mass (FFM), muscle mass and performance outcomes. Effect sizes (ESs) and 95% confidence intervals (CIs) were calculated, and a random-effects model was used for meta-analysis. Standard methods assessed heterogeneity, sensitivity and publication bias. The methodological quality of included studies was assessed using the AMSTAR2 tool. Eleven studies comprising 41 data sets were included, with participants aged 23-79 years. HMB supplementation significantly increased muscle mass (ES: 0.21; 95% CI: 0.06-0.35; p = 0.004), muscle strength index (ES: 0.27; 95% CI: 0.19-0.35; p < 0.001) and FFM (ES: 0.22; 95% CI: 0.11-0.34; p < 0.001). No significant changes were observed in FM (ES: 0.03; 95% CI: -0.04 to 0.35; p = 0.09) or body mass (ES: 0.09; 95% CI: -0.06 to 0.24; p = 0.22). The quality assessment revealed that five studies were of high quality, three were of low quality and three were of critically low quality. HMB supplementation may benefit individuals experiencing muscular atrophy due to physiological conditions, particularly enhancing muscle mass and strength without significant changes in fat mass or body weight.

Change and predictors of body composition after gastrectomy for gastric cancer during first postoperative year.

After gastrectomy for gastric cancer, patients often lose significant body weight because of decreased caloric intake and nutrient absorption. Body weight typically requires approximately 1 year to stabilize. This study aimed to examine the changes and predictors of body composition during the first postoperative year. A total of 230 patients underwent radical gastrectomy for stage I to III gastric cancers. Body composition was measured using bioelectrical impedance analysis, and changes were analyzed over 1 year. Multiple regression analysis was used to identify predictors of body composition changes. Body composition changes and significant body weight and body fat mass reductions occurred primarily within the first 6 months postoperatively. Skeletal muscle mass initially decreased but improved after 6 months without significant changes related to adjuvant chemotherapy. Increased edema was observed at 6 and 12 months postoperatively in patients after total gastrectomy and adjuvant chemotherapy. Gastrectomy type and body mass index significantly affected postoperative body weight changes. In addition, gastrectomy type was associated with changes in skeletal muscle mass and bone mineral content. Adjuvant chemotherapy significantly affected the whole-body phase angle at 6 and 12 months. Our findings emphasized the initial significant reductions postoperatively and subsequent adjustments over time and elucidated the complex interplay between surgical techniques, adjuvant treatment, and patient characteristics and midterm changes in body composition.

Body composition of older adults with normal body mass index. Cross-sectional analysis of the Toulouse Frailty clinic.

Body mass index (BMI) determines general corpulence and health, whatever age, sex or clinical background. Normal BMI (18.5-24.9 kgm2) is defined as healthy, normal, weight leading to a false impression that no intervention is needed. Assess the prevalence of body impairments in the presence of normal BMI. Cross-sectional design. Bivariate and a multivariate regression analysis assessed the association of body composition with clinical parameters in the presence of normal BMI. Community dwelling older adults attending the Toulouse Frailty Clinic at the University Hospital, Toulouse. 876 community dwelling, autonomous older adults, 70 years and over. Dual X-ray Absorptiometry (DXA) assessment, and cognitive, physical, nutritional, and demographic evaluations were included in the present analysis. Of the initial sample, 347 (39.61 %) patients had normal BMI, and among them, 152 (43.80 %) had low lean mass, 144 (41.49 %) were osteoporotic and 2 (0.58 %) increased fat mass. A poor nutritional status (Mini-Nutritional Assessment score, MNA-score, <24) was the only independent variable associated with body impairments in the presence of normal BMI (Odd Ratio 2.83; 95 % Confidence Interval 1.64-4.89). Nearly 70 % of the adults with normal BMI had at least one impairment in body composition (low lean mass, osteoporosis, or obesity). In the light of the present study, older adults with normal BMI and an MNA-score under 24 should be assessed with DXA to identify the age-associated impairments in body composition in order to lead to specific interventions.

