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

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.

Prevalence of low muscle mass according to body mass index in older adults

Overweight and obesity in Mexican elementary school children increased ten percentage points in the last 30 years; one of the factors attributed is inadequate dietary quality. The objective of this study was to evaluate the association of monounsaturated fat intake with abdominal obesity and nutrient intake and obesity and overweight with dietary quality of elementary school children from Northwest Mexico. A cross-sectional study was conducted with 218 first grade elementary school children. A socioeconomic survey and two nonconsecutive 24-HR were applied, and anthropometric measurements were taken. Dietary quality was evaluated and classified as: healthy, medium and poor. Children consumed fewer servings of fruits, vegetables, legumes, dairy products and water than recommended by the Mexican food guidelines. A negative association was found among monounsaturated fat intake and abdominal obesity (p = .032). Only 1.4% of the children presented healthy dietary quality, 44.5% showed a medium dietary quality, and 54.1% had poor dietary quality. Poor dietary quality was associated with a lower intake of fiber (p = .002), protein (p = .002), potassium (p = .001) and vitamin E (p = .002). Elementary school children from Northwest Mexico have inadequate dietary quality that compromises their nutritional and health status, while monounsaturated fat intake could be a protective factor for abdominal obesity.

Background and Aims Kidney transplant recipients have a higher prevalence of osteoporosis and osteopenia compared to the general population. Sarcopenia, characterized by loss of skeletal muscle mass and strength, is also common in this population and is hypothesized to impact bone health. This study aimed to investigate the relationship between skeletal muscle mass index (SMI) and bone mineral density (BMD) in kidney transplant recipients, addressing sex-specific differences and other related factors. Method This retrospective observational cohort study included 371 kidney transplant recipients at least six months post-transplantation, followed at a single center for kidney transplant follow-up in Japan. BMD was measured at the femoral neck using dual-energy X-ray absorptiometry (DXA), while SMI was assessed using bioelectrical impedance analysis. Multivariate regression models were employed to analyze the independent association of SMI with BMD, adjusted for factors such as eGFRcysC and 25-hydroxy vitamin D (25(OH)D). Analyses were stratified by sex to account for biological differences. Results Of the 371 participants (65.4% male, median age 52 years), SMI was independently associated with BMD across both sexes. In multivariate analyses, eGFRcysC, 25(OH)D, and SMI were significant predictors of BMD. Additional sex-specific findings included hemoglobin as a significant factor in men, while age and serum albumin were influential in women. Neither dialysis history nor time since transplantation was significantly associated with BMD. Stratified comparisons by SMI and 25(OH)D levels highlighted their substantial impact on BMD. Conclusion Low SMI is independently associated with reduced BMD in kidney transplant recipients, underscoring the interplay between muscle and bone health. The findings suggest the importance of incorporating muscle mass evaluation into routine post-transplant care to better manage osteoporosis risk. Future prospective studies are warranted to explore whether interventions targeting skeletal muscle can improve BMD and reduce fracture risk in this population.

Influence of protein intake on the changes in skeletal muscle mass after kidney transplantation

The effect of low muscle mass on neck disorder and cervical movement kinematics in university students: A comparative study.

Chronic elevations in alanine aminotransferase (ALT) levels are associated with body composition. The aim of this study was to evaluate the relationship between elevated liver enzyme levels and the visceral tissue area in subjects with and without nonalcoholic fatty liver disease (NAFLD).An observational cohort study was conducted with subjects undergoing general health examinations. To evaluate the visceral and subcutaneous abdominal adipose tissue area, a computed tomography scan was performed. NAFLD was diagnosed if a person demonstrated fatty liver on ultrasonography without a history of significant alcohol consumption or chronic liver disease. Abnormal liver enzyme levels were based on ALT elevations according to the updated Asian definition.Of the 5100 subjects, 3712 (72.8%) met the inclusion criteria, and NAFLD was found in 1185 subjects. Elevated ALT values were positively correlated with body mass index, waist circumference, and subcutaneous and visceral adipose tissue area. These relationships were attenuated, although they remained significant in a dose-dependent manner, after adjusting for multiple liver injury risk factors. In addition, when body mass index and subcutaneous and visceral tissue areas were finally considered in combination, only visceral adipose tissue remained independently associated with elevated ALT levels in the ultrasonographically diagnosed NAFLD group (P for trend <0.001 for men and women).Elevated ALT levels were independently and dose-dependently associated with visceral fat accumulation in the healthy general population, especially in ultrasonographically diagnosed NAFLD patients. These results reemphasize the importance of visceral fat in the pathogenesis of NAFLD.

Poor diet quality is associated with biochemical parameters of protein nutritional status after Roux-en-Y gastric bypass

Associations between Diet Quality and Body Composition in Young Children Born with Very Low Body Weight

