Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition? Structural and Functional Properties of Deep Abdominal Subcutaneous Adipose Tissue Explain Its Association With Insulin Resistance and Cardiovascular Risk in Men Dual-energy X-ray absorptiometry is a valid method to estimate visceral adipose tissue in adult patients with Prader-Willi syndrome during treatment with growth hormone. Epidemiology of sarcopenia among the elderly in New Mexico. Body composition is associated with clinical outcomes in patients with non-dialysis-dependent chronic kidney disease. Body composition in patients with non-small cell lung cancer: a contemporary view of cancer cachexia with the use of computed tomography image analysis. Muscle thickness, measured with ultrasound, may be an indicator of lean tissue wasting in multiple organ failure in the presence of edema. Body composition variation and impact of low skeletal muscle mass in patients with advanced medullary thyroid carcinoma treated with vandetanib: results from a placebo-controlled study. A critical analysis of whole body bioimpedance spectroscopy (BIS) for the estimation of body compartments in health and disease. Estimation of Body Composition and Normal Fluid Status Using a Calf Bioimpedance Technique Association of skeletal muscle wasting with treatment with sorafenib in patients with advanced renal cell carcinoma: results from a placebo-controlled study. Development of a bedside viable ultrasound protocol to quantify appendicular lean tissue mass Ultrasound assessment of lower limb muscle mass in response to resistance training in COPD Comparison of Bioimpedance and Dual-Energy X-Ray Absorptiometry for Measurement of Fat Mass in Hemodialysis Patients Longitudinal changes in anthropometrics and impact on self-reported physical function after traumatic brain injury. Computed tomography-derived skeletal muscle index: A novel predictor of frailty and hospital length of stay after transcatheter aortic valve replacement. Body Composition as an Independent Determinant of 5-Fluorouracil–Based Chemotherapy Toxicity Hypovitaminosis D is associated with increased whole body fat mass and greater severity of non-alcoholic fatty liver disease. Preoperative and postoperative agreement in fat free mass (FFM) between bioelectrical impedance spectroscopy (BIS) and dual-energy X-ray absorptiometry (DXA) in patients undergoing cardiac surgery. Postoperative Changes in Body Composition—Comparison of Bioelectrical Impedance Analysis and Magnetic Resonance Imaging in Bariatric Patients
Abstract Background Nutrition screening on admission to hospital is m and ated in many countries , but to date , there is no consensus on which tool is optimal in the oncology setting . Wasting conditions such as cancer cachexia ( CC ) and sarcopenia are common in cancer patients and negatively impact on outcomes ; however , they are often masked by excessive adiposity . This study aim ed to inform the application of screening in cancer population s by investigating whether commonly used nutritional screening tools are adequately capturing nutritionally vulnerable patients , including those with abnormal body composition phenotypes ( CC , sarcopenia , and myosteatosis ) . Methods A prospect i ve study of ambulatory oncology out patients presenting for chemotherapy was performed . A detailed survey incorporating clinical , nutritional , biochemical , and quality of life data was administered . Participants were screened for malnutrition using the Malnutrition Universal Screening Tool ( MUST ) , Malnutrition Screening Tool ( MST ) , and the Nutritional Risk Index ( NRI ) . Computed tomography ( CT ) assessment of body composition was performed to diagnose CC , sarcopenia , and myosteatosis according to consensus criteria . Results A total of 725 patients ( 60 % male , median age 64 years ) with solid tumours participated ( 45 % metastatic disease ) . The majority were overweight/obese ( 57 % ) . However , 67 % were losing weight , and CT analysis revealed CC in 42 % , sarcopenia in 41 % , and myosteatosis in 46 % . Among patients with CT‐identified CC , the MUST , MST , and NRI tools categorized 27 % , 35 % , and 7 % of them as ‘ low nutritional risk ’ , respectively . The percentage of patients with CT‐identified sarcopenia and myosteatosis that were categorised as ‘ low nutritional risk ’ by MUST , MST and NRI were 55 % , 61 % , and 14 % and 52 % , 50 % , and 11 % , respectively . Among these tools , the NRI was most sensitive , with scores < 97.5 detecting 85.8 % , 88.6 % , and 92.9 % of sarcopenia , myosteatosis , and CC cases , respectively . Using multivariate Cox proportional hazards models , NRI score < 97.5 predicted greater mortality risk ( hazard ratio 1.8 , confidence interval : 1.2–2.8 , P = 0.007 ) . Conclusions High numbers of nutritionally vulnerable patients , with demonstrated