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Nutrition in acute and chronic diseases

Sarcopenia assessed by computed tomography is associated with colectomy in patients with acute severe ulcerative colitis

Abstract

Background

Altered body composition is an important characteristic of malnutrition that may better reflect the clinical course. This study aimed to evaluate the prognostic role of sarcopenia by computed tomography (CT) on colectomy in acute severe ulcerative colitis (ASUC) during index hospitalization and follow-up.

Methods

254 ASUC patients undergoing CT scans at admission were retrospectively included. Sarcopenia was assessed by the skeletal muscle index (SMI) with CT scans at L3, and patients with an SMI below the lowest sex-specific quartile were diagnosed with sarcopenia. Body mass index (BMI) < 18.5 kg/m2 was defined as clinical malnutrition. Univariate and multivariate analyses were performed to determine the association between sarcopenia and colectomy.

Results

The prevalence of sarcopenia in ASUC was 50.0%, and malnutrition was 25.2%. Among sarcopenic patients, 36.2% was malnutrition, 51.2% had normal BMI, 11.8% was overweight, and 0.8% was obese. During index hospitalization, 66.9% patients needed rescue therapy with 52.4% received medical rescue therapy and 14.6% received colectomy. During follow-up, 33.2% patients needed colectomy. Significantly more sarcopenic patients required colectomy (22.0% vs 7.1%, p = 0.001) and rescue therapy (81.9% vs 52.0%, p < 0.001) during index hospitalization and colectomy during follow-up (44.4% vs 23.7%, p = 0.001) than non-sarcopenic patients. However, BMI < 18.5 kg/m2 was not related to the clinical course. In multivariate analyses, sarcopenia remained an independent risk factor for rescue therapy and colectomy during index hospitalization and colectomy during follow-up.

Conclusion

Sarcopenia rather than BMI was associated with clinical outcomes in ASUC and played an important role in predicting the need for colectomy.

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Fig. 1: Assessment of sarcopenia by computed tomography scan.

Data availability

The datasets generated during and/or analyzed during the current study are available from the first author or corresponding author on reasonable request.

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Acknowledgements

The authors gratefully acknowledge all of the investigators for their contributions to the trial, as well as Bin Chen, who provided medical writing assistance.

Funding

This work was supported by National Natural Science Foundation of China (grant number 81800474).

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Contributions

GXL, XJY, and BRP: conceptual design of the study. YLN, LW, WY, and QWL: data collection, data analysis, and data interpretation. GXL, ZW: manuscript writing. CQ, BRP, and ZW: overall supervision of the study. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and read and approved the final manuscript.

Corresponding authors

Correspondence to Rongpan Bai or Wei Zhou.

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Ge, X., Xia, J., Wu, Y. et al. Sarcopenia assessed by computed tomography is associated with colectomy in patients with acute severe ulcerative colitis. Eur J Clin Nutr (2021). https://doi.org/10.1038/s41430-021-00953-y

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