Malnutrition is a well-recognized predictor of poor prognosis in malignancies. Recent studies suggest that the geriatric nutritional risk index (GNRI) is a more accurate determinant of prognosis in elderly patients than conventional body mass index (BMI). This study aimed to evaluate the GNRI and body composition parameters in elderly patients with intrahepatic cholangiocarcinoma (ICC) and assess their prognostic impact on long-term outcomes. A total of 157 elderly ICC patients (aged ≥65 years) who underwent radical resection between 2009 and 2018 were retrospectively analyzed. Skeletal muscle index (SMI), muscle attenuation (MA), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and visceral-to-subcutaneous fat ratio (VSR) were quantified using computed tomography. Prognostic analyses were conducted using the Kaplan-Meier method, with adjustments using inverse probability weighting. A nomogram based on multivariate Cox regression was constructed and internally validated, comparing its prognostic accuracy with the TNM staging system. Among the body composition parameters, low SMI (sarcopenia, 56.1%), high VSR (visceral adiposity, 54.8%), and low MA (intramuscular fat deposition, 50.3%) were significantly associated with overall survival (OS) and recurrence-free survival (RFS) (all p < 0.05). Low GNRI was also a strong predictor of poor prognosis (p < 0.001). Multivariate analysis identified low GNRI (p = 0.009), sarcopenia (p = 0.020), visceral adiposity (p = 0.033), and intramuscular fat deposition (p = 0.036) as independent prognostic factors for OS and RFS. The nomogram, incorporating GNRI, SMI, VSR, MA, microvascular invasion (MVI), CA19-9 levels, and lymph node invasion, demonstrated superior prognostic performance compared to the TNM stage, with a C-index of 0.734 (OS) and 0.704 (RFS) and an AUC of 0.809 (OS) and 0.815 (RFS). GNRI, sarcopenia, IMF deposition, and visceral adiposity independently predict mortality and tumor recurrence in elderly ICC patients. Body composition is a major determinant of prognosis in patients with ICC. Our nomogram based on body composition reveals superior prognostic efficacy over TNM stages.

The nutritional status of patients with chronic obstructive pulmonary disease (COPD) is a significant factor that influences the prognosis of the disease. This observational study aimed to analyze the nutritional status of COPD patients and assess the associations between nutritional status, disease severity, and exercise capacity in four different regions of Croatia. In this multicenter study, 534 COPD patients were recruited and evaluated concerning fat-free mass (FFM), FFM index (FFMI), skeletal muscle mass index (SMMI), phase angle (PhA), pulmonary function tests, and the 6-minute walk test (6MWT). There were 325 (60.9%) male and 209 (39.1%) female patients with a mean age of 66.7±8.4 years. Most patients (73.2%) exhibited a moderate to severely abnormal obstructive pattern and had a reduced 6MWT distance (396.5±110.8 m). Among the participants, 32.8% were overweight and 22.3% were obese, and they had satisfactory values for nutritional status variables (FFM, FFMI, SMMI, PhA). There were no statistical differences between the centers in terms of nutritional status variables. There was a significantly positive correlation of forced expiratory volume in one second with body mass index (BMI) (r=0.148, p=0.001), PhA (r=0.256, p=0.00), FFM (r=0.365, p=0.00), and SMMI (r=0.238, p=0.00). However, there was no significant correlation of the 6MWT with BMI (r=-0.049, p=0.254), FFM (r=0.065, p=0.133), and SMMI (r=-0.007, p=0.867). The data analysis demonstrated that our patients were not underweight and that there was no significant difference between the centers in terms of BMI, FFM, FFMI, SMMI, and PhA. This lack of significant difference was observed even though one of the regions studied was Mediterranean.

BackgroundBody composition can be accurately quantified from abdominal computed tomography (CT) exams and is a predictor for the development of aging-related conditions and for mortality. However, reference ranges for CT-derived body composition measures of obesity, sarcopenia, and bone loss have yet to be defined in the general population.MethodsWe identified a population-representative sample of 4 900 persons aged 20 to 89 years who underwent an abdominal CT exam from 2010 to 2020. The sample was constructed using propensity score matching an age and sex stratified sample of persons residing in the 27-county region of Southern Minnesota and Western Wisconsin. The matching included race, ethnicity, education level, region of residence, and the presence of 20 chronic conditions. We used a validated deep learning based algorithm to calculate subcutaneous adipose tissue area, visceral adipose tissue area, skeletal muscle area, skeletal muscle density, vertebral bone area, and vertebral bone density from a CT abdominal section.ResultsWe report CT-based body composition reference ranges on 4 649 persons representative of our geographic region. Older age was associated with a decrease in skeletal muscle area and density, and an increase in visceral adiposity. All chronic conditions were associated with a statistically significant difference in at least one body composition biomarker. The presence of a chronic condition was generally associated with greater subcutaneous and visceral adiposity, and lower muscle density and vertebrae bone density.ConclusionsWe report reference ranges for CT-based body composition biomarkers in a population-representative cohort of 4 649 persons by age, sex, body mass index, and chronic conditions.

Diet Quality in Relation to Fat, Lean, and Bone Mass in Children: A Population-based Study (P18-105-19)

IntroductionInvolutional changes observed during aging increase rapidly in the postmenopausal period. These changes include body composition by affecting bone, muscle and fat tissue. A number of studies have investigated the mutual interaction between bone and muscle tissue, whereas adipose tissue had not been studied thoroughly.The aim of the present study was to assess the relation between fat tissue parameters and the musculoskeletal unit.Material and methodsThe study was conducted in a group of 120 postmenopausal women with an average age of 69 years (59–81; SD 5.3). All women had been asked to complete a questionnaire (medical history) and underwent a total body composition analysis [bone mineral density (BMD)] testing (spine and/or neck) followed by a handgrip test.ResultsThe study revealed strong correlations between appendicular skeletal muscle mass index – appen.lean/height2, visceral adipose tissue area (VAT) and fat/mass/height2 index (r = 0.589 and 0.658 respectively; p < 0.001). The results were not supported by muscle strength (handgrip). The authors identified correlations between the bone parameters and adipose tissue but these were identified as weak or moderate (p < 0.05). Special emphasis should be placed on the relation between the trabecular bone score (TBS) and VAT area (r = –0.385, p < 0.001).ConclusionsThere is a strong dependence between muscle and adipose tissues. Despite the fact that the increase in fat is correlated with the growth of muscle tissue, it is not accompanied by better quality of the muscle (handgrip). Bone microarchitecture is more related to VAT area than neck/spine BMD.

Predictors of maternal dietary quality and dietary inflammation during pregnancy: An individual participant data meta-analysis of seven European cohorts from the ALPHABET consortium