CoChat
Sign Up
Cited by 11Nutrition and Health in AgingClinical Nutrition and GastroenterologyBody Composition Measurement Techniques

Standard Nutritional Assessment Tools Are Unable to Predict Loss of Muscle Mass in Patients Due to Undergo Pancreatico-Duodenectomy: Highlighting the Need for Detailed Nutritional Assessment

Open access
Phillips, Mary E., Robertson, M. Denise, Bennett-Eastley, Kate, Rowe, Lily, Frampton, Adam E., Hart, Kathryn H.·2024·Nutrients
DOI 10.3390/nu16091269PMC PMC11085118
Open this paper in CoChat — free accountOpen PDF

Abstract

Background and Methods: Pancreatico-duodenectomy (PD) carries significant morbidity and mortality, with very few modifiable risk factors. Radiological evidence of sarcopenia is associated with poor outcomes. This retrospective study aimed to analyse the relationship between easy-to-use bedside nutritional assessment techniques and radiological markers of muscle loss to identify those patients most likely to benefit from prehabilitation. Results: Data were available in 184 consecutive patients undergoing PD. Malnutrition was present in 33–71%, and 48% had a high visceral fat-to-skeletal muscle ratio, suggestive of sarcopenic obesity (SO). Surgical risk was higher in patients with obesity (OR 1.07, 95%CI 1.01–1.14, p = 0.031), and length of stay was 5 days longer in those with SO (p = 0.006). There was no correlation between skeletal muscle and malnutrition using percentage weight loss or the malnutrition universal screening tool (MUST), but a weak correlation between the highest hand grip strength (HGS; 0.468, p < 0.001) and the Global Leadership in Malnutrition (GLIM) criteria (−0.379, p < 0.001). Conclusions: Nutritional assessment tools give widely variable results. Further research is needed to identify patients at significant nutritional risk prior to PD. In the meantime, those with malnutrition (according to the GLIM criteria), obesity or low HGS should be referred to prehabilitation.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.3390/nu16091269

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Recent epidemiological and nutritional shifts characterized by the coexistence of undernutrition and overnutrition, dietary transitions, and population aging have exposed important limitations of the classical ABCD model.

    “However, recent epidemiological and nutritional shifts characterized by the coexistence of undernutrition and overnutrition, dietary transitions, and population aging have exposed important limitations of this classical model [4,5].”

    From The Seven Methods for the Evaluation of Nutritional Status—ABCDEFG: Narrative Review (2026) · cites this paper as [5]

    The Discussion (section 4) and Conclusions (section 5; page unavailable) identify limitations of commonly used nutritional assessment tools in patients awaiting pancreatic surgery, including their weak relationship with muscle mass. The paper does not discuss the ABCD model or attribute its limitations to population-level coexistence of undernutrition and overnutrition, dietary transitions, or population aging. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

No references could be resolved yet.

