Point of care ultrasound in body composition assessment: a promising tool and a good opportunity for internists

Torres Macho, J.; Beltrán Romero, L.M.

doi:10.1016/j.rceng.2023.10.003

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Torres Macho, L.M. Beltrán Romero" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Torres Macho" "email" => array:1 [ 0 => "juan.torresm@salud.madrid.org" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L.M." "apellidos" => "Beltrán Romero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Virgen de la Torre, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ecografía clínica en la valoración de la composición corporal: herramienta prometedora y oportunidad para los internistas" ] ] "textoCompleto" => "The diagnosis of clinical conditions involving alterations in body composition, such as malnutrition or sarcopenia, remains a clinical challenge, primarily due to the increasing prevalence and prognostic implications of these conditions.Among the imaging techniques used in this field, computed tomography and magnetic resonance imaging are considered the gold standard, but they have limitations such as radiation exposure or limited availability. In fact, other more accessible techniques have been developed, such as bioimpedance analysis (BIA) and dual-energy X-ray absorptiometry. However, these techniques also have limitations, such as the inability to determine fat localization or provide qualitative information, such as muscle fat infiltration.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>In this context, clinical ultrasound emerges as a tool primarily used to assess two dimensions: fat-free mass through muscle ultrasound and adipose tissue (subcutaneous and visceral).<a class="elsevierStyleCrossRef" href="#bib0015">3</a>The advantages of ultrasound are well-known (portability, widespread availability, non-invasive technique, etc.). Its main limitation is that it is operator-dependent. From a technical point of view, muscle and adipose tissue ultrasound, both in obtaining images and interpreting them, is relatively easy to learn. Furthermore, muscle ultrasound allows the evaluation of different locations and parameters such as area, transverse diameter, and pennation angle (the angle at which muscle fibers join the tendon in pennate muscles). It is also possible to evaluate the degree of fat infiltration (myosteatosis). Among these parameters, the thickness and area of the rectus femoris muscle are the most validated, showing a good correlation with fat-free mass measured by BIA or grip strength.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a>Additionally, ultrasound allows the assessment of fat as tissue (subcutaneous, preperitoneal, intraabdominal, or visceral fat) and intracellular fat accumulations (hepatic steatosis or myosteatosis).<a class="elsevierStyleCrossRef" href="#bib0015">3</a> There are also multiple clinical scenarios where ultrasound can be useful. In diagnosing malnutrition or sarcopenia, it allows us to estimate whether there is reduced fat or muscle mass. Moreover, it enables the detection of abnormal visceral fat infiltration, an independent marker of cardiovascular risk that could help refine risk estimation. Finally, nutritional ultrasound provides prognostic information in patients with hip fractures, oncological patients, etc.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>The main limitations of this technique are due to studies being conducted on small populations and by a limited number of operators, as well as the absence of standardized examination protocols and validated cutoff points to define what is normal and pathological (currently, ultrasound is not included in diagnostic algorithms for malnutrition or sarcopenia).<a class="elsevierStyleCrossRef" href="#bib0035">7</a>To incorporate ultrasound into routine clinical practice, it is essential to advance research in two areas: 1) technique and diagnostic cutoff points; 2) clinical applicability, defining scenarios where ultrasound provides diagnostic, prognostic, or evolving information that influences clinical management. Among the ongoing studies, we can highlight the ECOSARCO study, led by Dr. Bernabeu, which aims to establish diagnostic ultrasound criteria for sarcopenia by evaluating the quadriceps and calf muscles in patients admitted to internal medicine services.Given its potential, it is also crucial to establish a standardized training plan to generalize the use of the technique. In this regard, 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, which has already involved more than 400 internists.In this issue of the Spanish Clinical Journal, Marín-Baselga et al.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> published a study that correlates different parameters of muscle and fat ultrasound with clinical, anthropometric, and analytical parameters. The study shows how, upon admission, the measurement of rectus femoris thickness and preperitoneal adipose tissue correlates with hospital stay. It is noteworthy that these two measurements are easy to obtain, which would greatly facilitate their applicability. Although the study has limitations, such as a small sample size, it raises two interesting questions: can these parameters identify patients with a worse prognosis? And, going a step further, could some nutritional or physiotherapy intervention improve this prognosis? Furthermore, 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.In conclusion, ultrasound in the assessment of body composition is a promising tool in the evaluation of nutritional disorders, sarcopenia, and cardiovascular risk. However, it is essential to promote research in this field, presenting an excellent opportunity for internists in our country." 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Revista Clínica Española (English Edition)

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Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI).
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Vol. 223. Issue 10.

Pages 647-648 (December 2023)

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