Metabolic dysfunction-associated steatotic liver disease (MASLD) is intrinsically linked with widespread metabolic perturbations, including within skeletal muscle. Indeed, MASLD is associated with a range of skeletal muscle abnormalities, including insulin resistance, myosteatosis, and sarcopenia, which all converge on the liver to drive disease progression and adverse patient outcomes. This review explores the mechanistic links between skeletal muscle and MASLD, including the role of abnormal glycemic control, systemic inflammation, and disordered myokine signaling. In turn, we discuss how intrinsic liver pathology can feed back to further exacerbate poor skeletal muscle health. Given the central importance of skeletal muscle in MASLD pathogenesis, it offers clinicians an opportunity to intervene for therapeutic benefit. We, therefore, summarize the role of nutrition and physical activity on skeletal muscle mass, quality, and metabolic function and discuss the knock-on effect this has on the liver. An awareness of these treatment strategies is particularly important in the era of effective pharmacological and surgical weight loss interventions, which can be associated with the development of sarcopenia. Finally, we highlight a number of promising drug agents in the clinical trial pipeline that specifically target skeletal muscle in an attempt to improve metabolic and physical functioning.

The recurrence rate after incisional hernia surgery is the most important concern for patients and surgeons, which not only causes pain to the patient but also adds additional medical costs. This study aims to investigate CT imaging features based on abdominal wall mechanics for recurrence after incisional hernia surgery.

We collected data from patients who were diagnosed with incisional hernia and underwent hernia repair from January 2017 to January 2022 in Shanxi Provincial People's Hospital. Based on Laplace's equation, an equation for spherical wall pressure, we further measured the preoperative abdominal wall thickness and abdominal wall radius of the patients by CT and measured the abdominal wall muscle area and visceral fat area at the third lumbar level by using Slice-O-Matic 5.0 software, and the sarcopenia index was further obtained by dividing the muscle area by the square of the height. Then, we analyzed their relationship with the postoperative recurrence of incisional hernia.

By univariate and multifactorial analyses, we found that excessive visceral adiposity, high BMI and sarcopenia were independent risk factors for incisional hernia recurrence. In further stratified analysis, we also found that patients with combined sarcopenia had a higher probability of recurrence. Our results found that visceral fat was a higher risk factor for incisional hernia recurrence than BMI.

This study was a retrospective study. Based on the Laplace equation, sarcopenia and visceral fat are independent risk factors for recurrence after incisional hernia.

Myosteatosis, characterized by fat infiltration into skeletal muscle, is increasingly recognized as a prognostic factor in hepatocellular carcinoma (HCC), although the results were not consistent. This meta-analysis aimed to summarize impact on overall survival (OS) and progression-free survival (PFS) in patients with HCC.A systematic search of PubMed, Embase, and Web of Science was conducted to identify observational studies reporting survival outcomes in HCC patients with and without myosteatosis. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. A total of 24 retrospective cohort studies involving 7436 HCC patients were included. Myosteatosis was significantly associated with poorer OS (HR: 1.60, 95% CI: 1.40-1.83, p < 0.001, I2 = 65%) and PFS (HR: 1.53, 95% CI: 1.33-1.76, p < 0.001, I2 = 36%). Subgroup analysis revealed a stronger association in Asian studies (HR: 1.74 for OS; 1.57 for PFS) compared to European studies (HR: 1.08 for OS; 1.05 for PFS). The prognostic impact remained significant regardless of anticancer treatment type, myosteatosis assessment method, sex-specific or universal cutoff values, and follow-up duration (p for subgroup differences all > 0.05). The results remained significant in studies adjusting for sarcopenia (HR: 1.89 for OS; 1.50 for PFS). Meta-regression analyses did not suggest any of the following variables may affect the results, including sample size, mean ages of the patients, proportions of men, follow-up durations, and study quality scores (p all > 0.05).Myosteatosis is independently associated with worse survival in HCC patients, particularly in Asian populations. These findings highlight the significance of assessing muscle quality as a prognostic factor in HCC.

BACKGROUND. CT muscle metrics hold promise for opportunistic sarcopenia screening and individualized clinical risk stratification, but reference values applicable across broad populations are lacking. OBJECTIVE. To estimate reference cutoff values for CT skeletal muscle metrics using data from populations of healthy young adults. EVIDENCE ACQUISITION. The PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases were searched through January 1, 2025 for studies reporting skeletal muscle index (SMI) and/or skeletal muscle density (SMD) on CT at the L3 vertebral level in healthy young adults (age range, 18-45 years). For SMI and SMD in both men and women, a random effects meta-analysis was used to estimate interstudy SD (as a measure of variance among studies) and mean values for a theoretic global population of healthy young adults. Presence of significant heterogeneity among individual study means was assessed using the Q statistic. Cutoff values for the theoretic global population corresponding with a T-score of -2 (i.e., values ≥ 2 SDs below the population's mean value) were calculated, incorporating the meta-analysis results and pooled intrastudy variance. EVIDENCE SYNTHESIS. The meta-analysis included 14 studies (16,958 individuals; 11,819 men, 5139 women) reporting SMI, of which seven studies (11,175 individuals; 8372 men, 2803 women) also reported SMD. The estimated global mean value for SMI was 54.6 in men and 42.4 in women and for SMD was 47.4 HU in men and 43.6 HU in women. The interstudy SD for SMI was 5.4 in men and 4.3 in women and for SMD was 1.9 in men versus 3.2 in women; significant heterogeneity was present among individual study means for both SMI and SMD in both men and women (all p<.001). The cutoff value corresponding with a T-score of -2 for SMI was 36.3 in men and 27.5 in women and for SMD was 36.4 HU in men and 28.1 HU in women. CONCLUSION. This meta-analysis of studies performed in healthy young adults provides reference mean values and standardized cutoffs analogous to a T-score of -2 for SMI and SMD at the L3 level on abdominal CT. CLINICAL IMPACT. These results can aid opportunistic screening for sarcopenia.

Sarcopenia has been identified as a potential predictor of poor prognosis in various types of cancer. However, the impact of pretreatment sarcopenia and the reduction of skeletal muscle mass during treatment on survival outcomes of patients with cervical cancer is still not well understood.

This meta-analysis was conducted to investigate the impact of pretreatment sarcopenia and treatment-associated muscle loss on survival outcomes in patients with cervical cancer.

The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for studies exploring the relationship between muscle loss and the prognosis of cervical cancer until January 1, 2023.

The hazard ratios (HRs) and 95% CIs for overall survival (OS) and progression-free survival (PFS) were extracted.

The data were analyzed using R software. The studies' quality was assessed using the Quality in Prognostic Studies tool. Twelve observational studies involving 1498 patients with cervical cancer were included in the analysis, with a prevalence of sarcopenia ranging from 24.8% to 57.5%. Sarcopenia was an independent predictor of poor OS (HR, 1.68; 95% CI, 1.28-2.21; P < .01) and PFS (HR, 1.53; 95% CI, 1.19-1.98; P < .01) in patients with cervical cancer. Additionally, the decrease in skeletal muscle during treatment was also significantly related to the OS (HR, 4.46; 95% CI, 2.87-6.94; P < .01) and PFS (HR, 2.89; 95% CI. 1.83-4.55; P < .01).