abnormal body composition phenotypes on CT analysis , were misclassified by MUST and MST . Caution should be exercised when categorizing the nutritional risk of oncology patients using these tools . NRI detected the majority of abnormal body composition phenotypes and independently predicted survival . Of the tools examined , the NRI yielded the most valuable information from screening and demonstrated usefulness as an initial nutritional risk grading system in ambulatory oncology patients OBJECTIVE Fat distribution is an important variable explaining metabolic heterogeneity of obesity . Abdominal subcutaneous adipose tissue ( SAT ) is divided by the Scarpa ’s fascia into a deep subcutaneous adipose tissue ( dSAT ) and a superficial subcutaneous adipose tissue ( sSAT ) layer . This study sought to characterize functional differences between the two SAT layers to explore their relative contribution to metabolic traits and cardiovascular risk ( CVR ) profile . RESEARCH DESIGN AND METHODS We recruited 371 Caucasians consecutively from a local r and om , population -based screening project in Oxford and 25 Asian Indians from the local community . The depth of the SAT layers was determined by ultrasound ( US ) , and adipose tissue ( AT ) biopsies were performed under US guidance in a subgroup of 43 Caucasians .  Visceral adipose tissue ( VAT ) mass was quantified by dual-energy X-ray absorptiometry scan . RESULTS Male adiposity in both ethnic groups was characterized by a disproportionate expansion of dSAT , which was strongly correlated with VAT mass . dSAT depth was a strong predictor of global insulin resistance ( IR ; homeostatic model assessment of IR ) , liver-specific IR ( insulin-like growth factor binding protein-1 ) , and Framingham risk score independently of other measures of adiposity in men . Moreover , dSAT had higher expression of proinflammatory , lipogenic , and lipolytic genes and contained higher proportions of saturated fatty acids . There was increased proportion of small adipocytes in dSAT . CONCLUSIONS SAT is heterogeneous ; dSAT exp and s disproportionally more than sSAT with increasing obesity in Caucasian males ( confirmed also in Asian Indians ) . Its expansion is related to increased CVR independent of other adiposity measures , and it has biological properties suggestive of higher metabolic activity contributing to global IR CONTEXT Visceral adipose tissue ( VAT ) is established as a risk factor for type 2 diabetes and cardiovascular disease , but the radiation exposure and cost of computed tomography ( CT ) measurements limits its daily clinical use . OBJECTIVE The main objective of this study was to compare the degree of agreement between VAT measurements by a new dual-energy X-ray absorptiometry ( DXA ) application and one of the st and ard methods , CT , in a population of patients with Prader-Willi syndrome ( PWS ) before and after GH treatment . Furthermore , we tested whether VAT estimations by these two methods are equivalent in assessing the metabolic risk in this population . DESIGN AND PATIENTS Data from the Norwegian population of a multicenter study in adults with genetically proven PWS were used . Subjects with complete anthropometry , biochemical , and imagistic measurements at all study visits ( baseline and after 12 and 24 months of GH treatment ) ( n = 14 , six men ) were included .  VAT was quantified both using CT scans ( GE Lightspeed 16 Pro ) of the abdomen at L2-L3 level and a total body DXA scan ( GE Healthcare Lunar Prodigy ) . RESULTS VAT DXA was strongly associated with VAT CT at baseline ( r = 0.97 ) and after 12 ( r = 0.90 ) and 24 months ( r = 0.89 ) of GH treatment ( all P < .001 ) . We found moderate to strong positive correlations between VAT by both methods , and blood pressure , weight , body mass index , waist circumference , glucose metabolism , and other fat depots ( arms , legs , and roid , trunk , total body ) but no association with age , gender , blood lipids , and IGF-I. Adiponectin was negatively associated with the amount of VAT . At baseline , the highest correlation with homeostasis model assessment of insulin resistance ( HOMA-IR ) was found for VAT DXA ( r = 0.76 , P = .001 ) and VAT CT ( r = 0.75 , P = .002 ) , respectively . CONCLUSION VAT can be accurately estimated by DXA , in patients with PWS , and might contribute to the assessment of the metabolic risk Muscle mass decreases with age , leading to " sarcopenia , " or low relative muscle mass , in elderly people . Sarcopenia is believed to be associated with metabolic , physiologic , and functional impairments and disability . Methods of estimating the prevalence of sarcopenia and its associated risks in elderly population s are lacking . Data from a  population -based survey of 883 elderly Hispanic and non-Hispanic white men and women living in New Mexico ( the