Holiday Weight Change in a US College Student Sample: AProspective Observational Cohort Study.

The November through January holiday period is often thought to produce weight gain, coined "holiday weight gain." While this trend has been documented among early to midlife adults, it is less certain whether college students experience similar levels of weight gain during this period, as they undergo lifestyle changes (e.g., returning to their families of origin) that may differ from adults at later stages of development. Thus, the primary aim of the current study was to determine body weight and body composition changes during the holiday season in college students. The secondary aim was to examine the association of psychosocial variables with primary outcomes. Participants included 47 undergraduate students. Body weight, body composition, and psychosocial variables were measured prior to Thanksgiving break and after returning from December to January break. Differences in body weight and body composition variables were determined using paired-sample t-tests. Associations of psychosocial variables with changes in primary outcomes were determined by Spearman's correlation coefficients and linear regressions. On average, college students experienced a 1.08% increase in body weight between study visit 1 in November and study visit 2 in January (0.74±1.81kg; p=0.02). Lean mass increased (1.49±3.21kg; p=0.01), while body fat % did not change (p=0.12). Psychosocial variables were not significantly associated with or predictive of changes in body weight or body fat % (p's>0.05). College students gained a small, yet significant, amount of weight over the holiday period. Weight gain occurred alongside increases in lean mass but not body fat. Results provide important context to previous findings observing weight gain in college students and adults over the holiday season. Specifically, findings indicate a healthy increase in lean mass-a potential promotive factor in optimal health and wellbeing.

Quantification of training-induced alterations in body composition via automated machine learning analysis of MRI images in the thigh region: A pilot study in young females.

The maintenance of an appropriate ratio of body fat to muscle mass is essential for the preservation of health and performance, as excessive body fat is associated with an increased risk of various diseases. Accurate body composition assessment requires precise segmentation of structures. In this study we developed a novel automatic machine learning approach for volumetric segmentation and quantitative assessment of MRI volumes and investigated the efficacy of using a machine learning algorithm to assess muscle, subcutaneous adipose tissue (SAT), and bone volume of the thigh before and after a strength training. Eighteen healthy, young, female volunteers were randomly allocated to two groups: intervention group (IG) and control group (CG). The IG group followed an 8-week strength endurance training plan that was conducted two times per week. Before and after the training, the subjects of both groups underwent MRI scanning. The evaluation of the image data was performed by a machine learning system which is based on a 3D U-Net-based Convolutional Neural Network. The volumes of muscle, bone, and SAT were each examined using a 2 (GROUP [IG vs. CG]) × 2 (TIME [pre-intervention vs. post-intervention]) analysis of variance (ANOVA) with repeated measures for the factor TIME. The results of the ANOVA demonstrate significant TIME × GROUP interaction effects for the muscle volume (F1,16 = 12.80, p = 0.003, ηP 2 = 0.44) with an increase of 2.93% in the IG group and no change in the CG (-0.62%, p = 0.893). There were no significant changes in bone or SAT volume between the groups. This study supports the use of artificial intelligence systems to analyze MRI images as a reliable tool for monitoring training responses on body composition.

Phoenixin's Influence on HPG Axis and Inflammation in Elite Ice Hockey Athletes: A Cross-Sectional Analysis.

