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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The diagnosis of clinical conditions involving alterations in body composition&#44; such as malnutrition or sarcopenia&#44; remains a clinical challenge&#44; primarily due to the increasing prevalence and prognostic implications of these conditions&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Among the imaging techniques used in this field&#44; computed tomography and magnetic resonance imaging are considered the gold standard&#44; but they have limitations such as radiation exposure or limited availability&#46; In fact&#44; other more accessible techniques have been developed&#44; such as bioimpedance analysis &#40;BIA&#41; and dual-energy X-ray absorptiometry&#46; However&#44; these techniques also have limitations&#44; such as the inability to determine fat localization or provide qualitative information&#44; such as muscle fat infiltration&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this context&#44; clinical ultrasound emerges as a tool primarily used to assess two dimensions&#58; fat-free mass through muscle ultrasound and adipose tissue &#40;subcutaneous and visceral&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The advantages of ultrasound are well-known &#40;portability&#44; widespread availability&#44; non-invasive technique&#44; etc&#46;&#41;&#46; Its main limitation is that it is operator-dependent&#46; From a technical point of view&#44; muscle and adipose tissue ultrasound&#44; both in obtaining images and interpreting them&#44; is relatively easy to learn&#46; Furthermore&#44; muscle ultrasound allows the evaluation of different locations and parameters such as area&#44; transverse diameter&#44; and pennation angle &#40;the angle at which muscle fibers join the tendon in pennate muscles&#41;&#46; It is also possible to evaluate the degree of fat infiltration &#40;myosteatosis&#41;&#46; Among these parameters&#44; the thickness and area of the rectus femoris muscle are the most validated&#44; showing a good correlation with fat-free mass measured by BIA or grip strength&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Additionally&#44; ultrasound allows the assessment of fat as tissue &#40;subcutaneous&#44; preperitoneal&#44; intraabdominal&#44; or visceral fat&#41; and intracellular fat accumulations &#40;hepatic steatosis or myosteatosis&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There are also multiple clinical scenarios where ultrasound can be useful&#46; In diagnosing malnutrition or sarcopenia&#44; it allows us to estimate whether there is reduced fat or muscle mass&#46; Moreover&#44; it enables the detection of abnormal visceral fat infiltration&#44; an independent marker of cardiovascular risk that could help refine risk estimation&#46; Finally&#44; nutritional ultrasound provides prognostic information in patients with hip fractures&#44; oncological patients&#44; etc&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The main limitations of this technique are due to studies being conducted on small populations and by a limited number of operators&#44; as well as the absence of standardized examination protocols and validated cutoff points to define what is normal and pathological &#40;currently&#44; ultrasound is not included in diagnostic algorithms for malnutrition or sarcopenia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">To incorporate ultrasound into routine clinical practice&#44; it is essential to advance research in two areas&#58; 1&#41; technique and diagnostic cutoff points&#59; 2&#41; clinical applicability&#44; defining scenarios where ultrasound provides diagnostic&#44; prognostic&#44; or evolving information that influences clinical management&#46; Among the ongoing studies&#44; we can highlight the ECOSARCO study&#44; led by Dr&#46; Bernabeu&#44; which aims to establish diagnostic ultrasound criteria for sarcopenia by evaluating the quadriceps and calf muscles in patients admitted to internal medicine services&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Given its potential&#44; it is also crucial to establish a standardized training plan to generalize the use of the technique&#46; In this regard&#44; the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine has developed a specific theoretical and practical course on ultrasound in the assessment of body composition&#44; which has already involved more than 400 internists&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Spanish Clinical Journal</span>&#44; Mar&#237;n-Baselga et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> published a study that correlates different parameters of muscle and fat ultrasound with clinical&#44; anthropometric&#44; and analytical parameters&#46; The study shows how&#44; upon admission&#44; the measurement of rectus femoris thickness and preperitoneal adipose tissue correlates with hospital stay&#46; It is noteworthy that these two measurements are easy to obtain&#44; which would greatly facilitate their applicability&#46; Although the study has limitations&#44; such as a small sample size&#44; it raises two interesting questions&#58; can these parameters identify patients with a worse prognosis&#63; And&#44; going a step further&#44; could some nutritional or physiotherapy intervention improve this prognosis&#63; Furthermore&#44; this is one of the first publications in the field of internal medicine to address this topic and may serve as a catalyst to promote research in this field&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion&#44; ultrasound in the assessment of body composition is a promising tool in the evaluation of nutritional disorders&#44; sarcopenia&#44; and cardiovascular risk&#46; However&#44; it is essential to promote research in this field&#44; presenting an excellent opportunity for internists in our country&#46;</p></span>"
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Editorial
Point of care ultrasound in body composition assessment: a promising tool and a good opportunity for internists
Ecografía clínica en la valoración de la composición corporal: herramienta prometedora y oportunidad para los internistas
J. Torres Machoa,b,
Corresponding author
juan.torresm@salud.madrid.org

Corresponding author.