The prevalence of pretreatment sarcopenia was high among patients with cervical cancer. Pretreatment sarcopenia and skeletal muscle loss during treatment both negatively affected prognosis in cervical cancer.

Muscle mass and fatty infiltration can be assessed on computed tomography (CT) images using the cross-sectional area (CSA) and computed tomography attenuation value (CTV). Femoral head collapse in osteonecrosis of the femoral head (ONFH) may affect both values. We investigated factors influencing the CSA and CTV of the periarticular muscles in patients with ONFH.

Overall, 101 patients with ONFH with unilateral hip pain (stage 2, 24 patients; stage 3 A, 49 patients; and stage 3B, 28 patients) were included. The CSA and mean CTV of the bilateral gluteus maximus (Gmax), gluteus medius (Gmed), gluteus minimus (Gmin), and iliopsoas (IP) muscles were measured using CT cross-sections. Bilateral comparisons and associations with Japanese Investigation Committee (JIC) stage were analysed. Multiple regression analysis was used to evaluate factors associated with the CSA and CTV.

On the symptomatic side, the CSA was significantly lower for the Gmax, Gmed, and IP, whereas the CTV was significantly lower for all tested muscles (all p < 0.01). The CTV, but not the CSA, of the Gmax, Gmed, and Gmin was significantly associated with the JIC stage severity bilaterally (all p < 0.01). Multiple regression analysis showed significant associations of the CTV with age, sex, and JIC stage (all p < 0.01).

Symptomatic ONFH leads to decreased muscle mass and increased fatty infiltration. Femoral head collapse progression is associated with a decrease in the CTV. Periarticular muscle assessment, including on the contralateral side, is important in patients with ONFH, particularly in older women.

Computed tomography (CT) measured muscle density is prognostic of health outcomes. However, the use of intravenous contrast obscures prognoses by artificially increasing CT muscle density. We previously established a correction to equalize contrast and noncontrast muscle density measurements. While this correction was validated internally, the objective of this study was to obtain external validation using different patient cohorts, muscle regions, and CT series.

CT images from 109 patients with kidney tumors who received abdominal CT scans with a multiphase intravenous contrast protocol were analyzed. Paraspinal muscle density measurements taken during noncontrast, venous phase, and delayed phase contrast scans were collected. An a priori correction of -7.5 Hounsfield units (HU) was applied to muscle measurements. Equivalence testing was utilized to determine statistical similarity.

In the sample of 109 patients (mean age: 63 years [SD: 14.3]; 41.3% female), densities in smaller regions of interest within the paraspinal muscles and the entire paraspinal muscle density (PS) in venous and delayed phase contrast scans were higher than in noncontrast. Equivalence testing showed that average corrected contrast and noncontrast muscle densities were within 3 HU for both muscle measures for the total patient sample, and for a majority of male and female subsamples. The correction is suitable for regions of interests of venous contrast (90% CI: -1.90, -0.69 HU) and delayed contrast scans (90% CI: 0.075, 1.29 HU) and within the PS measures of venous contrast (90% CI: -2.04, -0.94 HU) and delayed contrast scans (90% CI: -0.11, 0.89 HU).

The previously established correction for contrast of -7.5 HU was applied in a new patient population, axial muscle region, muscle measurement size, and expanded on previously studied contrast phases. The correction produced contrast-corrected muscle densities that were statistically equivalent to noncontrast muscle densities. The simplicity of the correction gives clinicians a tool that seamlessly integrates into practice or research to improve harmonization of data between contrast and noncontrast scans.

Sarcopenia has a negative impact on clinical outcome in adult patients with Crohn's Disease (CD), but data on children are scarce. The aim of this study is to evaluate the prevalence of sarcopenia in children with CD using magnetic resonance enterography (MRE) and describe its relationship with baseline values and clinical outcome.

We included children with a new diagnosis of CD from 2 tertiary referral pediatric Inflammatory Bowel Disease (IBD) centres, who underwent MRE at diagnosis between 2013 and 2023. Muscle mass was assessed by measuring the total area of the total psoas muscle (tPMA) at the level of the fourth and fifth lumbar vertebrae (L4/L5). Data were compared with pediatric reference values of tPMA, and sarcopenia was defined as a tPMA below the 3rd percentile. Demographic and anthropometric data, laboratory results, clinical disease activity and endoscopic index were collected at diagnosis and during follow-up. Clinical outcomes included relapse frequency, treatment changes, surgery, and IBD-related complications.

A total of 74 children (25 females, mean age 13.2 years) with CD were enrolled in the study. Sarcopenia was present in 34/74 patients (46 %) at diagnosis. Patients with sarcopenia had a lower Body Mass Index z-score and hemoglobin levels. Clinical disease activity (assessed using the Pediatric CD Activity Index) and endoscopic activity (assessed using the Simple Endoscopic Score for CD) were significantly higher in sarcopenic compared to non-sarcopenic children (median and quartiles scores: 25 [20, 40] vs. 21 [13, 35] and 10 [5, 13] vs. 6 [3, 13], respectively). During the follow-up period (median: 35 months; range: 1-99 months), no significant differences were observed between the sarcopenic and non-sarcopenic groups in terms of the composite outcome (defined as the occurrence of at least one unfavorable event). However, the rate of flares (number per person-year) was also higher in sarcopenic children compared to non-sarcopenic ones (27 % vs. 15 %; p = 0.0679).

Sarcopenia is highly prevalent among children with CD at diagnosis. MRE-based muscle mass measurement correlates with traditional anthropometric measurements and can be valuable for comprehensive nutritional screening in pediatric CD patients. Patients with sarcopenia presented with more severe clinical, laboratory, and endoscopic findings at diagnosis; although sarcopenic children experienced more clinical relapses we were not able to show a significant association between sarcopenia and outcomes. Larger series need to be studied.

With the aging global population, the decline in muscle mass and function among the elderly has emerged as a significant concern. This systemic progressive generalized loss of muscle function and mass is referred to as sarcopenia (SP). In recent years, a growing number of studies have investigated SP, revealing that many tumor diseases, especially in the digestive system, promote its occurrence due to the influence of the disease itself, diet, and other factors. Moreover, SP patients tend to have poorer postoperative recovery. At present, many diagnostic methods have been developed for SP, but no unified standard has been established. Furthermore, the cutoff values of many diagnostic methods for different populations are still in the exploratory stage, and additional clinical studies are required to explore these issues. This article comprehensively and systematically summarizes the diagnostic methods and criteria mentioned in previous research, focusing on the impact of SP on post-surgical patients with various malignant tumors.

The objective of this study was to investigate the association of radiological sarcopenia and frailty with postoperative outcomes in adult patients undergoing oncological surgery.

Data were derived from the PICNIC study, consisting of two consecutive series of patients undergoing surgical cancer treatment. Radiological sarcopenia was assessed based on CT imaging. The presence of low muscle mass and/or low muscle density was determined based on lowest quartile gender specific cut-off values. Frailty was defined by a score of ≥4 on the Groningen frailty index. Postoperative overall survival was analysed with Kaplan-Meier curves and Logrank testing. Multivariable Cox regression analyses adjusted for age and gender were performed to calculate adjusted hazard ratios (HR).

