Marked losses of computed tomography–derived skeletal muscle area and density over the first month of a critical illness are not associated with energy and protein delivery

Lambell, Kate; Goh, Gerard S; Tierney, Audrey C.; Forsyth, Adrienne; Nanjayya, Vinodh Bhagyalakshmi; Nyulasi, Ibolya; King, Sontoria D.

doi:10.1016/j.nut.2020.111061

Cited by 13 publications

(13 citation statements)

References 34 publications

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“…Lambell et al . showed that skeletal muscle area is markedly reduced in the first week after admission to the ICU, and this trend gradually slows down 12 . Similarly, Haines et al .…”

Section: Discussionmentioning

confidence: 81%

“…Baseline CT was determined as either the most recent preoperative image or the most recent pre‐acute care image. Follow‐up CT images were identified between 2 and 14 days, based on the date of surgery or hospital admission as a post‐acute care imaging 11,12 . The tube potential was set between 100–120 kV with a 512 × 512 matrix, and the electrical current (mA) was set automatically for each slice.…”

Section: Methodsmentioning

confidence: 99%

“…Follow‐up CT images were identified between 2 and 14 days, based on the date of surgery or hospital admission as a post‐acute care imaging. 11 , 12 The tube potential was set between 100–120 kV with a 512 × 512 matrix, and the electrical current (mA) was set automatically for each slice. Slice thickness and contrast enhancement were not standardized.…”

Section: Methodsmentioning

confidence: 99%

“… 2 In recent years, there has been an emphasis on in‐hospital treatment or bed rest acquired weakness, such as loss of muscle mass and physical dysfunction, in acute care settings. 8 Particularly, several studies have reported on acute skeletal muscle loss identified by CT imaging in cancer patients who underwent surgery, 9 , 10 patients who were admitted to the intensive care unit (ICU), or patients that are critically ill. 11 , 12 , 13 , 14 , 15 However, limited evidence is available to detail the changes in skeletal muscle area and density, especially in patients with cardiovascular disease. Changes in muscle area and density are expected to vary from muscle to muscle, 3 , 16 although most have measured these changes in all muscles or in only using a single muscle.…”

Section: Introductionmentioning

confidence: 99%

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Features of trunk muscle wasting during acute care and physical function recovery with aortic disease

Kamiya

Matsunaga

Kitamura

et al. 2022

J cachexia sarcopenia muscle

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Background Low skeletal muscle area or density, such as myosteatosis, identified on computed tomography (CT) is associated with poor prognosis in patients with cardiovascular diseases. However, there is a lack of evidence regarding the clinical process of skeletal muscle decline as a short‐term change during acute care settings. This study focused on the use of routine CT imaging for aortic disease management and investigated the changes in skeletal muscle before and after acute care. Methods This prospective study included 123 patients who underwent abdominal CT before and after acute care. The all‐abdominal and each abdominal muscle areas were divided into eight parts (e.g. rectus abdominis, psoas, and erector spine), and their areas and densities were measured at the third lumbar vertebra level after the patients were discharged and de‐identified with blinding to avoid measurement bias. Short physical performance battery (SPPB) was measured at the start and end of in‐hospital cardiac rehabilitation. A generalized linear model with patients as random effects was made to investigate skeletal muscle loss during acute care. Multivariate linear regression analysis was also used to assess the relationship between the change in skeletal muscle during acute care and SPPB during in‐hospital cardiac rehabilitation. Results The median age of the patients was 70 (interquartile: 58–77) years, and 69.9% (86/123) were men. The median day between acute care from the day of surgery or hospital admission and follow‐up CT was 7 (interquartile: 3–8) days. Overall muscle density declined after acute care (estimate value: −3.640, 95% confidence interval [CI]: −4.538 to −2.741), and each abdominal muscle density consistently declined (interaction: F value = 0.099, P = 0.998). In contrast, there was no significant change in the overall muscle area (estimate value: −0.863, 95% CI: −2.925 to 1.200). Changes in the muscle area were different for each skeletal muscle (interaction: F value = 2.142, P = 0.037), and only the erector spine muscle significantly declined (estimate value: −1.836, 95% CI: −2.507 to −1.165). After adjusting for confounding factors, a greater decline in muscle density was associated with lower recovery score on SPPB (β = 0.296, 95% CI: 0.066 to 0.400). Conclusions Muscle density consistently declined after acute care, especially the erector spine muscles, which also significantly decreased in size. A higher decline in muscle density was associated with a slower recovery of physical function during in‐hospital cardiac rehabilitation in patients with aortic diseases.

