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World J Hepatol. Jul 27, 2026; 18(7): 122692
Published online Jul 27, 2026. doi: 10.4254/wjh.122692
Computed tomography-based correction of the body mass index improves malnutrition detection in patients with cirrhosis and ascites
Hong-Jing Zhao, Lin-Hao Su, Fan-Hao Lu, Feng Gao, Jin-Hai Sai, Ping Li, Jun-Li Shi, Lei Wang, Si-Jin Li, Fan Zhou, Long-Mei Zhou, Na Wang, Pei-Yuan He
Hong-Jing Zhao, Ping Li, Jun-Li Shi, Lei Wang, Si-Jin Li, Fan Zhou, Long-Mei Zhou, Pei-Yuan He, Department of Gastroenterology and Hepatology, The Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
Lin-Hao Su, Department of Biomedical Engineering, Chengde Medical University, Chengde 067000, Hebei Province, China
Fan-Hao Lu, Feng Gao, Na Wang, Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Jin-Hai Sai, Department of Radiology, The Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei Province, China
Co-first authors: Hong-Jing Zhao and Lin-Hao Su.
Author contributions: Zhao HJ and Su LH contributed equally to this article, they are the co-first authors of this manuscript; Zhao HJ and He PY designed the study; Zhou F, Li P, and Li SJ collected clinical data; Su LH and Sai JH were responsible for computed tomography image processing, ascites segmentation, three-dimensional reconstruction, and ascites volume measurement using 3D Slicer, including slice-by-slice review and manual correction of the segmentation results; Lu FH, Gao F, and Zhou LM analyzed the data and prepared the figures; Zhao HJ and Shi JL drafted the manuscript; Wang L and Wang N revised the manuscript critically; and all authors approved the final version.
AI contribution statement: Doubao was used solely for English translation and language polishing during manuscript preparation. The AI-assisted text was carefully reviewed, verified, and revised by the authors. No AI tool was used to generate original research data, perform data analysis or statistical analysis, create figures or tables, or draw scientific conclusions. The authors take full responsibility for the accuracy, originality, integrity, and scientific validity of the manuscript and all submitted materials.
Supported by the Medical Science Research Project of Hebei Province, No. 20240053; and the Hebei Natural Science Foundation, No. H2023206912.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Affiliated Hospital of Chengde Medical University, approval No. CYFYLL2023431.
Informed consent statement: The requirement for informed consent was waived because of the retrospective design and the use of anonymized clinical data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data underlying this study are not publicly available because they contain sensitive patient information but are available from the corresponding author on reasonable request and with permission from the Ethics Committee of the Affiliated Hospital of Chengde Medical University.
Corresponding author: Pei-Yuan He, PhD, Chief Physician, Department of Gastroenterology and Hepatology, The Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi Street, Shuangqiao District, Chengde 067000, Hebei Province, China.
peiyuanhe@163.com
Received: April 30, 2026
Revised: June 17, 2026
Accepted: July 10, 2026
Published online: July 27, 2026
Processing time: 86 Days and 4.2 Hours
BACKGROUND
In patients with cirrhosis and ascites, fluid retention may artificially increase their body weight and body mass index (BMI), potentially masking a low BMI and leading to under recognition of malnutrition.
AIM
To investigate whether computed tomography (CT)-based correction of the body weight improves malnutrition detection in patients with cirrhosis and ascites.
METHODS
This retrospective study included 100 hospitalized patients with cirrhosis and ascites. The BMI was evaluated using three approaches: The actual body weight method, the CT-corrected method, and the CT-sensitive corrected method. Low BMI and Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition were assessed under the three methods, and differences in detection rates were compared.
RESULTS
Compared with the actual body weight method, both the CT-corrected method and the CT-sensitive corrected method resulted in lower BMI values (both P < 0.001), with further reduction observed for the CT-sensitive corrected method (P = 0.009). The detection rates of low BMI increased from 6.0% to 10.0% and 12.0%, respectively. The detection rates of GLIM-defined malnutrition increased from 19.0% to 22.0% and 24.0%, respectively. Reclassification was unidirectional, with patients shifting from a non-low BMI or non-malnourished status under the actual body weight method to a low BMI or malnutrition status under the CT-corrected or CT-sensitive corrected method.
CONCLUSION
CT-based body weight correction reduced BMI estimates and improved the detection of low BMI and GLIM-defined malnutrition in patients with cirrhosis and ascites. This approach may serve as a useful adjunct to nutritional assessment, particularly in patients with significant fluid retention.
Core Tip: In patients with cirrhosis and ascites, the body mass index (BMI) may be overestimated because of fluid retention. This study showed that computed tomography-based body weight correction reduced BMI estimates and identified additional patients with a low BMI and Global Leadership Initiative on Malnutrition-defined malnutrition. These findings suggest that computed tomography-based correction may serve as a supplementary approach to nutritional assessment in patients with substantial fluid retention.