New Mexico Elder Health Survey , 1993 - 1995 ) were analyzed to develop a method for estimating the prevalence of sarcopenia . An anthropometric equation for predicting appendicular skeletal muscle mass was developed from a r and om sub sample ( n = 199 ) of participants and was extended to the total sample . Sarcopenia was defined as appendicular skeletal muscle mass (kg)/height2 ( m2 ) being less than two st and ard deviations below the mean of a young reference group . Prevalences increased from 13 - 24 % in persons under 70 years of age to > 50 % in persons over 80 years of age , and were slightly greater in Hispanics than in non-Hispanic whites . Sarcopenia was significantly associated with self-reported physical disability in both men and women , independent of ethnicity , age , morbidity , obesity , income , and health behaviors . This study provides some of the first estimates of the extent of the public health problem posed by sarcopenia An inverse relationship between body mass index ( BMI ) and mortality ( the obesity paradox ) has been found in patients with non-dialysis-dependent chronic kidney disease ( CKD ) . However , it is unclear whether increased muscle mass or body fat confers the survival advantage . To resolve this we investigated the impact of body makeup on a composite outcome of death or cardiovascular events in a prospect i ve cohort of 326 patients with stage 3 - 5 CKD not yet on dialysis .  Lean mass and body fat were determined using the Body Composition Monitor , a multifrequency bioimpedance spectroscopy device , and were expressed as the lean tissue or fat tissue index , respectively . Patients were stratified as High ( above median ) or Low ( below median ) BMI , High or Low lean tissue index , or as High or Low fat tissue index . During a median follow-up of 4.6 years , there were 40 deaths and 68 cardiovascular events . In Cox proportional hazards models , a High lean tissue index , but not High BMI or High fat tissue index , predicted a lower risk of both the composite or its component outcomes ( reference : below median ) . When patients were further stratified into four distinct body composition groups based on both the lean and fat tissue index , only the High lean/fat tissue index group had a significantly lower risk of the composite outcome ( hazard ratio 0.36 , 95 % confidence interval 0.14 - 0.87 ; reference : Low lean/fat tissue index group ) . Thus , the lean tissue index can provide better risk prediction than the BMI alone in non-dialysis-dependent patients with CKD . The High lean/fat tissue index appears to be associated with best outcomes . An optimal body composition for improving the prognosis of CKD needs to be determined BACKGROUND The prominent clinical feature of cachexia has traditionally been understood to be weight loss ; however , in recognition of the potential for divergent behavior of muscle and adipose tissue , cachexia was recently defined as loss of muscle with or without loss of fat mass . Detailed assessment s are required to verify body composition in patients with cancer cachexia . DESIGN We adopted a population -based approach to study body composition in patients with cancer , with the use of diagnostic computed tomography images acquired for cancer diagnosis and follow-up . A prospect i ve cohort of 441 patients with non-small cell lung cancer , who were referred consecutively to a regional medical oncology service in Alberta , Canada , was evaluated . RESULTS At referral ( median time to death : 265 d ) , mean body mass index ( BMI ; in kg/m(2 ) ) was 24.9 , with 47.4 % of patients being overweight or obese . Only 7.5 % overall were underweight as conventionally understood ( BMI < 18.5 ) . Analysis of computed tomography images showed extremely high heterogeneity of muscle mass within all strata of BMI . The overall prevalence of severe muscle depletion ( sarcopenia ) was 46.8 % and was present in patients in all BMI categories . A much higher proportion of men ( 61 % ) than women ( 31 % ) met the criteria for sarcopenia . CONCLUSIONS Wasting of skeletal muscle is a prominent feature of patients with lung cancer , despite normal or heavy body weights . The significance of muscle wasting in normal-weight , overweight , and obese patients as a nutritional risk factor , as a prognostic factor , and as a predictor of cancer treatment toxicity is discussed in this article Multiple organ failure ( MOF ) is accompanied by muscle wasting , but changes in body composition are frequently obscured by fluid retention ( edema ) , mainly in superficial and visceral tissue . There is a need to assess body composition and changes in body composition in these circumstances independently of edema . A relation was sought between fat-free ( lean tissue ) mass [ calculated from body weight and skinfold thicknesses and measured by using dual-energy