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Major adverse nutritional events (MANE): A composite outcome linking body composition and postoperative risk in
Fiorella Palmas1, Francisco José Sánchez-Torralvo2, Rocío Fernández-Jiménez3
1Nutrition Support Unit, Endocrinology and Nutrition Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR) ISS IR-HUVH-VHIR, 08035, Barcelona, Spain; Diabetes and Metabolism Research Unit, Vall d'Hebron Institut de Recerca (VHIR), 08035, Barcelona, Spain.
Background:
Body composition alterations are associated with adverse outcomes after colorectal cancer (CRC) surgery, but available thresholds may not adequately reflect early postoperative vulnerability. Major Adverse Nutritional Events (MANE) is proposed as a composite outcome capturing early postoperative events with nutritional and functional relevance.
Objective:
To evaluate the newly proposed MANE construct in patients with CRC undergoing elective laparoscopic surgery and to examine its association with preoperative morphofunctional and CT-derived body composition parameters using a sex-specific approach.
Methods:
This prospective multicenter cohort included 502 patients with CRC. MANE comprised prolonged length of stay, discharge to a care facility, severe postoperative complications (Clavien-Dindo ≥ IIIb), and 90-day mortality, and was classified as No, Non-severe, or Severe MANE. Morphofunctional assessment included bioelectrical impedance analysis, nutritional ultrasound, handgrip strength, and CT-derived muscle and adipose tissue parameters. Sex-stratified multivariable analyses were adjusted for age and tumor stage.
Results:
MANE criteria were met in 54% of patients (46.6% Non-severe, 7.4% Severe). Severe MANE occurred in 9.2% of men and 4.3% of women. In men, higher lean muscle radiodensity was associated with lower odds of Non-severe (aOR 0.69 per 10 HU; 95% CI 0.52-0.90) and Severe MANE (aOR 0.35; 95% CI 0.19-0.59), while myosteatosis was strongly associated with Severe MANE (aOR 8.20; 95% CI 3.16-24.08). In women, greater subcutaneous adipose tissue area was associated with lower odds of Non-severe (aOR 0.95 per 10 cm2; 95% CI 0.92-0.98) and Severe MANE (aOR 0.88; 95% CI 0.76-0.97).
Conclusions:
MANE identified distinct sex-specific patterns of morphofunctional vulnerability, highlighting the relevance of tissue quality and distribution beyond muscle quantity alone. MANE may provide a clinically oriented framework for evaluating morphofunctional markers and developing sex-specific thresholds based on early clinical outcomes. External validation is required.