The neuropeptide phoenixin (PNX) may be involved in regulating the hypothalamic-pituitary-gonadal (HPG) axis and inflammatory responses. This study aims to investigate the role of PNX in the regulation of HPG axis function in ice hockey players and its impact on body composition. This cross-sectional study included 65 male ice hockey players aged 18-22, divided into untrained, non-elite athlete, and elite athlete groups. Body composition was assessed using bioelectrical impedance analysis, and plasma levels of PNX, gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), testosterone, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) were measured by enzyme-linked immunosorbent assay. Elite ice hockey players exhibited significantly higher lower limb and core skeletal muscle mass, skeletal muscle index, and testosterone levels, aligning with the high-intensity intermittent nature of hockey training. Compared to the non-training group, ice hockey training groups showed elevated levels of PNX, GnRH, testosterone, and TNF-α, along with reduced levels of LH and IL-6. PNX concentration positively correlated with lean body mass, skeletal muscle mass, skeletal muscle index, serum GnRH, and testosterone levels, and negatively correlated with serum LH and IL-6 levels. In conclusion, PNX may enhance skeletal muscle mass in ice hockey players, particularly in the lower limbs and core muscles, by promoting HPG axis activity while inhibiting inflammatory responses and reducing HPG axis suppression. These findings provide new insights into the physiological adaptation mechanisms of ice hockey players, potentially aiding in the optimization of training strategies and improvement of athletic performance.

Postoperative exercise in gastric cancer patients undergoing gastrectomy: A randomized controlled trial.

358 Background: Faster physical recovery after gastrectomy may lead to better physical and psychological health in patients with gastric cancer. Post-surgical exercise may prevent physical dysfunction and improve recovery, but its effects on physical function are not fully explored. Methods: In this trial, 52 gastric cancer patients (Stage 1-3) were randomly assigned to early postoperative exercise rehabilitation or usual care (1:1 ratio). Interventions Inpatient Supervised Exercise sessions were conducted for 15 minutes once a day on Postoperative Day (POD) 1 and 2 in the ward. Home-based Exercise involved 30-minute remote exercise sessions at home once a week following discharge, with additional recommendations for daily 30-minute sessions of low to moderate-intensity aerobic exercises and bodyweight exercises. Moreover, the exercise group was provided with an exercise log and instructional videos to record the duration of bodyweight exercises and aerobic exercises. Measurements were taken three times (baseline, POD3, and the first outpatient visit 1 month after surgery). The primary outcome was a Short Physical Performance Battery (SPPB), with secondary outcomes including grip strength, 30-second sit-to-stand (STS), body composition, C-reactive protein (CRP), and quality of life (QOL). Results: A total of 46 (88%) participants (mean [SD] age, 60.2 [12.24] years; 26 [57%] male) completed the trial. Compliance with intervention in-patient exercise was 96% and remote exercise was 79%. The significant difference in SPPB scores of 11.4±1.3 in the exercise group compared with 10.7±1.43 usual care group (mean difference, -1.09 score; 95%CI, -1.7 to -0.4; p=&lt;.001). Moreover, there were significant differences between groups in the STS exercise group 14.3±2.8 usual care group 13.6±4.5 (mean difference, 1.86; 95%CI, -3.3 to -0.4; p=.028), and CRP in POD3 exercise group 66.9±40.73 usual care group 103.7±54.25 (mean difference, -22.54 score; 95%CI, -46.5 to 1.4; p=.016). However, there was no significant difference in grip strength, body composition, and QOL. Conclusions: Postoperative exercise presents as a beneficial strategy to enhance physical recovery in patients undergoing gastrectomy, improving key physical function markers and reducing inflammation. Clinical trial information: NCT06260293 .

Intensified dietetic care during and up to three months after hospital admission in older patients at risk of malnutrition, a randomised controlled trial.

