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Updated: Dec 14, 2025
Author Spotlight: Advancements in 3D Optical Imaging for Comprehensive Body Composition Assessment in Modern Research
Published on: June 7, 2024
Body Composition of Infants With Biliary Atresia: Anthropometric Measurements and Computed Tomography-based Body
L Agnes Grutters1, Jan Pieter Pennings2, Janneke L M Bruggink1
1Department of Surgery, Section of Pediatric Surgery.
Insights
Computed tomography (CT) body metrics in infants with biliary atresia (BA) show strong agreement. These CT metrics offer additional insights into body composition beyond mid-upper arm circumference (MUAC) for nutritional assessment.
Area of Science:
- Pediatric Gastroenterology
- Surgical Research
- Nutritional Science
Background:
- Biliary atresia (BA) is a critical neonatal cholestasis requiring surgical intervention or liver transplantation (LT).
- Nutritional status, including sarcopenia and sarcopenic obesity, significantly impacts clinical outcomes in BA patients.
- Mid-upper arm circumference (MUAC) is currently the primary indicator for nutritional assessment.
Purpose of the Study:
- To determine computed tomography (CT)-based body composition metrics in infants diagnosed with biliary atresia (BA).
- To evaluate the correlation between these CT-derived metrics and the established nutritional indicator, MUAC.
- To assess the utility of CT in identifying sarcopenia and sarcopenic obesity in BA infants.
Main Methods:
- Retrospective analysis of BA infants under 2 years old who underwent CT scans for LT screening (2006-2019).
- Measured CT-based variables indexed by length: MUAC, total psoas muscle surface area (tPMSA), cross-sectional skeletal muscle area (CSMA), and total abdominal fat area.
- Calculated intraclass and Pearson correlation coefficients; defined sarcopenic obesity based on CSMA-to-abdominal fat area ratio quartiles.
Main Results:
- Eighty infants were included, with a median age of 4.6 months at LT screening.
- CT-based metrics demonstrated very strong interobserver agreement (ICC for tPMSA=0.94, CSMA=0.92, fat area=0.99).
- Correlation between MUAC z-score and CT metrics was weak (tPMSA r=0.02, CSMA r=0.06), but moderate for fat area (r=0.43). Sarcopenic obesity cutoff was a ratio below 0.93.
Conclusions:
- CT-based body composition metrics can be reliably determined in infants with BA during LT screening.
- The poor correlation between CT metrics and MUAC indicates that CT provides complementary information on muscle mass and fat distribution.
- CT-derived body metrics enhance the assessment of body composition in BA infants, aiding in nutritional management and outcome prediction.
Objectives:
Biliary atresia (BA) causes neonatal cholestasis that requires hepatoportoenterostomy or liver transplantation (LT) for long-term survival. Nutritional optimization is necessary as sarcopenia and sarcopenic obesity have been associated with adverse clinical outcome. Currently, mid upper arm circumference (MUAC) is considered the most accurate indicator. The aim of the study was to determine computed tomography (CT)-based body metrics in infants with BA and to evaluate its correlation with MUAC.
Methods:
We retrospectively analyzed all BA infants below 2 years of age who underwent CT as part of LT screening at our hospital between 2006 and 2019. Measured variables were indexed with length and included: MUAC, total psoas muscle surface area (tPMSA), cross-sectional skeletal muscle area (CSMA), and total abdominal fat area. Intraclass correlation coefficients and Pearson coefficients were calculated. CSMA-to-abdominal fat area ratio was divided in quartiles, the lowest quartile group was considered sarcopenic obese.
Results:
Eighty infants with a median age of 4.6 months at LT screening were included. Intraclass correlation coefficients were: tPMSA = 0.94, CSMA = 0.92, and total abdominal fat area = 0.99. Correlation between MUAC z-score and indices of tPMSA, CSMA, and total abdominal fat area were r = 0.02, r = 0.06, and r = 0.43, respectively. The cut-off for sarcopenic obesity was CSMA-to-abdominal fat area ratio below 0.93.
Conclusions:
In BA infants, it is possible to determine CT-based body metrics during LT screening with very strong interobserver agreement. Poor correlation between CT-based body metrics and MUAC suggests that CT-based body metrics provide additional information on body composition in BA infants, such as relative muscle mass.