X-ray absorptiometry ( DXA ) ] and muscle thickness ( measured using ultrasound at a variety of sites accessible in an unconscious supine subject ) to determine which sites correlated best with lean body mass . The three best sites were midbiceps , midforearm anteriorly , and midthigh anteriorly : R2 for the simple sum of the three sites correlated with fat-free mass from skinfold thicknesses was 71.1 % , and with lean tissue mass from DXA was 76.1 % . Serial measurements of both muscle thickness and midupper-arm circumference in nine patients with MOF showed a complete dissociation ; in all nine there was a significant negative correlation of muscle thickness with time ( P < 0.05 ) but changes in arm circumference were r and om . Only one patient showed a significant negative correlation with time , seven showed no change , and one other showed a significant increase . The muscle thicknesses that correlate best with lean body mass are measured over the biceps , anterior forearm , and anterior thigh . Monitoring muscle thicknesses at these three sites identifies wasting in edematous patients as it is happening OBJECTIVES V and etanib was approved by the U.S. Food and Drug Association for the treatment of advanced medullary thyroid cancer ( MTC ) . Because body weight ( BW ) loss is observed in MTC and because low skeletal muscle mass ( SM ) is associated with drug toxicity , this study assessed effects of v and etanib on SM and adipose tissue ( AT ) and explored the association between SM , toxicity , and serum concentration of v and etanib . METHODS Thirty-three patients with MTC received v and etanib ( n = 23 ) or placebo ( n = 10 ) in the ZETA study .  Visceral AT ( VAT ) , sc AT ( SAT ) , and SM were assessed with computed tomography imaging by measuring tissue cross-sectional areas ( square centimers per square meter ) . Dose-limiting toxicities ( DLTs ) were prospect ively recorded . RESULTS Early at 3 months , compared with placebo group who lost BW , muscle , and SAT , patients treated with v and etanib gained 1.5 kg BW ( P = 0.02 ) , 1.3 cm(2)/m(2 ) ( ∼0.7 kg ) of SM ( P = 0.009 ) , and 4.5 cm(2)/m(2 ) ( ∼0.5 kg ) of SAT ( P = 0.004 ) and gained more VAT , 5.1 cm(2)/m(2 ) ( ∼0.7 kg ) ( P = 0.02 ) . Patients with DLT had lower SM index ( 37.2 vs 44.3 cm(2)/m(2 ) , P = 0.003 ) and a higher v and etanib serum concentration ( 1091 vs 739 ng/mL , P = 0.03 ) . Patients with SM index < 43.1 cm(2)/m(2 ) had a higher probability of DLT ( 73 % vs 14 % , P = 0.004 ) and a higher v and etanib serum concentration ( 1037 vs 745 ng/mL , P = 0.04 ) . Patients with the highest compared with the intermediate and lower levels of v and etanib serum concentration experienced more DLT , respectively , 78 % vs 40 % vs 20 % ( P = 0.04 ) . CONCLUSIONS Muscle and adipose tissues are restored after only 3 months of v and etanib treatment . Patients with low muscle mass had high v and etanib serum concentration and high incidence of toxicities Aim of the study was to assess the accuracy and precision of a BIS device and the relative contribution of BIS beyond the anthropometric parameters . The output of the Impedimed device ( SFB7 ) and the relative contribution of height , weight , age , sex and resistance values at zero and infinite frequency ( Rzero and Rinf respectively ) to the prediction of total body water ( TBWd , deuterium space ) , of extracellular fluid ( ECFbr , sodium bromide space ) and of fat mass ( FMDXA ) were assessed in 116 subjects ( 32 healthy subjects and 84 patients with disorders of body composition ) . Using a repeated r and omization procedure , new equations for TBW , ECF and FM were derived . The SFB7 gave measures of determination similar to those obtained with equations that included only anthropometric data . The SFB7 , but not the newly derived regression equations , underestimated TBW and ECF by 3.82±3.37 ( mean±SD ) and by 0.93±2.62l and overestimated FM by 6.55±3.86 kg . Nine of 16 patients  with ECF overload as detected by ECFbr were also detected by BIS . BIS measurements contribute marginally but not significantly beyond anthropometric data to the prediction of TBW , ECF and FM , either in healthy subjects or in patients with disturbed body composition The aims of this study in hemodialysis ( HD ) patients were : 1 . To evaluate the relationship of calf bioimpedance with total body composition and fluid status as measured by gold st and ard methods . 