Myosteatosis is associated with poor physical fitness in patients undergoing hepatopancreatobiliary surgery

Abstract

Background Body composition assessment, measured using single‐slice computed tomography (CT) image at L3 level, and aerobic physical fitness, objectively measured using cardiopulmonary exercise testing (CPET), are each independently used for perioperative risk assessment. Sarcopenia (i.e. low skeletal muscle mass), myosteatosis [i.e. low skeletal muscle radiation attenuation (SM‐RA)], and impaired objectively measured aerobic fitness (reduced oxygen uptake) have been associated with poor post‐operative outcomes and survival in various cancer types. However, the association between CT body composition and physical fitness has not been explored. In this study, we assessed the association of CT body composition with selected CPET variables in patients undergoing hepatobiliary and pancreatic surgery. Methods A pragmatic prospective cohort of 123 patients undergoing hepatobiliary and pancreatic surgery were recruited. All patients underwent preoperative CPET. Preoperative CT scans were analysed using a single‐slice CT image at L3 level to assess skeletal muscle mass, adipose tissue mass, and muscle radiation attenuation. Multivariate linear regression was used to test the association between CPET variables and body composition. Main outcomes were oxygen uptake at anaerobic threshold ( O 2 at AT), oxygen uptake at peak exercise ( O 2 peak), skeletal muscle mass, and SM‐RA. Results Of 123 patients recruited [77 men (63%), median age 66.9 ± 11.7, median body mass index 27.3 ± 5.2], 113 patients had good‐quality abdominal CT scans available and were included. Of the CT body composition variables, SM‐RA had the strongest correlation with O 2 peak ( r = 0.57, P < 0.001) and O 2 at AT ( r = 0.45, P < 0.001) while skeletal muscle mass was only weakly associated with O 2 peak ( r = 0.24, P < 0.010). In the multivariate analysis, only SM‐RA was associated with O 2 peak ( B = 0.25, 95% CI 0.15–0.34, P < 0.001, R 2 = 0.42) and O 2 at AT ( B = 0.13, 95% CI 0.06–0.18, P < 0.001, R 2 = 0.26). Conclusions There is a positive association between preoperative CT SM‐RA and preoperative physical fitness ( O 2 at AT and at peak). This study demonstrates that myosteatosis, and not sarcopenia, is associated with reduced aerobic physical fitness. Com...

Visceral Adiposity and High Intramuscular Fat Deposition Independently Predict Critical Illness in Patients with SARS‐CoV‐2

“…Second, the possibility of selection bias in patient inclusion in the study group must be considered, as abdominal CT scan is not a routine examination for COVID‐19 patients. Besides, physical activity levels were not analyzed in our study, although they have been widely associated with adipose tissue distribution in previous studies (16,28). The association between smoking and severity of COVID‐19 is controversial; it was not analyzed in our study because electronic medical records for smoking were not complete in our hospital during the outbreak period (37,38).…”

“…Furthermore, lipids can be stored within skeletal muscle when the capacity for fat storage by subcutaneous and visceral tissue are exceeded, known as intramuscular fat (IMF) tissue (14). IMF deposition not only reflects the quality of muscle and poor physical function, it is also an independent risk factor for prognosis after cardiac and oncologic surgery (16‐19).…”

Enhanced recovery after surgery programmes in older patients undergoing hepatopancreatobiliary surgery: what benefits might prehabilitation have?

“…Body composition assessment, measured using routinely performed abdominal computed tomography (CT scan), demonstrated that both sarcopenia [61e63] and myosteatosis [64] contribute to poor postoperative outcomes following major abdominal surgery. As a recent study found that myosteatosis, and not sarcopenia, was associated with reduced aerobic fitness, combining preoperative body composition and aerobic fitness variables may provide additive risk assessment accuracy and guide interventions during the perioperative period in patients undergoing HPB surgery [65].…”

Myosteatosis predicting risk of transition to severe COVID-19 infection

“…Myosteatosis indicating fat deposition inside the muscles is defined as abnormal distribution of inter and intra-myocellular adipose tissue, which is related to reduced muscle quality, physical fitness and muscle function [ [19] , [20] , [21] ]. Computed tomography (CT) is one of common methods for accessing myosteatosis with a radiological marker termed skeletal muscle radiation attenuation (SM-RA) [ [21] , [22] , [23] ].…”