A total of 372 patients were included. Median age was 69 (28-86) years, 77 patients (23.5%) were frail and radiological sarcopenia was present in 134 patients (41.0%). Combined radiological sarcopenia and frailty was present in 35 patients (10.7%). One-year (65.6% versus 87.0%) and three-year survival (31.4% versus 66.8%) were significantly worse in patients with combined radiological sarcopenia and frailty. The combined presence of radiological sarcopenia and frailty was associated with significantly decreased overall survival (HRadjusted: 2.06, 95% CI: 1.39-3.05, P < .001).

Co-occurrence of radiological sarcopenia and frailty is strongly related to impaired survival in surgical cancer patients.

The combined presence of radiological sarcopenia and frailty is associated with decreased postoperative survival, strongly exceeding the effects of both risk factors separately. The use of radiological sarcopenia in addition to frailty screening can further optimize preoperative risk stratification.

Oropharyngeal dysphagia is a common and debilitating condition in head and neck cancer (HNC) patients. This study aimed to evaluate the relationship between tongue muscle composition (quantity and quality) and the risk of dysphagia in non-surgically treated HNC patients, using artificial intelligence (AI) analysis of pretreatment computed tomography (CT) scans.

A prospective analysis was conducted on 41 non-surgically treated HNC patients under-going curative radiotherapy. Tongue muscle quantity was measured as cross-sectional area (cm2) and as a percentage of body composition using AI-based segmentation of CT images. Muscle quality was assessed through Hounsfield Units (HU), representing muscle density. Dysphagia risk was evaluated with the validated EAT-10 questionnaire, considering scores ≥ 3 as indicative of increased risk.

A significant association was found between EAT-10 categorical scores and dysphagia risk (Chi2 = 26.07, p < 0.0001). However, no significant correlation was observed between the percentage of tongue muscle and density (R = 0.081, p = 0.07). Patients with EAT-10 scores ≥ 3 had significantly larger percentages of tongue muscle area (mean 61.17 ± 10.44 cm2) compared to those with EAT-10 < 3 (mean 56.58 ± 5.77 cm2; p = 0.004). Additionally, higher tongue muscle density (HU) was associated with increased dysphagia risk (p = 0.046). A significant association was also observed between pre-treatment and post-treatment dysphagia, with patients who reported pre-treatment dysphagia (EAT-10 ≥ 3) continuing to experience higher post-treatment dysphagia (p = 0.009, R = 0.411). Biologically Effective Dose (BED) (p = 0.0042), advanced tumor stage (p = 0.004), and systemic treatment (p = 0.027) were further associated with increased post-treatment dysphagia risk.

The study demonstrates that non-surgically treated HNC patients with increased tongue area percentages and higher muscle density are at greater risk of dysphagia. Additionally, pre-treatment dysphagia was found to be a strong predictor of post-treatment dysphagia. The use of AI-based CT analysis provides a precise method for identifying patients at risk, allowing for timely interventions to improve swallowing function and quality of life.

This study aims to identify the optimal lumbar vertebral level for CT-based assessments of trunk muscles in relation to physical function and muscle strength, and to establish a foundation for opportunistic CT screening for sarcopenia.

A cross-sectional study was conducted between April 2022 and December 2022. Pearson's correlation coefficients and multiple linear regression analyses were employed to estimate the correlation between CT parameters of trunk muscle with physical function and muscle strength.

The study included community residents aged 50 years and older from Kunming, Yunnan Province, China, who were part of the SOY (Sarcopenia and Osteoporosis Study of Yunnan) cohort. A total of 615 participants were enrolled, comprising 424 men and 191 women. Among these, 31 individuals (20 men and 11 women) were diagnosed with sarcopenia.

Each participant underwent lumbar CT scanning, the Short Physical Performance Battery (SPPB) and handgrip strength (HGS) assessment.

A correlation analysis was conducted for both the general and sarcopenia groups, after adjusting for age and body mass index. Additionally, a gender-stratified analysis was performed.

Muscle density and muscle area at all levels exhibited a moderate correlation with grip strength, with the correlation for muscle area being more pronounced (correlation β of muscle density =0.48-0.54, p value <0.001; correlation β of muscle area=0.66-0.68, p value <0.001). However, only muscle density demonstrated a weak correlation in the correlation analysis with SPPB (correlation β of muscle density =0.09-0.12, p value <0.01). When stratified by gender, trunk muscle attenuation at the L1 vertebral level in the male group showed a more pronounced correlation with physical performance (L1-βHGS =0.25, p value <0.001 vs L2-L5-βHGS =0.16-0.19, p value =0.01-0.04; L1-βSPPB =0.31, p value <0.001 vs L2-L5-βSPPB =0.23-0.29, p value <0.01). In the female cohort, both the muscle area and muscle density at all levels showed correlations with grip strength, and the muscle area at L3 vertebrae showed the best performance (L3-βHGS =0.23, p value <0.001). In the sarcopenia group, the L1 level correlates better with HGS and SPPB than other levels. (L1-βHGS =0.54, p value =0.03 and L1-βSPPB =-0.35, p value =0.04).

In this study, the area and density of lumbar muscles based on CT showed correlations of varying degrees with grip strength or SPPB. The L1 layer exhibited superior performance in those aged more than 50 years, especially in the male and sarcopenia groups. This study suggests that CT-based muscle assessment at the L1 vertebra may be a feasible option for opportunistic sarcopenia screening.

ChiCTR210005215; Pre-results.

Sarcopenia is an emerging determinant of oncologic patients' prognosis, but few data are available in extremities and trunk wall soft tissue sarcomas (ESTS). The aim was to evaluate sarcopenia impact on outcomes of patients affected by ESTS.

Through SliceOMatic software we selected cross-sectional skeletal muscle area (SMA), subcutaneous fat area (SFA) and visceral fat area (VFA) on a basal CT-slice at level of the third lumbar vertebra. Muscle density (MD) was computed in Hounsfield units (HU). Skeletal mass index (SMI, cm2/m2) was computed by normalizing SMA for the square of patient's height. Cut-offs for SMI were 52 and 39 cm2/m2 for men and women, respectively, while we used median values for MD, SFA and VFA. We explored the correlation of the different parameters with post-surgical complications and survival outcomes (Kaplan-Meier method).

268 patients were included. Median SMAs, SMIs and MD were 155.7 cm2, 51.2 cm2/m2, and 33.8 HU for men, 91.4 cm2, 39.2 cm2/m2, and 30.4 HU for women. Sarcopenia rate was not significantly higher in patients ≥65 years nor according to baseline prognostic factors (Sarculator app). Overall survival (OS) was significantly worse for sarcopenic patients: median OS 111.7 months (95%CI 72.8-150.6) vs not reached (NR; HR = 1.55, 95%CI:1.00-2.41, p = 0.049) for low-vs high-SMI; median OS 79.6 months (38.6-120.6) vs NR (HR 2.11, 1.34-3.34, p = 0.001) for low-vs high-MD, respectively. Sarcopenic patients showed increased post-surgical complications (30.5 % vs 17.0 %, p = 0.073).

Although retrospective, our study suggests to further explore sarcopenia as a negative prognostic factor in ESTS patients.