Inadequate protein intake is associated with poor physical functioning and suboptimal recovery in hospitalised older adults. Despite standard dietetic care, dietary protein intakes falls well below the recommended levels. To address this problem, we developed an intensified trans-sectorial dietetic intervention that targets hospitalised older adults. This study aims to evaluate its impact on physical functioning and dietary protein intake during and post hospitalisation. This multicentre individually randomised controlled trial was conducted in five hospitals from January 2021 until December 2022. Hospitalised older adults, aged ≥55 years and at risk of malnutrition were randomised to receive regular care (CON) or intensive dietetic intervention (INT). The intervention consisted of personalized, intensive care, including trans-sectorial guidance by trained dietitians, increased consultations, and supportive materials focused on protein intake. Additionally, the intervention emphasized engagement in dietary behaviour and physical activity during hospitalisation and continued for three months post-discharge. The primary outcome was change in physical functioning measured by the Short Physical Performance Battery (SPPB) from admission to three months post-discharge, analysed with linear mixed models for repeated measures. Secondary outcomes included protein intake, body composition, muscle strength, physical activity, activities of daily living, fear of falling, pain, fatigue, appetite and quality of life. A total of 76 hospitalised older adults were included in the study of which 38 were in CON and 38 received INT. The overall drop-out was 30% (CON 26%; INT 34%). The participants had a median age 73y (Inter Quartile Range: 62-78y) with 50% females. Overall, Physical functioning improved from 6 points (IQR: 1-9 points) at baseline to 9 points (IQR: 7-11) at three months post-discharge (p<0.0001). Likewise, protein intake increased from 0.8g/kg bodyweight (IQR: 0.6-1.0) to 1.0g/kg bodyweight (IQR: 0.8-1.2) (p<0.0001). There were no significant differences between intervention and control group. All secondary outcomes improved over time, except for fear of falling, leg extension strength, and body composition, with no significant differences between intervention and control group. Hospitalised older patients improved their physical functioning and protein intake after three months post-discharge, although the majority not to recommended levels. No effects of the intensive dietetic treatment could be detected due to low intervention adherence and a small sample size. Future research should be conducted with an intervention consisting of a strong combination of nutritional support and exercise with a successful implementation and a flexible study design catered to the needs of the older patient. Landelijk Trial Register (NL8041; NL72069.029.19) www.onderzoekmetmensen.nl; registered 2019-09-23; covering all WHO Trial Registration Data Set items.

The Cross-Sectional Relation of Body Mass Index to Adiposity among 8- to 19-Year-Olds within Several Races and Ethnicities

To assess the screening ability of a high body mass index (BMI) for high adiposity among 8- to 19-year-olds. This cross-sectional study included 6454 National Health and Nutrition Survey participants from 2011 through 2018. Fat and lean mass were measured with dual-energy X-ray absorptiometry. We expressed adiposity as fat mass index (FMI, kg÷m2) and %fat. Based on the Centers for Disease Control and Prevention 95th percentile, a high BMI correctly classified a high FMI for about 95% of participants in each racial and ethnic group. About 81% (Blacks) to 90% (Hispanics) of participants with a high BMI also had a high FMI. Further, children with a high BMI were 17 (Hispanics) to 46 (Blacks) times more likely to have a high FMI than those with a "normal" BMI. The screening ability of high BMI for high %fat was weaker because levels of %fat are influenced by both fat mass (numerator) and lean mass (denominator). Despite differences in body composition, a high BMI is a very good screening tool for identifying high FMI not only among White 8- to 19-year-olds but also among Asians, Blacks, and Hispanics. Compared with %fat, FMI is likely a better adiposity metric among children and adolescents.

Clinical outcomes and changes in body composition following endoscopic submucosal dissection versus total gastrectomy in patients with proximal early gastric cancer.

