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

Journal article

Lambell, Kate J., Goh, Gerard S., Tierney, Audrey C., Forsyth, Adrienne, Nanjayya, Vinodh, Nyulasi, Ibolya and King, Susannah J.. (2021). 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. Nutrition. 82, p. Article 111061. https://doi.org/10.1016/j.nut.2020.111061
AuthorsLambell, Kate J., Goh, Gerard S., Tierney, Audrey C., Forsyth, Adrienne, Nanjayya, Vinodh, Nyulasi, Ibolya and King, Susannah J.
Abstract

Objectives
Changes in muscularity during different phases of critical illness are not well described. This retrospective study aimed to describe changes in computed tomography (CT)–derived skeletal muscle area (SMA) and density (SMD) across different weeks of critical illness and investigate associations between changes in these parameters and energy and protein delivery.

Methods
Thirty-two adults admitted to the intensive care unit (ICU) who had ≥2 CT scans at the third lumbar area performed ≥7 d apart were included in the study. CT-derived SMA (cm2) and SMD (Hounsfield units) were determined using specialized software. A range of clinical and nutrition variables were collected for each day between comparator scans. Associations were assessed by Pearson or Spearman correlations.

Results
There was a significant decrease in SMA between the two comparator scans where the first CT scan was performed in ICU wk 1 (n = 20; P < .001), wk 2 (n = 11; P < .007), and wk 3 to 4 (n = 7; P = .012). There was no significant change in SMA beyond ICU wk 5 to 7 (P = .943). A significant decline in SMD was observed across the first 3 wk of ICU admission (P < .001). Overall, patients received a mean 24 ± 6 kcal energy/kg and 1.1 ± 0.4 g protein/kg per study day and 83% of energy and protein requirements according to dietitian estimates. No association between SMA or SMD changes and nutrition delivery were found.

Conclusions
Critically ill patients experience marked losses of SMA over the first month of critical illness, attenuated after wk 5 to 7. Energy and protein delivery were not associated with degree of muscle loss.

Keywordsbody composition; computed tomography; skeletal muscle mass; critical illness; nutrition support
Year2021
JournalNutrition
Journal citation82, p. Article 111061
PublisherElsevier Inc.
ISSN0899-9007
Digital Object Identifier (DOI)https://doi.org/10.1016/j.nut.2020.111061
Scopus EID2-s2.0-85099497482
Page range1-7
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online19 Nov 2020
Publication process dates
Accepted28 Oct 2020
Deposited28 Nov 2022
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