Research works printed but not linked: 48

  1. [1]Kostalas M. Nageswaran H. Froghi S. Riga A. Kumar R. Menezes N. Worthington T.R. Karanjia N.D. Centralisation for resection of the pancreatic head: A comparison of operative factors and early outcomes during the evolving unit and tertiary unit phases at a UK institution Am. J. Surg. 2018 216 310 313 10.1016/j.amjsurg.2017.07.033 29275908 · DOI
  2. [2]Kanhere H.A. Trochsler M.I. Kanhere M.H. Lord A.N. Maddern G.J. Pancreaticoduodenectomy: Outcomes in a low-volume, specialised Hepato Pancreato Biliary unit World J. Surg. 2014 38 1484 1490 10.1007/s00268-013-2431-9 24378551 · DOI
  3. [4]Jones R.P. Psarelli E.E. Jackson R. Ghaneh P. Halloran C.M. Palmer D.H. Campbell F. Valle J.W. Faluyi O. O’Reilly D.A. Patterns of Recurrence After Resection of Pancreatic Ductal Adenocarcinoma: A Secondary Analysis of the ESPAC-4 Randomized Adjuvant Chemotherapy Trial JAMA Surg. 2019 154 1038 1048 10.1001/jamasurg.2019.3337 31483448 PMC6727687 · DOI
  4. [5]Minnella E.M. Awasthi R. Loiselle S.E. Agnihotram R.V. Ferri L.E. Carli F. Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery: A Randomized Clinical Trial JAMA Surg. 2018 153 1081 1089 10.1001/jamasurg.2018.1645 30193337 PMC6583009 · DOI · Paper page
  5. [6]Fukami Y. Saito T. Arikawa T. Osawa T. Komatsu S. Kaneko K. Ishida Y. Maeda K. Mori N. Sano T. European Society for Clinical Nutrition and Metabolism (ESPEN) Malnutrition Criteria for Predicting Major Complications After Hepatectomy and Pancreatectomy World J. Surg. 2020 45 243 251 10.1007/s00268-020-05767-w 32880680 · DOI
  6. [7]Shinkawa H. Takemura S. Uenishi T. Sakae M. Ohata K. Urata Y. Kaneda K. Nozawa A. Kubo S. Nutritional risk index as an independent predictive factor for the development of surgical site infection after pancreaticoduodenectomy Surg. Today 2013 43 276 283 10.1007/s00595-012-0350-2 23052741 · DOI
  7. [8]Peng P. Hyder O. Firoozmand A. Kneuertz P. Schulick R.D. Huang D. Makary M. Hirose K. Edil B. Choti M.A. Impact of sarcopenia on outcomes following resection of pancreatic adenocarcinoma J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract 2012 16 1478 1486 10.1007/s11605-012-1923-5 PMC3578313 22692586 · DOI · Paper page
  8. [9]Amini N. Spolverato G. Gupta R. Margonis G.A. Kim Y. Wagner D. Rezaee N. Weiss M.J. Wolfgang C.L. Makary M.M. Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: A New Tool to Assess Sarcopenia J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract 2015 19 1593 1602 10.1007/s11605-015-2835-y PMC4844366 25925237 · DOI
  9. [10]Pecorelli N. Capretti G. Sandini M. Damascelli A. Cristel G. De Cobelli F. Gianotti L. Zerbi A. Braga M. Impact of Sarcopenic Obesity on Failure to Rescue from Major Complications Following Pancreaticoduodenectomy for Cancer: Results from a Multicenter Study Ann. Surg. Oncol. 2018 25 308 317 10.1245/s10434-017-6216-5 29116490 · DOI
  10. [11]Bauer J. Morley J.E. Schols A. Ferrucci L. Cruz-Jentoft A.J. Dent E. Baracos V.E. Crawford J.A. Doehner W. Heymsfield S.B. Sarcopenia: A Time for Action. An SCWD Position Paper J. Cachexia Sarcopenia Muscle 2019 10 956 961 10.1002/jcsm.12483 31523937 PMC6818450 · DOI
  11. [12]Mourtzakis M. Prado C.M. Lieffers J.R. Reiman T. McCargar L.J. Baracos V.E. A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care Appl. Physiol. Nutr. Metab. 2008 33 997 1006 10.1139/H08-075 18923576 · DOI · Paper page
  12. [13]Vogele D. Otto S. Sollmann N. Haggenmuller B. Wolf D. Beer M. Schmidt S.A. Sarcopenia—Definition, Radiological Diagnosis, Clinical Significance Rofo 2023 195 393 405 10.1055/a-1990-0201 36630983 · DOI
  13. [14]Contreras-Bolivar V. Sanchez-Torralvo F.J. Ruiz-Vico M. Gonzalez-Almendros I. Barrios M. Padin S. Alba E. Olveira G. GLIM Criteria Using Hand Grip Strength Adequately Predict Six-Month Mortality in Cancer Inpatients Nutrients 2019 11 2043 10.3390/nu11092043 31480635 PMC6770834 · DOI