2 . To investigate the ability of calf normalized resistivity ( CNR ) to predict the normal fluid status ( dry weight : DW ) in a prospect i ve study . In the body composition study ( n = 41 ) , fluid status ( ECVBr/FFMMRI ) , muscle mass ( MMMRI ) , and total adipose tissue ( TATMRI ) were measured by dilution ( D2O and Br ) and MRI methods three hours prior to HD treatment . Calf extracellular and intracellular resistance , resistivity , and CNR were measured with a multi-frequency bioimpedance device ( Hydra 4200 ) . In the fluid status study ( n = 32 with 429 measurements ) , a nonlinear model based on the differences in CNR between patients and healthy subjects was established to predict DWcBIS previously determined by a separate continuous calf bioimpedance spectroscopy ( cBIS ) method . CNR significantly correlated with a gold st and ard hydration marker ( ECVBr/FFMMRI ) . Calf body composition models were highly correlated with MMMRI ( R2 = 0.85 ) and TATMRI ( R2 = 0.85 ) . DWcBIS prediction was vali date d with a CNR model in the degree of differences of 0.94 ± 0.18 , 0.39 ± 0.7 and -0.02 ± 0.8 kg from DWcBIS when post HD fluid overload was 1.8 ± 1.2 , 1.15 ± 0.8 and 0.54 ± 0.5 kg , respectively . These differences are not considered to be clinical ly significant . Conclusion : This practical method of calf bioimpedance is useful to predict body composition and normal fluid status in dialysis patients PURPOSE Effects of specific antineoplastic therapies on progression of cancer-associated wasting remain uncharacterized . We selected a targeted therapy , sorafenib , because of its reported association with weight loss . PATIENTS AND METHODS Patients with metastatic renal cell cancer ( RCC ) who were resistant to st and ard therapy ( N = 80 ) received sorafenib 400 mg twice daily or placebo in a r and omized , double-blinded clinical trial . Computed tomography image analysis , which has high precision and specificity for evaluation of specific muscles and adipose tissues , was used to define change in total skeletal muscle and adipose tissue . Results At inclusion , 51 % of patients were overweight or obese ( ie , body mass index [ BMI ] > 25 kg/m(2 ) ) . Only 5 % were underweight .  Advanced muscle wasting ( ie , sarcopenia ) was present in 72 % of patients with BMI less than 25 and in 34 % of those with a BMI greater than 25 . Patients received placebo for an average of 6 months and received sorafenib for 1 year . Patients in the placebo group had stable body weight during 6 months ( 0.8 kg + /- 0.7 kg ) , with no significant alteration of muscle or fat . Patients who received sorafenib  lost 2.1 kg + /- 0.6 kg ( P < .01 ) in 6 months and lost 4.2 kg + /- 0.7 kg ( P < .01 ) by 1 year . Sorafenib-treated patients lost skeletal muscle progressively at 6 months ( decrease of 4.9 % ; P < .01 ) and 12 months ( decrease of 8.0 % ; P < .01 ) . CONCLUSION Sarcopenia is prevalent in patients with metastatic RCC and is an occult condition in patients with normal or high BMI . Muscle loss is specifically exacerbated by sorafenib , consistent with the evidence for a role of kinases in regulating muscle mass . Muscle loss is a sorafenib adverse effect that may relate to asthenia , fatigue , and physical disability Abstract Background Ultrasound is a non‐invasive and readily available tool that can be prospect ively applied at the bedside to assess muscle mass in clinical setting s. The four‐site protocol , which images two anatomical sites on each quadriceps , may be a viable bedside method , but its ability to predict musculature has not been compared against whole‐body reference methods . Our primary objectives were to ( i ) compare the four‐site protocol 's ability to predict appendicular lean tissue mass from dual‐energy X‐ray absorptiometry ; ( ii ) optimize the predictability of the four‐site protocol with additional anatomical muscle thicknesses and easily obtained covariates ; and ( iii ) assess the ability of the optimized protocol to identify individuals with low lean tissue mass . Methods This observational cross‐sectional study recruited 96 university and community dwelling adults . Participants underwent ultrasound scans for assessment of muscle thickness and whole‐body dual‐energy X‐ray absorptiometry scans for assessment of appendicular lean tissue . Ultrasound protocol s included ( i ) the nine‐site protocol , which images nine anterior and posterior muscle groups in supine and prone positions , and ( ii ) the four‐site protocol , which images two anterior sites on each quadriceps muscle group in a supine position . Results The four‐site protocol was strongly associated ( R 2 = 0.72 ) with appendicular lean tissue mass , but Bl and –Altman analysis displayed wide limits of agreement ( −5.67 , 5.67 kg ) . Incorporating the anterior upper arm muscle thickness , and covariates age and sex , alongside the four‐site protocol , improved the association ( R 2 = 0.91 ) with appendicular lean tissue and displayed narrower limits of agreement ( −3.18 , 3.18 kg ) . The optimized protocol demonstrated a strong ability to identify low lean tissue mass ( area under the curve = 0.89 ) . Conclusions The four‐site protocol can be improved with the addition of the anterior upper arm muscle thickness , sex , and age when predicting appendicular lean tissue mass . This optimized protocol can accurately identify low lean tissue mass , while still being easily applied at the bedside Background Quantifying the improvements in lower limb or quadriceps muscle mass following resistance training ( RT ) , is an important outcome measure in COPD .  