415 Background: Sarcopenia is associated with poor surgical outcomes and prognosis in patients with gastric cancer. However, the relationship between changes in skeletal muscle following endoscopic submucosal dissection (ESD) versus total gastrectomy (TG) in patients with proximal early gastric cancer (EGC) remains unclear. This study aimed to investigate the clinical outcomes and skeletal muscle mass changes between ESD and TG in patients with proximal EGC. Methods: We retrospectively reviewed 329 patients who underwent either ESD (n=127) or TG (n=202) for cT1N0M0 gastric cancer in the upper third of the stomach between 2015 and 2019 at a tertiary care center. The skeletal muscle index (SMI), visceral/subcutaneous fat, and abdominal circumference were measured preoperatively, and at 1 and 3 years after surgery, using cross-sectional computed tomography. We compared these parameters between the two groups and assessed both short- and long-term outcomes, as well as prognostic factors. Results: No significant differences were observed between the two groups with respect to overall survival (P=0.266), recurrence-free survival (P=0.079), or disease-specific survival (P=0.24). The recurrence rate was four (3.1%) in the ESD group and two (0.9%) in the TG group. Of the four recurrences in the ESD group, two were cured by gastrectomy, and two by ESD. Two recurrences in the TG group died of cancer progression. In the ESD group, all deaths were unrelated to gastric cancer, compared to 83.3% in the TG group (P=0.376). Patients in the ESD group showed more preserved SMI (P&lt;0.001), visceral/subcutaneous fat (P&lt;0.001), and abdominal circumference (P&lt;0.001) at 1 and 3 years after surgery, compared to the TG group. The incidence of sarcopenia was significantly lower in the ESD group at postoperative years 1 (22.2% vs. 34.7%, P=0.02) and years 3 (25.7% vs. 40.6%, P=0.001). Sarcopenia had a significant impact on survival, with 5-year OS rates being lower in patients with preoperative sarcopenia (85.3% vs. 95.6%, P=0.005). Multivariate analysis revealed that the prognostic nutritional index was significantly associated with OS (hazard ratio, 0.86; 95% confidence interval: 0.75–0.99, P=0.03). Conclusions: Although OS was comparable between the ESD and TG groups, ESD was associated with better preservation of skeletal muscle and visceral/subcutaneous fat. These results suggest that ESD should be considered for patients with proximal EGC who are at high risk for sarcopenia.

Development and application of a thermoregulatory control for a thermal manikin: A comparative study of the thermal response of young and elderly individuals

Thermal manikins enable a detailed, reproducible evaluation of the human body heat exchange with clothing and the surrounding environment. Conventional control of thermal manikins limits their use to steady-state conditions, but several studies have reported successful coupling of thermal manikins and human thermoregulatory models to expand their applicability to transient conditions. This study reports on the coupling of a thermal manikin with the open-source human thermoregulatory model JOS-3. The performance of the developed control was confirmed through climate chamber measurements within a temperature range corresponding to a predicted mean vote (PMV) of ± 2. Utilizing the capability of the JOS-3 model to personalize parameters such as age and body composition, a case study emulating the thermal response of young and elderly individuals was conducted. The manikin was exposed to transient conditions with and without local heating at room temperatures of 16, 19, and 21 °C. The measurement results showed that the manikin controlled with parameters of elderly individuals were more sensitive to the ambient temperatures and showed a larger decrease in body surface temperature. At 16 °C room temperature, the predicted whole-body thermal sensation based on body surface temperature showed a substantial increase with local heating only for the young individual setting. Measurements with the elderly individual setting did not yield a noticeable increase due to the lower surface temperature of body parts not targeted by the heater. The results confirmed that the developed control can assess the thermal response of different individuals in transient conditions.

Association between muscle mass, visceral adiposity, and histologic tumor stromal features in colon cancer.

Sarcopenia and obesity are indicators for poor outcomes in colon cancer. Additionally, aggressive histopathologic tumor stromal features, such as a low tumor-stroma ratio (TSR) and low tumor-infiltrating lymphocytes (TILs) predict survival and treatment response. As their relationship remains underexplored, we studied the association between skeletal muscle mass, visceral adipose tissue (VAT), TSR, and TILs in patients with colon cancer. We studied 194 stage II/III colon carcinoma patients who underwent elective surgery. Preoperative computed tomography (CT) scans classified patients into four groups based on skeletal muscle index (normal/low) and visceral adipose tissue index (normal/high). Tumor tissues were assessed for TSR and TILs, and five-year disease recurrence and relative hazard were evaluated. Among the patients, 56 (28.9%) were classified as Normal Muscle, Normal VAT, 26 (13.4%) as Normal Muscle, High VAT, 75 (38.7%) as Low Muscle, Normal VAT, and 37 (19.1%) as Low Muscle, High VAT. Patients with low skeletal muscle mass were more often male (62.5% vs. 39%, P=0.005). Stroma-high tumors were less common in Low Muscle, Normal VAT patients (24%) compared to Normal Muscle, High VAT (50%), Low Muscle, High VAT (48.6%), and Normal Muscle, Normal VAT (41.1%) patients (P=0.020). Tumors with low TILs were similarly distributed across groups (P=0.679). Low Muscle, Normal VAT patients had a lower recurrence hazard compared to both Low Muscle, High VAT (hazard ratio [HR] 0.34, 95% CI 0.12-0.98, P=0.048) and Normal Muscle, Normal VAT (HR 0.31, 95% CI 0.11-0.87, P=0.027) patients. Low Muscle, Normal VAT colon cancer patients exhibited fewer aggressive tumor features and a lower recurrence risk compared to Low Muscle, High VAT patients. These findings highlight the importance of body composition in tumor biology and prognosis.

