Sarcopenia after Roux-en-Y Gastric Bypass: Detection by Skeletal Muscle Mass Index vs. Bioelectrical Impedance Analysis

Abstract

Background: In sarcopenic patients the skeletal muscle reduction is the primary symptom of age- or disease-related malnutrition, which is linked to postoperative morbidity and mortality. The skeletal muscle mass index (SMI) from magnet resonance imaging (MRI) is increasingly used as a prognostic factor in oncologic and surgical patients, but under-represented in the field of obesity surgery. The bioelectrical impedance analysis (BIA), on the other hand is a commonly used method for the estimation of the body composition of bariatric patients, but still believed to be inaccurate, because of patient-related and environmental factors. The aim of this study was to compare the postoperative SMI values as a direct, imaging measured indicator for muscle mass with the BIA results in patients undergoing Roux-en-Y gastric bypass (RYGB). Methods: We performed a prospective single-center trial. Patients undergoing RYGB between January 2010 and December 2011 at our institution were eligible for this study. MRI and BIA measurements were obtained 1 day before surgery and at 6, 12 and 24 weeks after surgery. Results: A total of 17 patients (four male, 13 female, average age of 41.9 years) were included. SMI values decreased significantly during the postoperative course (p < 0.001). Comparing preoperative and postoperative measurements at 24 weeks after surgery, increasing correlations of SMI values with body weight (r = 0.240 vs. r = 0.628), phase angle (r = 0.225 vs. r = 0.720) and body cell mass (BCM, r = 0.388 vs. r = 0.764) were observed. Conclusions: SMI decreases significantly after RYGB and is correlated to distinct parameters of body composition. These findings show the applicability of the SMI as direct imaging parameter for the measurement of the muscle mass in patients after RYGB, but also underline the important role of the BIA, as a precise tool for the estimation of patients’ body composition at low costs. BIA allows a good overview of patients’ status post bariatric surgery, including an estimation of sarcopenia.