Ultrasound is a portable , radiation free imaging technique that can measure the size of superficial muscles belonging to the quadriceps group such as the rectus femoris , but has not been previously used in COPD patients following RT . We compared the responsiveness of ultrasound derived measures of quadriceps mass against dual energy x-ray absorptiometry ( DEXA ) , in patients with COPD and healthy controls following a programme of high intensity knee extensor RT . Methods Portable ultrasound was used to assess the size of the dominant quadriceps in 45 COPD patients and 19 healthy controls-before , during , and after 8 weeks of bilateral high intensity isokinetic knee extensor RT . Scanning was performed at the mid-thigh region , and 2 indices of quadriceps mass were measured-rectus femoris cross-sectional area ( RFcsa ) and quadriceps muscle thickness ( Qt ) . Thigh lean mass ( Tdexa ) was determined by DEXA . Results Training result ed in a significant increase in Tdexa , RFcsa and Qt in COPD patients [ 5.7 % , 21.8 % , 12.1 % respectively ] and healthy controls [ 5.4 % , 19.5 % , 10.9 respectively ] . The effect size for the changes in RFcsa ( COPD = 0.77 ; Healthy=0.83 ) and Qt ( COPD = 0.36 ; Healthy=0.78 ) were greater than the changes in Tdexa ( COPD = 0.19 ; Healthy=0.26 ) following RT . Conclusions Serial ultrasound measurements of the quadriceps can detect changes in muscle mass in response to RT in COPD . The technique has good reproducibility , and may be more sensitive to changes in muscle mass when compared to DEXA.Trial registration http://www.controlled-trials.com ( Identifier : IS RCT N22764439 Background : Fat mass ( FM ) is measured with dual-energy X-ray absorptiometry ( DXA ) , but is expensive and not portable . Multifrequency bioimpedance spectroscopy ( BIS ) measures total body water ( TBW ) , intracellular water ( ICW ) and extracellular water ( ECW ) . FM is calculated by subtracting fat-free mass ( FFM ) from weight assuming a fractional hydration of FFM of 0.73 . Hemodialysis ( HD ) patients , however , have nonphysiologic expansion of ECW . Our aim was to apply a model to estimate FM in HD patients and controls . Methods : We estimated the hydration of FFM in healthy subjects and HD patients with  BIS  ( Impedimed multifrequency ) assuming a hydration of 0.73 or using a model allowing ECW and ICW to vary , deriving a value for FM accounting for variances in ECW and ICW . FM was measured by DXA ( Hologic Discovery W ) in 25 controls and in 11 HD patients . We measured TBW , ECW and ICW with BIS and calculated FM using either weight - TBW/0.73 or with a model accounting for variations in ECW/ICW to estimate FM . Results : ECW/ICW was greater in HD patients than in controls ( 0.83 ± 0.08 vs. 0.76 ± 0.04 ; p = 0.001 ) . FM ( kg ) measured by DXA or estimated from TBW using constant hydration or accounting for variations in ECW/ICW was not significantly different in controls or in HD patients . Values obtained by all methods correlated ( p < 0.001 ) and none of the Bl and -Altman plots regressed ( r2 = 0.00 ) . FM measured by DXA and by BIS in both controls and HD patients combined correlated ( r2 = 0.871 ) . Conclusion : Expansion of ECW in HD patients is statistically significant ; however , the effect on hydration of FFM was insufficient to cause significant deviation from values derived using a hydration value of 0.73 within the range of expansion of ECW in the HD patient population studied here BACKGROUND AND AIMS Patients admitted to the ICU with a traumatic brain injury ( TBI ) are at risk of muscle wasting but this has not been quantified . Our aims were to describe longitudinal changes in anthropometrical data , compare the accuracy of non-invasive method ologies to the vali date d dual-energy x-ray absorptiometry ( DXA ) , and assess the relationships between anthropometrical data and self-reported physical function . METHODS In a prospect i ve observational study , we recruited patients admitted to the ICU with a moderate-to-severe TBI over 12 months .  