PD019 - RETHINKING MALNUTRITION: IMAGING‑BASED PHENOTYPING IN HOSPITALIZED PATIENTS

PD019

RETHINKING MALNUTRITION: IMAGING‑BASED PHENOTYPING IN HOSPITALIZED PATIENTS

A. Bode^1,*, C. Bury¹

¹Cleveland Clinic, Cleveland, United States

Rationale: Traditional malnutrition frameworks emphasize undernutrition and rely heavily on weight loss and nutrition‑focused physical examination (NFPE). Malnutrition encompasses both under‑ and overnutrition, yet current assessments fail to capture the full spectrum of risk. This study aimed to characterize malnutrition phenotypes using CT‑derived body composition measures in hospitalized patients.

Methods: Hospitalized adults with an abdominal CT and an NFPE within two days were included. CT images at the L3 vertebral level were analyzed using Voronoi DAFS v.3 to quantify skeletal muscle index (SMI), skeletal muscle density (SMD), visceral‑to‑subcutaneous adipose tissue ratio (VAT/SAT), and intramuscular adipose tissue (IMAT). Severely low muscle mass was defined as SMI >2 SD below sex‑specific reference values. Inadequate SMD was defined as mean attenuation <32.4 HU in males and <26.7 HU in females. Elevated IMAT was defined as sex‑specific upper tertiles. Phenotypes included normal composition; myopenia (severely low SMI and low SMD); combined myopenia and adiposity; and elevated IMAT. 

Results: In the overall cohort (n=120), normal body composition was present in 13 patients (11%), while severe myopenia and combined adverse phenotypes were observed in 28% and 13% of patients, respectively. IMAT demonstrated wide variability, with sex‑specific upper tertiles (>11.4 cm² in men; >12.9 cm² in women). Among patients without muscle wasting identified by NFPE (n=68), only 7 (10%) demonstrated normal body composition on CT analysis. Severe myopenia was identified in 15 patients (22%), and 9 patients (13%) exhibited a combined adverse muscle and adiposity phenotype. 

Conclusion: CT‑derived phenotyping identifies a high burden of severe myopenia and adverse adiposity in hospitalized patients, including those without muscle wasting by NFPE. This supports the integration of objective imaging‑based measures into malnutrition assessment. 

Disclosure of Interest: A. Bode Grant / Research Support from: Morrison Cleveland Clinic Research Collaborative, C. Bury: None declared