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

Background: 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.Methods: 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.Results: 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. Conclusion: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.

Nutrition in intestinal transplantation: centre stage or supporting act?

“…A recent study in 56 paediatric ITx patients found that 64% were sarcopenic before transplantation, but without a correlation with worse outcomes and surprisingly even a better graft survival in sarcopenic patients [15 ▪ ]. A study in adult ITx patients found that the preoperative diagnosis of malnutrition, established through CT scan measurements of adipose and muscle mass, predicted no increase in postoperative infections, length of stay or mortality [16 ▪ ]. Nonetheless, it seems reasonable to ‘prehabilitate’ transplant recipients as much as possible and optimize nutritional status, as well as to offer them physiotherapy to increase muscle mass.…”

Nutrition care for the adult post–intestinal transplant patient

“…24,25 In one study comparing sarcopenia and visceral adiposity in 42 pre-and posttransplant patients, 40% of patients were diagnosed with malnutrition at the time of pretransplant evaluation, and 60% were diagnosed with malnutrition after transplant. 26 Promptly identifying and addressing factors that can contribute to malnutrition can proactively mitigate the decline in nutrition status and helps maintain patients in an optimal state for transplantation. Therefore, it is crucial for these patients to receive close monitoring from a highly skilled registered dietitian nutritionist within the framework of an IF and/or transplant center that offers a multifaceted approach.…”

“…Malnutrition and sarcopenia have been associated with higher rates of morbidity and mortality while on waitlists and in the posttransplant setting, along with more frequent and extended hospital stays 24,25 . In one study comparing sarcopenia and visceral adiposity in 42 pre‐ and posttransplant patients, 40% of patients were diagnosed with malnutrition at the time of pretransplant evaluation, and 60% were diagnosed with malnutrition after transplant 26 . Promptly identifying and addressing factors that can contribute to malnutrition can proactively mitigate the decline in nutrition status and helps maintain patients in an optimal state for transplantation.…”