Chemotherapy remains a central component of breast cancer treatment, significantly improving patient survival rates. However, its toxic side effects, along with cancer-related paraneoplastic syndromes, can lead to the loss of skeletal muscle mass and function, impairing physical abilities and increasing the risk of complications during treatment. Chemotherapeutic agents directly impact skeletal muscle cells by promoting protein degradation, inhibiting protein synthesis, and triggering systemic inflammation, all of which contribute to muscle atrophy. Additionally, these drugs can interfere with the proliferation and differentiation of stem cells, such as satellite cells, disrupting muscle regeneration and repair while inducing abnormal differentiation of intermuscular tissue, thereby worsening muscle wasting. These effects not only reduce the effectiveness of chemotherapy but also negatively affect patients' quality of life and disease prognosis. Recent studies have emphasized the role of exercise as an effective non-pharmacological strategy for preventing muscle loss and preserving muscle mass in cancer patients. This review examines the clinical manifestations of muscle dysfunction following breast cancer chemotherapy, the potential mechanisms underlying these changes, and the evidence supporting exercise as a therapeutic approach for improving muscle function.

The relationship between the psoas muscle gauge (PMG), a combined sarcopenia indicator obtained from psoas muscle index (PMI) and psoas muscle density (PMD), and adverse clinical outcomes in patients on hemodialysis remains unclear. We examined whether psoas muscle gauge could predict all-cause mortality and new cardiovascular events more accurately than psoas muscle index in these patients.

We retrospectively included 217 hemodialysis patients who underwent abdominal computed tomography. We calculated the psoas muscle gauge (arbitrary unit [AU]) at the fourth lumbar vertebra level as follows: PMI (cm2/m2) × PMD (Hounsfield units). We categorized the patients into higher and lower psoas muscle gauge groups based on sex-specific cutoffs obtained from the young Asian population. The outcomes were death and new cardiovascular events.

The psoas muscle gauge cutoffs were set at 231.1 and 328.8 AU in women and men, respectively. Eighty-five deaths and 95 new cardiovascular events occurred during the follow-up period of 4.4 (2.4-7.3) years. The 5-year survival rates were 59.2% and 94.9% in the lower and higher psoas muscle gauge groups, respectively (p < 0.0001). Moreover, after adjusting for sex and age, history of cardiovascular disease, C-reactive protein, modified creatinine index, and geriatric nutritional risk index, lower psoas muscle gauge was independently associated with increased all-cause death and new cardiovascular events (adjusted hazard ratio (aHR) 7.65; 95% confidence interval (CI) 2.37-24.66 and aHR 2.98; 95% CI 1.54-5.75, respectively). The concordance index (C-index) for predicting all-cause mortality and new cardiovascular events significantly improved when either psoas muscle index or psoas muscle gauge were added to the baseline risk model. Additionally, the C-index of the psoas muscle gauge-added model was significantly higher than that of the psoas muscle index-added model (0.815 vs. 0.784, p = 0.026) only when predicting all-cause mortality.

Psoas muscle gauge accurately predicted the risk of all-cause mortality and new cardiovascular events in patients undergoing hemodialysis. For predicting all-cause mortality, psoas muscle gauge may be recommended compared to psoas muscle index.

This review emphasizes a novel, multidisciplinary, coordinated approach in the management of chronic liver diseases (CLDs).

Chronic liver diseases represent a significant global health burden, marked by a notable shift in the prevalence patterns from virus-related to metabolic and alcohol-related entities. Malnutrition, frailty, and sarcopenia exert a substantial impact on patients with cirrhosis, affecting 75%-90% of cases and escalating as the disease progresses. The European Association for the Study of the Liver recommends a comprehensive approach to nutritional care, emphasizing the need for detailed assessments in patients with cirrhosis, using diverse tools such as computed tomography scans, bioelectrical impedance analysis, and evaluations of muscle function. Considering the prevalence of nutritional and psychological disorders in the CLD population, the treatment of these patients should be founded indispensably on a multidisciplinary approach.

A systematic search was conducted of the PubMed, MEDLINE, and SCOPUS databases to identify trials investigating the health effects of nutritional and psychological assessments in patients with CLD.

In dealing with the treatment of patients with CLD, an exploration of the psychological domain emerges as crucial, because psychological distress, especially depression, exerts a tangible influence on patient outcomes. Thus, the engagement of psychologists and/or psychotherapists, who might use techniques such as cognitive behavioral therapy, could enhance patients' comprehension of nutritional implications in their treatment and make them more aware of their illness.

The review emphasizes the relevance of both nutritional and psychological assessments in patients with CLD that could improve patient education on the pivotal role of nutrition in disease management. Randomized controlled trials evaluating the combined impact of nutritional and psychological support are recommended to further investigate this complex clinical landscape.

Intramuscular adiposity, which can be reflected by muscle computed tomography (CT) attenuation, may be a marker of sarcopenia. This study aimed to investigate muscle attenuation across the life course and thresholds of muscle attenuation for evaluating low muscle quality in older adults.

This retrospective multicenter study included 9701 subjects aged 20 years and older who underwent CT lung cancer screening from 2019 to 2021 at our institutions in cohort 1. Muscle attenuation (Hounsfield units [HUs]) of the bilateral erector spinae and spleen attenuation at the middle level of the T11 vertebra were measured. The T score, which is analogous to that used to define osteoporosis, was calculated on the basis of absolute muscle attenuation and the muscle‒spleen ratio (M/S). A T score < -2.5 was used to define low muscle density. The cutoff points for muscle CT attenuation and M/S were subsequently calculated to define low muscle density. Another cohort (cohort 2) of 2006 subjects aged 50 years or older was included to explore the association between low muscle quality and vertebral compression fracture (VCF).

The mean [SD] age of cohort 1 was 51.8 [15.5] years, and 5896 [60.8%] men were included. The mean [SD] age of cohort 2 was 62.4 [9.6] years, and 1162 [57.9%] men were included. Multiple linear regression analysis revealed that age was associated with muscle CT attenuation (β = -0.19, 95% confidence interval (CI): -0.21 to -0.18) and the M/S ratio (β = -0.004, 95% CI: -0.004 to -0.003). The prevalence of low muscle density was dependent on the cutoff point and increased with age. A cutoff point of 32 HU for women and 37 HU for men and an M/S of 0.65 for women and 0.75 for men were used to define low muscle density. Low muscle density defined by those cutoff points was associated with the risk of VCF [muscle attenuation: adjusted hazard ratio (aHR) = 0.422 (95% CI: 0.256-0.696) for women; aHR = 0.391 (95% CI: 0.173-0.883) for men; M/S: aHR = 0.40 (95% CI: 0.23-0.68) for women; aHR = 0.23 (95% CI: 0.09-0.58) for men].

Muscle density decreases with age. The muscle attenuation of 32 HU for women and 37 HU for men, an M/S of 0.65 for women and 0.75 for men, may be used to define low muscle density.

Gastric cancer remains a major health concern worldwide, with locally advanced gastric cancer (LAGC) posing significant challenges due to frequent lymph node metastasis and poor prognosis. While curative gastrectomy with D2 lymph node dissection is the standard treatment, sarcopenia and perioperative skeletal muscle loss (SML) have emerged as critical prognostic factors.

We retrospectively analyzed 198 LAGC patients who underwent curative gastrectomy. Preoperative and postoperative sarcopenia were assessed via computed tomography (CT)-derived skeletal muscle index (SMI) at the L3 level. SML was defined based on sex-specific thresholds of SMI changes (%/30 days). Prognostic significance for overall survival (OS) and disease-free survival (DFS) was evaluated using Kaplan-Meier and Cox regression analyses.