  14. [16]Byrne C.A. Zhang Y. Fantuzzi G. Geesey T. Shah P. Gomez S.L. Validation of skeletal muscle and adipose tissue measurements using a fully automated body composition analysis neural network versus a semi-automatic reference program with human correction in patients with lung cancer Heliyon 2022 8 e12536 10.1016/j.heliyon.2022.e12536 36619471 PMC9816970 · DOI
  15. [17]van der Werf A. Langius J.A.E. de van der Schueren M.A.E. Nurmohamed S.A. van der Pant K. Blauwhoff-Buskermolen S. Wierdsma N.J. Percentiles for skeletal muscle index, area and radiation attenuation based on computed tomography imaging in a healthy Caucasian population Eur. J. Clin. Nutr. 2018 72 288 296 10.1038/s41430-017-0034-5 29242526 PMC5842880 · DOI · Paper page
  16. [18]Ryu Y. Shin S.H. Kim J.H. Jeong W.K. Park D.J. Kim N. Heo J.S. Choi D.W. Han I.W. The effects of sarcopenia and sarcopenic obesity after pancreaticoduodenectomy in patients with pancreatic head cancer HPB Off. J. Int. Hepato Pancreato Biliary Assoc. 2020 22 1782 1792 10.1016/j.hpb.2020.04.004 32354655 · DOI
  17. [19]Stratton R.J. Hackston A. Longmore D. Dixon R. Price S. Stroud M. King C. Elia M. Malnutrition in hospital outpatients and inpatients: Prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults Br. J. Nutr. 2004 92 799 808 10.1079/BJN20041258 15533269 · DOI
  18. [20]Cederholm T. Jensen G.L. Correia M. Gonzalez M.C. Fukushima R. Higashiguchi T. Baptista G. Barazzoni R. Blaauw R. Coats A. GLIM criteria for the diagnosis of malnutrition—A consensus report from the global clinical nutrition community Clin. Nutr. 2019 38 1 9 10.1016/j.clnu.2018.08.002 30181091 · DOI · Paper page
  19. [21]Dindo D. Demartines N. Clavien P.A. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey Ann. Surg. 2004 240 205 213 10.1097/01.sla.0000133083.54934.ae 15273542 PMC1360123 · DOI · Paper page
  20. [22]Wente M.N. Bassi C. Dervenis C. Fingerhut A. Gouma D.J. Izbicki J.R. Neoptolemos J.P. Padbury R.T. Sarr M.G. Traverso L.W. Delayed gastric emptying (DGE) after pancreatic surgery: A suggested definition by the International Study Group of Pancreatic Surgery (ISGPS) Surgery 2007 142 761 768 10.1016/j.surg.2007.05.005 17981197 · DOI
  21. [23]Bassi C. Marchegiani G. Dervenis C. Sarr M. Abu Hilal M. Adham M. Allen P. Andersson R. Asbun H.J. Besselink M.G. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After Surgery 2017 161 584 591 10.1016/j.surg.2016.11.014 28040257 · DOI
  22. [24]Wente M.N. Veit J.A. Bassi C. Dervenis C. Fingerhut A. Gouma D.J. Izbicki J.R. Neoptolemos J.P. Padbury R.T. Sarr M.G. Postpancreatectomy hemorrhage (PPH): An International Study Group of Pancreatic Surgery (ISGPS) definition Surgery 2007 142 20 25 10.1016/j.surg.2007.02.001 17629996 · DOI
  23. [25]Mukaka M.M. Statistics corner: A guide to appropriate use of correlation coefficient in medical research Malawi Med. J. 2012 24 69 71 23638278 PMC3576830
  24. [26]Probst P. Haller S. Bruckner T. Ulrich A. Strobel O. Hackert T. Diener M.K. Buchler M.W. Knebel P. Prospective trial to evaluate the prognostic value of different nutritional assessment scores in pancreatic surgery (NURIMAS Pancreas) Br. J. Surg. 2017 104 1053 1062 10.1002/bjs.10525 28369809 · DOI
  25. [27]Jager-Wittenaar H. Ottery F.D. Assessing nutritional status in cancer: Role of the Patient-Generated Subjective Global Assessment Curr. Opin. Clin. Nutr. Metab. Care 2017 20 322 329 10.1097/MCO.0000000000000389 28562490 · DOI
  26. [28]Jager-Wittenaar H. de Bats H.F. Welink-Lamberts B.J. Gort-van Dijk D. van der Laan B. Ottery F.D. Roodenburg J.L.N. Self-Completion of the Patient-Generated Subjective Global Assessment Short Form Is Feasible and Is Associated With Increased Awareness on Malnutrition Risk in Patients with Head and Neck Cancer Nutr. Clin. Pract. Off. Publ. Am. Soc. Parenter. Enter. Nutr. 2020 35 353 362 10.1002/ncp.10313 31134665 PMC7078954 · DOI