Calf circumference may complement the nutritional assessment of children under 10 in the paediatric intensive care unit.

Nutritional intervention during hospitalisation is vital in managing of children and adolescents in intensive care. In this context, body composition measurements, such as mid-upper arm circumference (MUAC), can help improve the accuracy of nutritional assessments. However, using MUAC has some limitations. Calf circumference (CC) is a straightforward, inexpensive, and easily obtainable measurement. However, no reference values currently exist for CC in paediatric patients. To describe the nutritional monitoring of critically ill children and adolescents in the Paediatric Intensive Care Unit (PICU) using CC. Patients aged 6 months to 18 years old who were admitted to the PICUs participated in the study. Two MUAC and CC measurements were performed: one in the first 48h of admission to the PICU and another after 7 days. The percentage change between the two measurements was compared. Information was also evaluated about demographic and outcome data. Analyses were conducted with all patients included in the sample collectively and subdivided by age (<10 years and ≥10 years). Two hundred and eleven patients underwent anthropometric assessment on admission, and the sample for comparative analyses consisted of 103 patients (after discharges and deaths). MUAC and CC significantly decreased in the first week of hospitalisation. A positive weak correlation was found between the percentage change in the MUAC and CC only for individuals under 10 years old and for the total sample, but not for adolescents. The all age group and children under 10 years old showed a greater reduction in CC than in MUAC. The same did not occur for adolescents. Calf circumference may be a promising method for nutritional monitoring of critically ill children in Paediatric Intensive Care Units because it can indicate signs of depletion earlier than mid-upper arm circumference. These results are more meaningful for children than for adolescents.

CT Morphomics and Antifibrotic Therapy in Idiopathic Pulmonary Fibrosis

IntroductionIdiopathic pulmonary fibrosis (IPF) is a debilitating and fatal lung disease. Changes in body composition potentially correlate with outcomes in patients with IPF. Materials and MethodsPatients with IPF on antifibrotic treatment attending a single institution were identified and retrospectively evaluated (n=84). Three groups were formed based on antifibrotic treatment; Pirfenidone group, Nintedanib group and Pirfenidone-Nintedanib switch group. Morphomic analysis of muscle quantity (cross-sectional area in cm2) and quality (density in Hounsfield Units) on thoracic CT was performed using a web-based morphomic segmentation tool. Bilateral erector spinae and pectoralis muscles were measured at pre-defined vertebral levels. ResultsAll three treatment groups showed a statistically significant decline in forced vital capacity (FVC), diffusion capacity of the lung for carbon monoxide (DLCO), pectoral muscle cross sectional area (PMA) and erector spinae muscle cross sectional area (ESMA). Muscle density did not change significantly. Differences existed in analytic morphomics between treatment groups. Patients with a pre-treatment BMI below 30 were found to have a significantly greater loss of PMA when treated with Nintedanib instead of Pirfenidone. FVC and DLCO did not differ between treatment groups. ConclusionsThere were no direct correlations between pulmonary function and morphomic parameters in our entire group of IPF patients. However, between different treatment groups, the rate of muscle bulk loss differed. This is an important consideration for clinicians when deciding on an antifibrotic agent of choice.