Anthropometric measurements included the subjective global assessment ( SGA ) , bodyweight and ultrasoundderived quadriceps muscle layer thickness ( QMLT ) , which we performed weekly in hospital and 3 months after admission . We assessed total body composition using DXA within 7 days of ICU discharge , and compared the total lean muscle mass with ultrasound-derived QMLT taken within 5 days of the DXA measurement . We assessed functional outcomes at 3 months using the physical component score of the Short Form-36 ( SF- 36 ) and the Extended Glasgow Outcome Scale ( GOS-E ) . RESULTS Thirty-seven patients were included , with a mean age of 45 years ( SD , 16 years ) , and 87 % were men . Participants were admitted to the ICU for a mean of 13 days ( IQR , 6 - 18 days ) and to hospital for a mean of 38 days ( IQR , 19 - 52 days ) . They had significant weight loss in hospital ( mean , 4.9 % [ SD , 7.7 % ] ; P = 0.001 ) . Malnutrition , measured with the SGA , was twice as prevalent at hospital discharge than at admission ( P = 0.005 ) . A reduction in QMLT occurred in the ICU but stabilised after ICU discharge . DXA-derived total lean mass taken within 7 days of ICU discharge strongly correlated with ultrasound-derived QMLT taken within 5 days of DXA measurements ( ρ = 0.74 , P = 0.037 ) . Improvements in self-reported physical function , using the SF- 36 and GOS-E at 3 months , were associated with a greater QMLT at hospital discharge ( SF-36 : ρ = 0.536 , P = 0.010 ; GOS-E : ρ = 0.595 , P = 0.003 , n = 23 ) and at 3 months ( SF-36 : ρ = 0.658 , P = 0.020 ; GOS-E : ρ = 0.642 , P = 0.025 , n = 12 ) . CONCLUSIONS Patients with a TBI lose muscle thickness while in the ICU but the trajectory of loss stabilises after ICU discharge . Ultrasound-derived QMLT is related to total lean mass and physical function after discharge . Further studies are needed to confirm that ultrasound measurement of QMLT is a useful surrogate measure of muscle mass and functional outcomes after trauma and critical illness To determine the prevalence of low skeletal muscle mass in patients undergoing transcatheter aortic valve replacement ( TAVR )  and whether skeletal muscle mass measured from preoperative computed tomography ( CT ) images provides value in predicting postoperative length of stay ( LOS ) . BACKGROUND There are limited data on the use of body composition as a frailty measure in TAVR patients and no studies have determined if this measure predicts LOS . METHODS We studied 104 consecutive patients who underwent TAVR at Tallahassee Memorial Hospital from 2012 to 2016 . Patient demographics , st and ard frailty measures ( h and grip , albumin , and 5-m walk test ) , clinical comorbidities , echocardiographic data , and Valve Academic Research Consortium II major complications were recorded prospect ively . Skeletal muscle index ( SMI ) [ skeletal muscle mass cross-sectional area at L3/height2 ] was measured from CT images using Slice-O-Matic software ( Tomovision , Montreal , Quebec , Canada ) . Clinical outcomes were assessed and multivariate methods used to determine predictors of LOS . RESULTS Sarcopenia was prevalent in men ( 83 % ) and women ( 56 % ) . Patients who suffered from a major complication had significantly longer length of stay ( 13 vs 4.6days , P<.0001 ) . Skeletal muscle index correlated with age , sex , body mass index , h and grip strength , and previous coronary artery bypass graft surgery , but not major complications . A multivariate model including all univariate predictors of LOS showed SMI , major complications , transapical access , atrial fibrillation , and chronic obstructive pulmonary syndrome as independent predictors of LOS . For every 14-cm2/m2 increase in SMI , there was a 1-day reduction in LOS . None of the st and ard measures of frailty predicted LOS . CONCLUSIONS Skeletal muscle index , a measure of sarcopenia readily determined from pre-TAVR CT scans , independently predicts TAVR LOS better than st and ard frailty testing . Further evaluation of SMI as a frailty measure after TAVR and other cardiovascular procedures is warranted Purpose : Evidence suggests that lean body mass ( LBM ) may be useful to normalize doses of chemotherapy . Data from a prospect i ve study were used to determine if the highest doses of 5-fluorouracil ( 5-FU ) per kilogram LBM would be associated with dose-limiting toxicity in stage II/III colon cancer patients treated with 5-FU and leucovorin .  Experimental Design : Toxicity after cycle 1 was grade d according to National Cancer Institute Common Toxicity Criteria , version 2.0 . Muscle tissue was measured by computerized tomography . An extrapolation to the LBM compartment of the whole body was employed . Results : Mean values of 5-FU/LBM of the entire population were different in terms of presence or absence of toxicity ( P = 0.036 ) . A cut point of 20 mg 5-FU/kg LBM seemed to be a threshold for developing toxicity ( P = 0.005 ) . This observation was pertinent to women ( odds ratio , 16.73 ; P = 0.021 ) . Women in this study had a relatively low proportion of LBM relative to their body surface area . Conclusion : Our study shows that low LBM is a significant predictor of  toxicity in female patients administered 5-FU  using the convention of dosing per unit of body surface area . We conclude that variation in toxicity between females and