Sarcopenia and body composition abnormalities in chronic pancreatitis: Pathophysiology, assessment, and clinical...

Chronic pancreatitis is a progressive inflammatory disease associated with substantial nutritional and metabolic consequences. Beyond classical malnutrition, patients frequently develop alterations in body composition, particularly sarcopenia, which are increasingly recognised as clinically relevant but remain inconsistently assessed. The reported prevalence of sarcopenia ranges from 20% to 70%, including a substantial proportion of patients with normal or elevated body mass index. Sarcopenia reflects the combined effects of chronic inflammation, pancreatic exocrine insufficiency, endocrine dysfunction, reduced oral intake, malabsorption, and lifestyle factors such as alcohol use, smoking, and physical inactivity. Advances in imaging and functional assessment allow more precise evaluation of muscle mass, fat distribution, and bone density. Computed tomography-derived skeletal muscle indices, often obtained from routine imaging, provide accurate muscle mass quantification, while handgrip strength and gait speed capture clinically meaningful functional impairment. Observational studies associate sarcopenia with increased healthcare utilisation, higher mortality, and poorer surgical outcomes, although heterogeneity in definitions and study design limits causal inference. Most studies rely on CT-derived muscle mass as the sole diagnostic criterion, consistent with pre-EWGSOP2 frameworks, rather than incorporating muscle strength - typically assessed by grip strength - as now recommended by current consensus groups. Evidence regarding sarcopenic obesity, myosteatosis, and ectopic fat deposition remains limited. Structured nutritional assessment, including the GLIM criteria for malnutrition diagnosis, alongside systematic body composition evaluation and multidisciplinary nutritional and exercise-based interventions, may improve risk stratification and outcomes. Further longitudinal and interventional studies are needed to define disease-specific thresholds and optimise management strategies.