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Presenter: Weston, Bush, Indianapolis, United States
Authors: Weston Bush, Jason Davis, Chandrashekhar Kubal, Richard Mangus
Weston Bush1, Jason Davis1, Chandrashekhar A. Kubal1, Richard S. Mangus1.
1Transplant Division, Department of Surgery, Indiana University, School of Medicine, Indianapolis, IN, United States
Introduction: Patients with intestine failure (IF) and dependence on parenteral nutrition (PN) develop severe nutrition deficits that impact on perioperative morbidity and mortality. Previous research demonstrates that laboratory measures of nutrition status fail to assess clinical deficits in muscle mass and fat tissue. This study employs computed tomography imaging to assess (1) muscle mass and (2) subcutaneous and (3) visceral fat stores in adult and pediatric patients with IF.
Methods: A 1:1 case-control study design is used to compare IF patients with healthy controls. Study patients were selected from a database of IF patients, known to have long-standing PN dependence and being evaluated for isolated intestine transplant. Controls were selected from the trauma database. Cases and controls were matched for gender, age +/- 5 years (adults) and +/- 6 months (pediatrics), and BMI +/- 2 (adults). For cases and controls, measures of nutrition status included psoas muscle area, perinephric fat, and subcutaneous fat at time of transplant (or trauma) derived at the L2/L3 disc space.
Results: There were 56 subjects (30 adults, 26 children ≤ age 18) and 56 controls. IF patients had a -22% (adults) and -24% (peds) muscle mass deficit and a -7% (adults) and 46% (peds) subcutaneous fat difference from controls. There was no difference in visceral fat stores in adults and a 30% increase in visceral fat area in children with IF. Subgroup analysis by gender revealed no difference in muscle mass in boys and girls, but demonstrated a greater loss of muscle mass in adult IF males compared to adult IF females, (-36% vs -16%, p=0.26). Four age groups were analyzed: ≤18, 19-40, 40-60, and >60 years. Older age showed less muscle deficit, with the 19-40 age group showing the greatest muscle deficit compared to healthy age and gender-matched controls (-24%, -42%, -25%, +12%).
Conclusions: These results support previous research demonstrating substantial nutritional deficits in IF patients that are not adequately measured by laboratory testing. Standard CT scans can be employed to assess the distribution and quantity of nutritional deficits. Adult IF patients in this study have significant deficits of muscle and subcutaneous fat stores, but a similar amount of visceral fat. Pediatric IF patients also have significant sarcopenia, but have increased subcutaneous fat. Nutritional deficits in IF vary by age and, in adults, by gender.
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