males may be partially explained by this feature of body composition BACKGROUND & AIMS Hypovitaminosis D is common in obesity and insulin-resistant states . Increased fat mass in patients with non-alcoholic fatty liver disease ( NAFLD ) may contribute to hypovitaminosis D. To determine the relation among plasma vitamin D concentration , severity of disease and body composition in NAFLD . METHODS  Plasma vitamin D concentration  was quantified in 148 consecutive biopsy-proven patients with NAFLD ( non-alcoholic steatohepatitis - NASH : n = 81 ; and hepatic steatosis : n = 67 ) and healthy controls ( n = 39 ) . NAFLD was scored using the NASH CRN criteria . Body composition was quantified by bioelectrical impedance analysis and abdominal CT image analysis . RESULTS Plasma vitamin D concentration was significantly lower in NAFLD ( 21.2 ± 10.4 ng/ml ) compared with healthy controls ( 35.7 ± 6.0 ng/ml ) . Higher NAFLD activity scores were associated with lower plasma concentration of vitamin D ( r(2 ) = 0.29 ; P < 0.001 ) . Subgroup analysis among patients with NAFLD showed that patients with NASH had significantly lower ( P < 0.01 ) vitamin D levels than those with steatosis alone ( 18.1 ± 8.4 vs. 25.0 ± 11.3 ng/ml ) . Low concentrations of vitamin D were associated with greater severity of steatosis , hepatocyte ballooning and fibrosis ( P < 0.05).On multivariate regression analysis , only severity of hepatocyte ballooning was independently associated ( P = 0.02 ) with low vitamin D concentrations . Plasma vitamin D ( P = 0.004 ) and insulin concentrations ( P = 0.03 ) were independent predictors of the NAFLD activity score on biopsy . Patients with NAFLD had higher fat mass that correlated with low vitamin D ( r(2 ) = 0.26 ; P = 0.008 ) . CONCLUSIONS Low plasma vitamin D concentration is an independent predictor of the severity of NAFLD . Further prospect i ve studies demonstrating the impact of vitamin D replacement in NAFLD patients are required BACKGROUND & AIMS To measure undernutrition in terms of fat free mass ( FFM ) , there are several options . The aim of this study was to assess agreement in FFM between the portable , bedside bioelectrical impedance spectrometry ( BIS ) and relatively expensive , non-portable dual-energy X-ray absorptiometry ( DXA ) in patients undergoing cardiac surgery . METHODS In a prospect i ve study , body composition measurements by BIS and DXA were performed two weeks prior and two months after cardiac surgery . Preoperative and postoperative agreement in FFM between BIS and DXA were analyzed with Bl and and Altman plots . RESULTS Twenty-six patients were analyzed .  BIS  overestimated preoperative and postoperative FFM by 2 kg compared to DXA ( 2.3 kg ( 95%CI : -3.5 - 8.1 kg ) and 2.1 kg ( 95%CI : -4.5 - 8.7 kg ) , respectively ) . BIS underestimated FFM change by -0.5 % ( 95%CI : -8.4 - 7.5 % ) . CONCLUSIONS There is a large inter-individual variation between BIS and DXA . This hinders the interchange-ability of BIS and DXA in routine clinical practice and may lead to misclassifications and thereby inappropriate nutritional treatment and possible postoperative complications . To evaluate nutritional therapy in patients undergoing cardiac surgery , we advocate the use of DXA assessed FFM in parallel to BIS assessed extracellular and intracellular water and FFM Background Roux-en-Y gastric bypass ( RYGB ) result in a marked reduction of body fat and also visceral fat ( VF ) decrease up to 36 % in 16 weeks . This leads to positive effects on cardiometabolic risks , which are known to be correlated with the occurrence of VF . This study analyzed the validity of bioelectrical impedance analysis ( BIA ) for determining VF in the postoperative course . In addition , magnetic resonance imaging ( MRI ) was performed for prediction of whole VF in bariatric patients on the basis of a single slice . Methods Eighteen patients , who underwent RYGB ( 18 ) , were included in this study .  MRI and BIA measurements were performed 1 day before surgery , as well as 6 , 12 , and 24 weeks after surgery . Results During the postoperative observation period , we found a significant decrease of both subcutaneous fat ( SF ) and VF . SF measured by MRI was highly correlated with the level of body fat shown by BIA . In contrast , the VF volume , as determined by MRI , showed no correlation with the body fat measured by BIA . In addition , we were able to show a significant correlation between MRI measured VF volume and the particular single-layer fat area . Conclusions Compared to the widely used bioelectrical impedance analysis to measure changes in body composition after bariatric procedures , a single-layer MRI was superior in determining VF . Single-layer MRI may be a better tool to recognize changes of VF after bariatric procedures
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