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“…Lambell et al . showed that skeletal muscle area is markedly reduced in the first week after admission to the ICU, and this trend gradually slows down 12 . Similarly, Haines et al .…”

Section: Discussionmentioning

confidence: 81%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Features of trunk muscle wasting during acute care and physical function recovery with aortic disease

Kamiya

Matsunaga

Kitamura

et al. 2022

J cachexia sarcopenia muscle

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“…Lambell et al in a systematic review that included 4 observational studies and 2 RCTs that measured skeletal muscle mass and/or total body protein at ≥ 2 time points during critical illness found no association between energy and protein delivery and changes in skeletal muscle mass [ 48 ]. In another study, the same group found that the marked losses of computed tomography–derived skeletal muscle area and density over the first month of critical illness are not associated with energy and protein delivery [ 49 ]. While Puthucheary et al in an observational study demonstrated that increasing protein delivery was associated with increased muscle wasting at day 10 within the limit of average daily protein delivery of 0.67 g/kg/day [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials

et al. 2021

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Background The optimal protein dose in critical illness is unknown. We aim to conduct a systematic review of randomized controlled trials (RCTs) to compare the effect of higher versus lower protein delivery (with similar energy delivery between groups) on clinical and patient-centered outcomes in critically ill patients. Methods We searched MEDLINE, EMBASE, CENTRAL and CINAHL from database inception through April 1, 2021.We included RCTs of (1) adult (age ≥ 18) critically ill patients that (2) compared higher vs lower protein with (3) similar energy intake between groups, and (4) reported clinical and/or patient-centered outcomes. We excluded studies on immunonutrition. Two authors screened and conducted quality assessment independently and in duplicate. Random-effect meta-analyses were conducted to estimate the pooled risk ratio (dichotomized outcomes) or mean difference (continuous outcomes). Results Nineteen RCTs were included (n = 1731). Sixteen studies used primarily the enteral route to deliver protein. Intervention was started within 72 h of ICU admission in sixteen studies. The intervention lasted between 3 and 28 days. In 11 studies that reported weight-based nutrition delivery, the pooled mean protein and energy received in higher and lower protein groups were 1.31 ± 0.48 vs 0.90 ± 0.30 g/kg and 19.9 ± 6.9 versus 20.1 ± 7.1 kcal/kg, respectively. Higher vs lower protein did not significantly affect overall mortality [risk ratio 0.91, 95% confidence interval (CI) 0.75–1.10, p = 0.34] or other clinical or patient-centered outcomes. In 5 small studies, higher protein significantly attenuated muscle loss (MD −3.44% per week, 95% CI −4.99 to −1.90; p < 0.0001). Conclusion In critically ill patients, a higher daily protein delivery was not associated with any improvement in clinical or patient-centered outcomes. Larger, and more definitive RCTs are needed to confirm the effect of muscle loss attenuation associated with higher protein delivery. PROSPERO registration number: CRD42021237530

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Routine computed tomography body composition analysis—experience in intensive care patients

Heer

Erley

Kemper

et al. 2023

Med Klin Intensivmed Notfmed

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Die Erfassung des Ernährungsstatus von Intensivpatient:innen wird in aktuellen Leitlinien empfohlen und sollte die Beurteilung des Muskelstatus beinhalten. Eine geeignete apparative Methode stellt die Analyse von Routinecomputertomographien (CT), die gerade bei kritisch Kranken häufig durchgeführt werden, dar. Mithilfe spezieller Softwares werden einzelne CT-Schichten bearbeitet und verschiedene Parameter, wie Muskelfläche, Muskeldichte oder der Fettgewebeanteil, dargestellt und quantifiziert. Es konnte gezeigt werden, dass die Erfassung des Skelettmuskulaturquerschnitts im Bereich der Lendenwirbelsäule sehr gut mit der Gesamtkörpermuskulatur korreliert. Es gibt definierte, wenn auch populationsabhängige, Cut-off-Werte, mit deren Hilfe die Diagnose einer Sarkopenie gestellt werden kann. Die Überprüfung einer individuellen Ernährungstherapie kann durch Beurteilung repetitiver CT-Untersuchungen erfolgen. Die stetig wachsende Datenlage bestätigt, dass das Verfahren in der Intensivmedizin einen wertvollen Beitrag zur Erhebung der Körperzusammensetzung liefern kann. Die meisten der aktuell verfügbaren Softwares erfordern eine zeitaufwendige Bearbeitung der CT. Mittlerweile vereinzelt verfügbare automatisierte Programme, die den Großteil der manuellen Bearbeitung überflüssig machen, könnten in Zukunft die Methode noch attraktiver machen. Das Risiko eines Intensivtransports zur CT bzw. die Strahlenbelastung können grundsätzlich nur bei sicherer medizinischer Indikation für eine CT gerechtfertigt werden. Eine verfügbare CT sollte beim Intensivpatienten auch zur Analyse der Körperzusammensetzung genutzt werden.

show abstract

Marked losses of computed tomography–derived skeletal muscle area and density over the first month of a critical illness are not associated with energy and protein delivery

Cited by 13 publications

References 34 publications

Features of trunk muscle wasting during acute care and physical function recovery with aortic disease

Features of trunk muscle wasting during acute care and physical function recovery with aortic disease

The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials

Routine computed tomography body composition analysis—experience in intensive care patients

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