The prevalence of sarcopenia increased from 23.7% preoperatively to 33.3% postoperatively. Patients with significant muscle loss (SML) showed worse OS and DFS compared to non-SML patients (P < 0.05). SML was also associated with a higher incidence of Clavien-Dindo grade ≥ 3a complications (P < 0.05). Multivariate analysis identified preoperative sarcopenia (HR = 2.332, P = 0.001), postoperative sarcopenia (HR = 3.189, P = 0.011), and SML (HR = 11.231, P = 0.002) as independent risk factors for OS. Adjuvant chemotherapy significantly improved both OS (HR = 0.532, P = 0.015) and DFS (HR = 0.587, P = 0.041).

Both preoperative sarcopenia and perioperative SML may negatively impact postoperative prognosis in LAGC patients, suggesting that perioperative evaluation of skeletal muscle mass may help identify high-risk surgical candidates for targeted interventions.

Low skeletal muscle mass and impaired muscle quality (myosteatosis) have been associated with poor outcomes in cancer patients. This study aimed to evaluate the impact of pre-therapeutic low muscle mass and myosteatosis on chemoradiotherapy (CRT)-induced toxicity and survival outcomes in patients with non-resectable pancreatic cancer (PC).

In this retrospective study, pre-therapeutic CT scans were used to measure muscle mass/density. Low muscle mass was defined as a skeletal muscle index <38.5 cm²/m² (women) and <52.4 cm²/m² (men), and myosteatosis as a mean psoas density <41 HU if BMI < 25 kg/m² or <33 HU if BMI > 25 kg/m². Adverse effects were collected per week (W) of treatment. Dose-limiting toxicity (DLT) was defined as any toxicity leading to dose reduction, treatment delays or permanent discontinuation.

Among the 85 included patients, 75 (88.2%) and 18 (22.2%) had pre-therapeutic low muscle mass and myosteatosis, respectively. Only 12 patients (14.1%) experienced DLT. Patients with low muscle mass developed significantly more toxicities at W2 (p = 0.013) and W5 (p = 0.026), notably more nausea (p = 0.037) and anemia (p = 0.004). Low muscle mass was associated with poorer overall survival (HR 4.41 [1.50-12.94], p = 0.007) in multivariate Cox analysis, while myosteatosis was not associated with CRT toxicities, DLT and overall survival (p = 0.408).

Patients with low muscle mass experienced more toxicities and poorer outcomes during CRT for non-resectable PC.

Primary hyperparathyroidism (PHPT) patients commonly report weakness and fatigue, though the underlying mechanisms are uncertain. Our purpose is to determine whether CT-derived muscle and adipose tissue metrics are associated with weakness and fatigue in PHPT patients.

For this retrospective study, cross-sectional muscle and adipose tissue metrics were derived from CTs in PHPT patients undergoing preoperative imaging within 1 year of parathyroid surgery. Skeletal muscle index (SMI) and visceral adipose tissue (VAT)/subcutaneous adipose tissue (SAT) ratio were calculated based on a single CT image at the level of the L3 vertebra. Established sex-specific SMI thresholds were used to define sarcopenia. Demographic and clinical data were collected from the electronic health record. When available, postoperative CT images were analyzed to assess for changes in body composition pre- and post-parathyroidectomy.

The cohort comprised 53 PHPT patients (38 females, 15 males, mean age 61.4 years), of whom 24 (45%) reported weakness, 43 (81%) reported fatigue, and 31 (58%) met CT-based criteria for sarcopenia. Lower SMI was significantly associated with preoperative weakness in females but not males. For both weakness and fatigue, VAT/SAT ratios were higher in symptomatic females and lower in symptomatic males than their asymptomatic counterparts, though these differences were not statistically significant. In patients with postoperative CTs (n = 23), no significant changes in CT metrics were observed after parathyroidectomy.

In females but not males with PHPT, subjective preoperative weakness was significantly associated with lower SMI. Effects of parathyroid hormone on skeletal muscle and visceral adiposity may differ by sex.

Low muscle mass is common in hospitalized patients. It is associated with adverse clinical outcomes. Reported prevalence varies widely due to non-universally accepted diagnostic criteria and the heterogeneity of the populations studied. Non-surgical ill patients are underrepresented in the literature.

To estimate the prevalence of low muscle index and its impact on survival in patients admitted to an internal medicine unit.

We prospectively enrolled patients with abdominal CT scans on admission to the Internal Medicine ward. We assessed muscle mass index (L3MI) at the level of the L3 lumbar vertebra. The primary outcome was to estimate the prevalence of low muscle mass on admission. Secondary outcomes were to determine the relationship of low L3MI with hospital mortality, length of stay, nosocomial infections, and hospital readmission.

One hundred and seven patients were included. The prevalence of low L3MI was 46.7%. An L3MI of 46.3 cm2/m2 in men and 40.9 cm2/m2 in women predicted death at one year with a sensitivity of 66% and a specificity of 78% (AUC = 0.62 [95% CI 0.38-0.86]) and 69 and 66% (AUC of 0.63 [95% IC 0.47-0.78]), respectively. In-hospital mortality, death at 60, 90, and 360 d, and hospital readmission were significantly higher in patients with low L3MI.

Almost half of the patients admitted to an internal medicine ward have low muscle mass index. The cutoff point of 40.9 cm2/m2 in females and 46.3 cm2/m2 in males predicts relevant clinical variables. We established the better L3MI cutoff value to predict 12-month mortality.

We assess the efficacy of artificial intelligence (AI)-based, fully automated, volumetric body composition metrics in predicting the risk of diabetes.

This was a cross-sectional and 10-year retrospective longitudinal study. The cross-sectional analysis included health check-up data of 15,330 subjects with abdominal computed tomography (CT) images between January 1, 2011, and September 30, 2012. Of these, 10,570 subjects with available follow-up data were included in the longitudinal analyses. The volume of each body segment included in the abdominal CT images was measured using AI-based image analysis software.

Visceral fat (VF) proportion and VF/subcutaneous fat (SF) ratio increased with age, and both strongly predicted the presence and risk of developing diabetes. Optimal cut-offs for VF proportion were 24% for men and 16% for women, while VF/SF ratio values were 1.2 for men and 0.5 for women. The subjects with higher VF/SF ratio and VF proportion were associated with a greater risk of having diabetes (adjusted OR 2.0 [95% CI 1.7-2.4] in men; 2.9 [2.2-3.9] in women). In subjects with normal glucose tolerance, higher VF proportion and VF/SF ratio were associated with higher risk of developing prediabetes or diabetes (adjusted HR 1.3 [95% CI 1.1-1.4] in men; 1.4 [1.2-1.7] in women). These trends were consistently observed across each specified cut-off value.

AI-based volumetric analysis of abdominal CT images can be useful in obtaining body composition data and predicting the risk of diabetes.