, L.M. Beltrán Romeroc
a Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain
b Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain
c Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The diagnosis of clinical conditions involving alterations in body composition&#44; such as malnutrition or sarcopenia&#44; remains a clinical challenge&#44; primarily due to the increasing prevalence and prognostic implications of these conditions&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Among the imaging techniques used in this field&#44; computed tomography and magnetic resonance imaging are considered the gold standard&#44; but they have limitations such as radiation exposure or limited availability&#46; In fact&#44; other more accessible techniques have been developed&#44; such as bioimpedance analysis &#40;BIA&#41; and dual-energy X-ray absorptiometry&#46; However&#44; these techniques also have limitations&#44; such as the inability to determine fat localization or provide qualitative information&#44; such as muscle fat infiltration&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this context&#44; clinical ultrasound emerges as a tool primarily used to assess two dimensions&#58; fat-free mass through muscle ultrasound and adipose tissue &#40;subcutaneous and visceral&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The advantages of ultrasound are well-known &#40;portability&#44; widespread availability&#44; non-invasive technique&#44; etc&#46;&#41;&#46; Its main limitation is that it is operator-dependent&#46; From a technical point of view&#44; muscle and adipose tissue ultrasound&#44; both in obtaining images and interpreting them&#44; is relatively easy to learn&#46; Furthermore&#44; muscle ultrasound allows the evaluation of different locations and parameters such as area&#44; transverse diameter&#44; and pennation angle &#40;the angle at which muscle fibers join the tendon in pennate muscles&#41;&#46; It is also possible to evaluate the degree of fat infiltration &#40;myosteatosis&#41;&#46; Among these parameters&#44; the thickness and area of the rectus femoris muscle are the most validated&#44; showing a good correlation with fat-free mass measured by BIA or grip strength&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Additionally&#44; ultrasound allows the assessment of fat as tissue &#40;subcutaneous&#44; preperitoneal&#44; intraabdominal&#44; or visceral fat&#41; and intracellular fat accumulations &#40;hepatic steatosis or myosteatosis&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There are also multiple clinical scenarios where ultrasound can be useful&#46; In diagnosing malnutrition or sarcopenia&#44; it allows us to estimate whether there is reduced fat or muscle mass&#46; Moreover&#44; it enables the detection of abnormal visceral fat infiltration&#44; an independent marker of cardiovascular risk that could help refine risk estimation&#46; Finally&#44; nutritional ultrasound provides prognostic information in patients with hip fractures&#44; oncological patients&#44; etc&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The main limitations of this technique are due to studies being conducted on small populations and by a limited number of operators&#44; as well as the absence of standardized examination protocols and validated cutoff points to define what is normal and pathological &#40;currently&#44; ultrasound is not included in diagnostic algorithms for malnutrition or sarcopenia&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">To incorporate ultrasound into routine clinical practice&#44; it is essential to advance research in two areas&#58; 1&#41; technique and diagnostic cutoff points&#59; 2&#41; clinical applicability&#44; defining scenarios where ultrasound provides diagnostic&#44; prognostic&#44; or evolving information that influences clinical management&#46; Among the ongoing studies&#44; we can highlight the ECOSARCO study&#44; led by Dr&#46; Bernabeu&#44; which aims to establish diagnostic ultrasound criteria for sarcopenia by evaluating the quadriceps and calf muscles in patients admitted to internal medicine services&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Given its potential&#44; it is also crucial to establish a standardized training plan to generalize the use of the technique&#46; In this regard&#44; the Clinical Ultrasound Working Group of the Spanish Society of Internal Medicine has developed a specific theoretical and practical course on ultrasound in the assessment of body composition&#44; which has already involved more than 400 internists&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Spanish Clinical Journal</span>&#44; Mar&#237;n-Baselga et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> published a study that correlates different parameters of muscle and fat ultrasound with clinical&#44; anthropometric&#44; and analytical parameters&#46; The study shows how&#44; upon admission&#44; the measurement of rectus femoris thickness and preperitoneal adipose tissue correlates with hospital stay&#46; It is noteworthy that these two measurements are easy to obtain&#44; which would greatly facilitate their applicability&#46; Although the study has limitations&#44; such as a small sample size&#44; it raises two interesting questions&#58; can these parameters identify patients with a worse prognosis&#63; And&#44; going a step further&#44; could some nutritional or physiotherapy intervention improve this prognosis&#63; Furthermore&#44; this is one of the first publications in the field of internal medicine to address this topic and may serve as a catalyst to promote research in this field&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion&#44; ultrasound in the assessment of body composition is a promising tool in the evaluation of nutritional disorders&#44; sarcopenia&#44; and cardiovascular risk&#46; However&#44; it is essential to promote research in this field&#44; presenting an excellent opportunity for internists in our country&#46;</p></span>"
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ISSN: 22548874
Original language: English
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