Western University of Health Sciences, College of Osteopathic Medicine, Lebanon, OR, USA.
Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA.
Clin Nutr. 2023 May;42(5):625-635. doi: 10.1016/j.clnu.2023.03.005. Epub 2023 Mar 11.
Computed tomography (CT) defined myosteatotic, sarcopenic, and visceral obesity are associated with adverse surgical outcomes and mortality in patients with malignancies. These occult conditions may also be widely prevalent in today's general surgery patients who tend to be overweight/obese. This study identified the predominant obesity phenotypes in 906 patients aged 18-85 years who were scheduled for laparoscopic resection for benign abdominal or colorectal disease at Vanderbilt University Medical Center between 2010 and 2017.
Sex and body mass index (BMI) specific cut-points were used to identify myosteatotic, sarcopenic, and visceral obesity phenotype from abdominal CT scan morphometrics. Multivariable regression modeling determined relationships between sex, obesity phenotype, and postoperative outcomes.
The myosteatostic + sarcopenic obesity phenotype associated with longer surgery duration and increased the likelihood for major complication (OR 1.34, 95%CI 1.01-1.74) and ICU admission (OR 1.39, 95%CI 1.04-1.90). Having myosteatotic obesity doubled the likelihood for hospital stay >7 days and discharge to a nursing home (OR 2.11, 95%CI 1.43,3.11), increasing the likelihood for readmission within 90 days. Obesity was more prevalent in females, but myosteatotic, sarcopenic, and visceral obesity were more prevalent in males, regardless of age or BMI. Males had more major complications (23.6% vs 17.7%, P = 0.03), particularly wound dehiscence or infection, and a 2-day longer hospital stay.
This study shows that sarcopenic and myosteatotic obesity phenotypes are highly prevalent, especially in male general surgery patients, regardless of age or BMI. Importantly, sarcopenic and myosteatostic obesity may be more detrimental than visceral obesity; these phenotypes robustly associated with adverse postoperative outcomes. Future work could use these findings for design of phenotype-specific interventions to reduce patient risk and prevent outcomes that are harmful and costly.
计算机断层扫描（CT）定义的肌内脂肪增多型、少肌型和内脏型肥胖与恶性肿瘤患者的不良手术结局和死亡率相关。这些隐匿性疾病在现今超重/肥胖的普通外科患者中可能也广泛存在。本研究于 2010 年至 2017 年期间，在范德比尔特大学医学中心对因良性腹部或结直肠疾病行腹腔镜切除术的 906 名 18-85 岁患者的腹部 CT 扫描形态计量学数据进行分析，以确定主要肥胖表型。采用多变量回归模型确定性别、肥胖表型与术后结局之间的关系。
使用性别和体重指数（BMI）特定切点，从腹部 CT 扫描形态计量学中识别肌内脂肪增多型、少肌型和内脏型肥胖表型。多变量回归模型确定性别、肥胖表型与术后结局之间的关系。
肌内脂肪增多型+少肌型肥胖与手术时间延长相关，且更有可能发生重大并发症（OR 1.34，95%CI 1.01-1.74）和入住重症监护病房（OR 1.39，95%CI 1.04-1.90）。肌内脂肪增多型肥胖使住院时间超过 7 天和出院至疗养院的可能性增加一倍（OR 2.11，95%CI 1.43-3.11），90 天内再入院的可能性增加。肥胖在女性中更为常见，但无论年龄或 BMI 如何，肌内脂肪增多型、少肌型和内脏型肥胖在男性中更为常见。男性发生重大并发症的可能性更高（23.6%比 17.7%，P=0.03），特别是伤口裂开或感染，且住院时间延长 2 天。
本研究表明，少肌型和肌内脂肪增多型肥胖表型非常普遍，尤其是超重/肥胖的男性普通外科患者，无论年龄或 BMI 如何。重要的是，少肌型和肌内脂肪增多型肥胖可能比内脏型肥胖更具危害性；这些表型与不良术后结局显著相关。未来的研究可以利用这些发现设计表型特异性干预措施，以降低患者风险并预防有害和昂贵的结局。