Background Skeletal muscle density (SMD) and intermuscular adipose tissue (IMAT) are myosteatosis markers. The prognostic value of myosteatosis markers in preoperative risk stratification of patients with early-stage non-small cell lung cancer (NSCLC) remains unknown. Purpose To assess whether increased myosteatosis markers at chest CT before lung resection of early-stage NSCLC are associated with and predictive of worse overall survival (OS). Materials and Methods This retrospective cohort study included patients with stage 0-IIB NSCLC who underwent lobectomy or bilobectomy at three hospitals between 2014 and 2017. The indexes (cross-sectional area [in centimeters squared] divided by height [in meters squared]) and densities (mean attenuation [in Hounsfield units]) of skeletal muscle, subcutaneous adipose tissue (SAT), and IMAT were assessed at CT at the level of the 12th thoracic vertebral body via semiautomated threshold-based segmentation. Associations of SMD and the IMAT index with OS were evaluated via separate Cox proportional hazards models adjusted for skeletal muscle index, SAT index, SAT density, and relevant confounders. The ability of indexes and densities to predict OS was explored with penalized Cox proportional hazards models and internally validated concordance statistics. Results Among 838 patients (median age, 68 years [IQR, 61-74 years]; 475 [56.7%] female patients), 219 died after a median follow-up of 5.3 years (IQR, 3.0-6.4 years). Increased myosteatosis, represented by decreased SMD and an increased IMAT index, was associated with worse OS (adjusted hazard ratio, 0.87 [95% CI: 0.80, 0.93]; P < .001 and adjusted hazard ratio, 1.24 [95% CI: 1.12, 1.37]; P < .001, respectively). There was no evidence of an association between OS and skeletal muscle index, SAT index, and SAT density. The predictive performance (concordance) increased from 0.723 (95% CI: 0.686, 0.753) to 0.731 (95% CI: 0.692, 0.762) after including myosteatosis markers. Conclusion Increased thoracic myosteatosis markers were associated with worse OS after lobectomy or bilobectomy of stage 0-IIB NSCLC, independent of skeletal muscle index, SAT index, and SAT density, and improved OS prediction. © RSNA, 2025 Supplemental material is available for this article.

Muscle mass has been traditionally assessed by measuring paraspinal muscle areas at the level of the third lumbar vertebra on computed tomography (CT). Neurological or neurosurgical patients seldom undergo CT scans of the lumbar region. Instead, temporal muscle thickness (TMT), cross-sectional area (TMA) and radiodensity measured from head CT scans are readily available measures of muscle mass and quality in these patient cohorts. The purpose of this retrospective study was to establish CT-based reference values for TMT, TMA and radiodensity for each decade of age from 0 to 100 years normalized by age and sex, and to define cut-off values for subjects at risk for sarcopenia as defined by the European Working Group on Sarcopenia in Older People (EWGSOP). Subjects diagnosed with a concussion at the Oulu University Hospital between January 2014 and December 2022 (n = 9254) were identified to obtain a reference population. Subjects with significant pre-existing co-morbidities were excluded. TMT, TMA and radiodensity were measured, measurement reliability was quantified, and sex-adjusted reference values were calculated for each age decade. Quantile regression was used to model age-related changes in muscle morphomics. A total of 500 subjects [250 (50.0%) males] with a mean age of 49.2 ± 27.9 years were evaluated. Inter- and intra-observer reliability was almost perfect for TMT and TMA, and substantial-to-almost perfect for radiodensity. The mean TMT, TMA and radiodensity were 5.2 ± 1.9 mm, 284 ± 159 mm2 and 44.6 ± 17.7HU, respectively. The cut-off values for reduced TMT, TMA and radiodensity for males/females using the European Working Group on Sarcopenia in Older People compliant criteria were ≤ 4.09 mm/≤3.44 mm, ≤ 166 mm2/≤156 mm2, and ≤ 35.5HU/≤35.2HU, respectively. We described a standardized CT-based TMT and TMA measurement protocol practical for clinical use with almost perfect reliability. Using the protocol, we produced quantile regression models for the detection of reduced TMT, TMA and radiodensity at the lowest 5th, 10th, 20th, 30th, 40th and 50th percentiles as well as the EWGSOP compliant criteria cut-off values for reduced muscle mass to facilitate generalizable radiological sarcopenia research.

Both quantitative and qualitative aspects of muscle status significantly impact clinical outcomes in critically ill patients. Comprehensive monitoring of baseline muscle status and its changes is crucial for risk stratification and management optimization. However, repeatable and accessible indicators are lacking. We hypothesized that creatinine production rate (CPR) could serve as an integrative indicator of skeletal muscle status.

We conducted a series of animal and clinical studies. First, animal experiments were performed to determine whether CPR reflects not only muscle volume, but also qualitative muscle properties. We also evaluated the effects of acute systemic inflammation, a common feature of critical illness, on CPR, as well as its impact on muscle volume and metabolism. In clinical studies, we analyzed CPR, calculated based on urinary creatinine excretion and changes in serum creatinine, of critically ill patients. We assessed the factors affecting CPR on ICU admission and its temporal changes. Finally, we evaluated the clinical utility of CPR by examining the associations of the CPR index (CPR divided by height squared) on ICU admission and its changes with one-year survival.

Animal studies revealed that CPR is determined by muscle volume, creatine content, and metabolic status. Systemic inflammation accompanied by muscle loss led to reduced CPR. Moreover, even without muscle loss, systemic inflammation decreased CPR, likely due to metabolic derangements. In ICU patients, CPR on admission strongly correlated with muscle cross-sectional area (CSA), with age and sex as additional significant factors. In contrast, the percent change in CPR showed a weak correlation with muscle CSA changes. Additionally, the acute-phase CPR trajectories did not show a consistent decline, suggesting multifactorial influences. In a cohort of 629 ICU patients, lower baseline CPR index (hazard ratio [HR] 1.125 per 0.1 g/day/m2 less, P < .001) and a decrease in CPR over the first three days (HR 1.028 per 5%, P = 0.032) were independently associated with higher one-year mortality.

CPR represents an integrative indicator of skeletal muscle status in critically ill patients, reflecting both quantitative and qualitative aspects. Monitoring CPR in the ICU may facilitate risk stratification and optimization of patient care.

Patients with sepsis in the intensive care unit (ICU) often experience rapid muscle loss. The urea-to-creatinine ratio (UCR) is thought to reflect muscle breakdown (creatinine) and catabolism (urea) and is commonly used to assess nutritional and metabolic status. This study aimed to investigate whether changes in UCR (ΔUCR) can predict the development of rapid muscle loss in patients with sepsis.

This retrospective observational study was conducted in a university ICU between 2014 and 2021, involving adult patients (≥ 18 years) diagnosed with sepsis. The primary outcome was the incidence of rapid muscle loss during ICU hospitalization. Changes in the cross-sectional muscle area at the third lumbar vertebra (L3SMA) were measured using CT images to evaluate muscle loss. Rapid muscle loss was defined as a change in ΔL3SMA greater than 2% per day. Multivariable logistic regression was used to examine the association between UCR or ΔUCR and rapid muscle loss. The area under the receiver operating characteristic curve (AUC) was calculated to assess the predictive performance of UCR or ΔUCR for rapid muscle loss.

Of the 482 patients, 141 (29.2%) experienced rapid muscle loss during their ICU stay. Multivariable logistic regression analysis revealed that ΔUCR was significantly associated with an increased risk of rapid muscle loss, with an odds ratio (OR) of 1.02 [95% CI: 1.01, 1.02]. The AUC for ΔUCR in predicting rapid muscle loss was 0.76 [95% CI: 0.68-0.83], with a threshold value of 19.4 µmol urea/µmol creatinine for ΔUCR.

