Purpose While obesity is considered a prognostic factor in colorectal cancer (CRC), there is increasing evidence that not only body-mass-index (BMI) matters, but specifically abdominal fat distribution. As part of the ColoCare study, this study measured the distribution of adipose tissue compartments in CRC patients and aimed to identify the body metric that best correlates with these measurements as a useful proxy for adipose tissue distribution. Materials and methods In 120 newly-diagnosed CRC patients who underwent multi-detector-CT, densitometric quantification of total(TFA), visceral(VFA), intraperitoneal(IFA), retroperitoneal(RFA) and subcutaneous fat area(SFA), M.erector spinae and psoas was performed to test the association with gender, age, tumor stage, metabolic equivalents, BMI, Waist-to-Height (WHtR) and Waist to-Hip ratio (WHR). Results VFA was 28.8% higher in men (pVFA<0.0001) and 30.5% higher in patients older than 61 years (pVFA<0.0001). WHtR correlated best with all adipose tissue compartments (rVFA=0.69, rTFA=0.84, p<0.0001) and visceral-to-subcutaneous-fat-ratio(VFR, rVFR=0.22, p=<0.05). Patients with tumor stages III/IV showed significantly lower overall adipose tissue than I/II. Increased M. erector spinae mass was inversely correlated with all compartments. Conclusion Densitometric quantification on CT is a highly reproducible and reliable method to show fat distribution across adipose tissue compartments. This distribution might be best reflected by WHtR, rather than BMI or WHR.
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