The results demonstrate that ΔUCR is independently associated with rapid muscle loss in patients with sepsis and the AUC of the ROC curve for the ability of ΔUCR to predict rapid muscle loss was 0.76. Though additional prospective data are needed, our results suggest that ΔUCR may be useful in the early identification of critically ill patients with sepsis at risk of rapid muscle loss.

Background/Objectives: This single-center cohort study investigated preoperative risk factors such as physical function, quantity, and quality of the quadriceps femoris for physical activity (PA) 1 year after total knee arthroplasty (TKA). Methods: This study included 204 patients with knee osteoarthritis who underwent TKA; they were divided into increased and decreased PA groups. Items with significant differences between the two groups in non-operative-side quadriceps strength, knee injury and osteoarthritis outcome scores (KOOS), Sport/Rec scores, operative-side cross-sectional area (CSA) of the vastus medialis (VM), and operative-side computed tomography attenuation values (CTV) of the vastus lateralis (VL) were fitted in the multiple logistic regression analysis. The cutoff value of the preoperative CSA of the VM required for PA to exceed the required points at 1 year postoperatively was calculated using the receiver operating characteristic (ROC) curve. Results: Multivariate logistic regression analysis showed that the non-operative-side quadriceps strength KOOS sport/rec, operative-side CSA of VM, and operative-side CTV of the VL were significantly associated with increased PA after TKA. The ROC-calculated cutoff value was 10.2 cm2. Conclusions: These results suggested that preoperative muscle quantity and quality, particularly in the VM, could play important roles in postoperative PA outcomes after TKA.

In this retrospective cohort study, we investigated the prognostic value of sarcopenia evaluated by Computed Tomography (CT)-based indices for adverse hospitalization outcomes in patients with acute infections. We analyzed data from 225 patients admitted to the hospital for acute infections between 2019 and 2020. Patients who had undergone an abdominal CT scan either up to 1 month before or within the first 3 days of hospitalization were included. CT image analysis was used to evaluate skeletal muscle mass (by skeletal muscle index (SMI)) and muscle quality (by psoas muscle density, pMD). Low pMD was associated with higher in-hospital mortality (31% vs 11.4% p < 0.001) as well as higher longer-term mortality rates (p = 0.008 for 30 days and <0.001 for 90- and 1-year mortality). Low pMD remained an independent poor prognostic factor after controlling for confounders, with an adjusted odds ratio (aOR) of 2.74, (95% CI 1.33-5.67, p = 0.006) for 1-year mortality, and aOR of 2.61, (95% CI 1.23-5.55) for a prolonged hospital stay. Low SMI was associated with adverse outcomes, although this association was not independent after controlling for confounders. Notably, patients with both low SMI and pMD exhibited the poorest hospitalization outcomes: aOR for 1-year mortality 5.015 (95% CI 1.767-14.23, p = 0.002), and prolonged length of stay aOR 3.197, (95% CI 1.159-8.821, p = 0.025). CT-based muscle indices serve as independent prognostic factors in medical patients admitted with acute infection. Incorporating radiological assessments of sarcopenia into routine care for hospitalized patients with acute infection may enable risk stratification and early intervention in reversible conditions.

The pelvic floor muscle (PFM) plays a major role in sexual and urinary functions. No objective method exists to measure the PFM in male. This study evaluated the reliability of male PFM volume using three-dimensional computed tomography (3D-CT).

PFMs of five patients aged 43-83 years were selectively extracted from thin-slice CT using a workstation to reconstruct stereoscopic images and measure PFM volume. Two raters measured the PFM volume three times in all patients to confirm the reliability of PFM volume measurement. Intra- and inter-rater correlation coefficients, i.e., intraclass correlation coefficient, were determined. The CT attenuation of PFMs was also evaluated.

Raters 1 and 2 reported an average PFM volume of 46.4 ± 11.5 cm3 and 46.1 ± 12.5 cm3, respectively. The intra- and inter-rater correlation coefficients were 0.99 and 0.98, respectively. The average CT value of PFMs had a minimum of 13.7 Hounsfield Unit (HU) in the eldest male and a maximum of 38.9 HU in the youngest male.

Male PFMs could be selectively extracted using a workstation to reconstruct a stereoscopic image. The PFM volume measurement is feasible and highly reproducible. To our knowledge, this is the first study that standardizes the method for measuring the male PFM volume using 3D-CT and examines its reliability.

Background/Objectives: Sarcopenia and frailty are both multidimensional and interrelated problems for patients with cirrhosis and require prompt assessment and appropriate management because of their impact on disease outcomes. Our purpose is to identify the prevalence of sarcopenia and frailty in patients with advanced liver disease. Furtherksdnvk more, our purpose is to explore the association between sarcopenia, frailty, and various complications and the impact of these conditions on short- and long-term hospital survival rates. Methods: A prospective, observational, unicentric study was conducted in an emergency university hospital in Romania between January 2021 and December 2023 that included patients with advanced liver diseases. The patients with sarcopenia and frailty were selected using measurements of handgrip strength (HGS), Short Physical Performance Battery (SPPB), liver frailty index (LFI), and skeletal muscle index (SMI). Patients were divided into four groups based on the presence of sarcopenia and/or frailty. Results: This study included 128 patients. Younger patients associated with both sarcopenia and frailty (55.76 ± 10.46 years). Most males were without sarcopenia and frailty (63.93%) compared to those with both sarcopenia and frailty (36.07%). The Child-Pugh score C was identified in the majority of those with both sarcopenia and frailty (69.70%). Higher values for MELD-Na scores were obtained in the group with sarcopenia and frailty (25.45 ± 6.924). Biomarkers like albumin, sodium, C-reactive protein, bilirubin, and platelets were statistically significant as mortality predictors in all four groups. Patients with both sarcopenia and frailty presented more often with encephalopathy and spontaneous bacterial peritonitis. Survival rates in the short and long term were lower for the patients who associated both sarcopenia and frailty compared to those without sarcopenia and frailty. Conclusions: The presence of sarcopenia and frailty significantly impacts outcomes in patients with decompensated advanced liver disease. When both conditions coexist in the same patient, they markedly increase in-hospital mortality, as well as short- and long-term survival rates.

Intramuscular mRNA vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have a low intensity and latency of antibody response in patients with muscular disorders (MDs). However, the mechanisms involved in this phenomenon remain unknown. This study aimed to clarify the mechanism of the low immunogenicity of intramuscular SARS-CoV-2 mRNA vaccination in patients with MDs.

We evaluated 44 individuals, including 23 patients with MDs and 21 patients without MDs. The median age of the patients was 39 years (range 20-63 years). The anti-SARS-CoV-2 spike protein receptor-binding domain (S-RBD) IgG levels from a previous study were reused. Mean computed tomography (CT) values and areas of the deltoid muscle from CT images were measured, and they were compared with the anti-SARS-CoV-2 S-RBD IgG levels.

One month following the second vaccination, the antibody response among patients with MDs showed a low tendency compared with that among patients without MDs. Surprisingly, a similar pattern was observed when comparing mean CT values. Patients with mean CT values of zero HU and lower had a lower tendency of antibody response after the intramuscular administration of SARS-CoV-2 mRNA vaccines.

The low immunogenicity of intramuscular SARS-CoV-2 mRNA vaccination against MDs may be mainly affected by disease type and MD pathogenesis. However, SARS-CoV-2 immunization in patients with MDs warrants further investigation.

Surgery for esophageal cancer has an associated high rate of postoperative complications such as anastomotic leakage (AL) and fistulas. Pre-operative sarcopenia as a loss of skeletal muscle mass and function is identified as a potential prognostic factor in determining the outcomes of oncological surgical resections for esophageal cancers. In this study, we evaluated the impact of body composition on postoperative complications in esophageal cancer surgery.

In this cohort study, we analyzed patients' body composition at the level of the third lumbar vertebra on CT scans before Ivor Lewis resections for esophageal cancers between January 2015 and December 2022. Patients with a skeletal muscle index (SMI) ≤ 38.5 cm2/m2 in women and ≤52.4 cm2/m2 in men were classified as sarcopenic. Postoperative complications were categorized following the Dindo-Clavien classification and included AL, postoperative pneumonia, length of hospital stay, and failure-to-rescue which were compared between the sarcopenic and non-sarcopenic patients.

From a group of 111 patients with Ivor Lewis esophagectomy, 70 patients (63.1%) were classified as sarcopenic based on the SMI and the previously published gender-specific cut-off values. AL occurred at 12.6% (5.6% in adenocarcinoma). Within the whole cohort, patients with AL had a significantly low SMI of 43.487 ± 8.088 vs. 48.668 ± 7.514; p = 0.012. Additionally, the SMI showed a negative correlation to the length of postoperative hospital stay (r = -0.204; p = 0.032; N = 111). The failure-to-rescue rate was higher in the group of sarcopenic patients (12.8% vs. 8%).

Our data showed a correlation between SMI and AL. This effect could not be seen in gender-specific SMI. This study showed a lower failure-to-rescue rate in non-sarcopenic patients after Ivor Lewis esophagectomy. These findings underscore the crucial role of determining the preoperative nutritional and body composition status as measured by the preoperative CT scans.

Understanding ethnic variations in body composition is crucial for assessing health risks. Universal models may not suit all ethnicities, and there is limited data on the Inuit population. This study aimed to compare body composition between Inuit and European adults using computed tomography (CT) scans and to investigate the influence of demographics on these measurements. A retrospective analysis was conducted on 50 adults (29 Inuit and 21 European) who underwent standard trauma CT scans. Measurements focused on skeletal muscle index (SMI), various fat indices, and densities at the third lumbar vertebra level, analyzed using the Wilcoxon-Mann-Whitney test and multiple linear regression. Inuit women showed larger fat tissue indices and lower muscle and fat densities than European women. Differences in men were less pronouncehd, with only Intramuscular fat density being lower among Inuit men. Regression indicated that SMI was higher among men, and skeletal muscle density decreased with Inuit ethnicity and age, while visceral fat index was positively associated with age. This study suggests ethnic differences in body composition measures particularly among women, and indicates the need for Inuit-specific body composition models. It higlights the importance of further research into Inuit-specific body composition measurements for better health risk assessment.

Clinically, the body mass index remains the most frequently used metric of overall obesity, although it is flawed by its inability to account for different adipose (i.e., visceral, subcutaneous, and inter/intramuscular) compartments, as well as muscle mass. Numerous prior studies have demonstrated linkages between specific adipose or muscle compartments to outcomes of multiple diseases. Although there are no universally accepted standards for body composition measurement, many studies use a single slice at the L3 vertebral level. In this study, we use computed tomography (CT) studies from patients in The Cancer Genome Atlas (TCGA) to compare current L3-based techniques with volumetric techniques, demonstrating potential limitations with level-based approaches for assessing outcomes. In addition, we identify gene expression signatures in normal kidney that correlate with fat and muscle body composition traits that can be used to predict sex-specific outcomes in renal cell carcinoma.

To investigate the association between computed tomography-measured quality characteristics of skeletal muscle (SM) and early diagnosis of diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM).

This retrospective study included patients diagnosed with T2DM, with and without early DKD, between January 2019 and December 2021. To reduce potential bias, propensity score matching (PSM) was performed. The area and computed tomography attenuation values for SM and different abdominal adipose depots were measured. After PSM, logistic and multiple linear regression analyze were performed to analyse risk factors for early DKD.

A total of 267 patients were enrolled (mean age, 61.67 years ± 10.87; 155 men) and divided into two groups: T2DM with early DKD (n = 133); and T2DM without DKD (n = 134). After PSM, 230 patients were matched (T2DM with early DKD [n = 115]; and T2DM without DKD [n = 115]), with no statistical differences in general characteristics between the two groups (P > .05). In multivariate logistic regression analysis, high-density lipoprotein cholesterol (odds ratio [OR] 0.14; 95% confidence interval [CI] 0.04-0.49; P = .002), uric acid (OR 1.01; 95% CI 1.00-1.01; P = .006), and SM attenuation value (OR 0.94; 95% CI 0.90-0.98; P = .003) were independent risk factors for early DKD. Multiple linear regression analysis revealed significant correlations between SM attenuation value and cystatin C (β = -0.39, P = .004), urine albumin-to-creatinine ratio (β = -0.26, P = .026), and estimated glomerular filtration rate (β = 0.31 P = .009) after adjustment for confounders.

Patients with T2DM and lower SM attenuation values may exhibit a higher risk for early DKD than those with higher values, which provides a potential imaging biomarker for early DKD diagnosis.

Myosteatosis has emerged as an important concept in muscle health as it is associated with an increased risk of adverse health outcomes, a higher rate of complications, and increased mortality associated with ageing, chronic systemic and neuromuscular diseases, cancer, metabolic syndromes, degenerative events, and trauma. Myosteatosis involves ectopic infiltration of fat into skeletal muscle, and it exhibits a negative correlation with muscle mass, strength, and mobility representing a contributing factor to decreased muscle quality. While myosteatosis serves as an additional biomarker for sarcopenia, cachexia, and metabolic syndromes, it is not synonymous with sarcopenia. Myosteatosis induces proinflammatory changes that contribute to decreased muscle function, compromise mitochondrial function, and increase inflammatory response in muscles. Imaging techniques such as computed tomography (CT), particularly opportunistic abdominal CT scans, and magnetic resonance imaging (MRI) or magnetic resonance spectroscopy (MRS), have been used in both clinical practice and research. And in recent years, ultrasound has emerged as a promising bedside tool for measuring changes in muscle tissue. Various techniques, including CT-based muscle attenuation (MA) and intermuscular adipose tissue (IMAT) quantification, MRI-based proton density fat fraction (PDFF) and T1-T2 mapping, and musculoskeletal ultrasound (MSUS)-based echo intensity (EI) and shear wave elastography (SWE), are accessible in clinical practice and can be used as adjunct biomarkers of myosteatosis to assess various debilitating muscle health conditions. However, a stan¬dard definition of myosteatosis with a thorough understanding of the pathophysiological mechanisms, and a consensus in assessment methods and clinical outcomes has not yet been established. Recent developments in image acquisition and quantification have attempted to develop an appropriate muscle quality index for the assessment of myosteatosis. Additionally, emerging studies on artificial intelligence (AI) may provide further insights into quantification and automated assessment, including MRS analysis. In this review, we discuss the pathophysiological aspects of myosteatosis, all the current imaging techniques and recent advances in imaging assessment as potential biomarkers of myosteatosis, and the most common clinical conditions involved.