  27. [29]Klassen P. Baracos V. Gramlich L. Nelson G. Mazurak V. Martin L. Computed-Tomography Body Composition Analysis Complements Pre-Operative Nutrition Screening in Colorectal Cancer Patients on an Enhanced Recovery after Surgery Pathway Nutrients 2020 12 3745 10.3390/nu12123745 33291416 PMC7762071 · DOI
  28. [30]Alhmly H.F. Fielding R.A. A Critical Review of Current Worldwide Definitions of Sarcopenia Calcif. Tissue Int. 2024 114 74 81 10.1007/s00223-023-01163-3 38043100 · DOI
  29. [31]Ackermans L. Rabou J. Basrai M. Schweinlin A. Bischoff S.C. Cussenot O. Cancel-Tassin G. Renken R.J. Gomez E. Sanchez-Gonzalez P. Screening, diagnosis and monitoring of sarcopenia: When to use which tool? Clin. Nutr. ESPEN 2022 48 36 44 10.1016/j.clnesp.2022.01.027 35331514 · DOI
  30. [32]Choi M.H. Yoon S.B. Lee K. Song M. Lee I.S. Lee M.A. Hong T.H. Choi M.G. Preoperative sarcopenia and post-operative accelerated muscle loss negatively impact survival after resection of pancreatic cancer J. Cachexia Sarcopenia Muscle 2018 9 326 334 10.1002/jcsm.12274 29399990 PMC5879976 · DOI
  31. [33]Abe T. Amano H. Kobayashi T. Hanada K. Hattori M. Nakahara M. Ohdan H. Noriyuki T. Preoperative anthropomorphic and nutritious status and fistula risk score for predicting clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy BMC Gastroenterol. 2020 20 264 10.1186/s12876-020-01397-7 32770952 PMC7414683 · DOI
  32. [34]Pecorelli N. Carrara G. De Cobelli F. Cristel G. Damascelli A. Balzano G. Beretta L. Braga M. Effect of sarcopenia and visceral obesity on mortality and pancreatic fistula following pancreatic cancer surgery Br. J. Surg. 2016 103 434 442 10.1002/bjs.10063 26780231 · DOI
  33. [35]Nauheim D.O. Hackbart H. Papai E. Moskal D. Yeo C.J. Lavu H. Nevler A. Preoperative sarcopenia is a negative predictor for enhanced postoperative recovery after pancreaticoduodenectomy Langenbeck’s Arch. Surg./Dtsch. Ges. Fur Chir. 2022 407 2355 2362 10.1007/s00423-022-02558-w 35593934 · DOI
  34. [36]Ali N.A. O’Brien J.M. Jr. Hoffmann S.P. Phillips G. Garland A. Finley J.C. Almoosa K. Hejal R. Wolf K.M. Lemeshow S. Acquired weakness, handgrip strength, and mortality in critically ill patients Am. J. Respir. Crit. Care Med. 2008 178 261 268 10.1164/rccm.200712-1829OC 18511703 · DOI
  35. [37]Kohler M. Olesen S.S. Rasmussen H.H. Body composition predicts clinical outcome in patients with intestinal failure on long-term home parenteral nutrition Clin. Nutr. ESPEN 2018 28 193 200 10.1016/j.clnesp.2018.08.004 30390880 · DOI
  36. [38]Lakenman P. Ottens-Oussoren K. Witvliet-van Nierop J. van der Peet D. de van der Schueren M. Handgrip Strength Is Associated With Treatment Modifications During Neoadjuvant Chemoradiation in Patients with Esophageal Cancer Nutr. Clin. Pract. Off. Publ. Am. Soc. Parenter. Enter. Nutr. 2017 32 652 657 10.1177/0884533617700862 PMC5613809 28459652 · DOI
  37. [39]Kimber J.S. Woodman R.J. Narayana S.K. John L. Ramachandran J. Schembri D. Chen J.W.C. Muller K.R. Wigg A.J. Association of physiological reserve measures with adverse outcomes following liver transplantation JGH Open 2022 6 132 138 10.1002/jgh3.12702 35155823 PMC8829098 · DOI
  38. [40]Mendes J. Alves P. Amaral T.F. Comparison of nutritional status assessment parameters in predicting length of hospital stay in cancer patients Clin. Nutr. 2014 33 466 470 10.1016/j.clnu.2013.06.016 23849810 · DOI
  39. [41]Marano L. Carbone L. Poto G.E. Gambelli M. Nguefack Noudem L.L. Grassi G. Manasci F. Curreri G. Giuliani A. Piagnerelli R. Handgrip strength predicts length of hospital stay in an abdominal surgical setting: The role of frailty beyond age Aging Clin. Exp. Res. 2022 34 811 817 10.1007/s40520-022-02121-z 35389186 PMC9076715 · DOI
  40. [42]Hillman T.E. Nunes Q.M. Hornby S.T. Stanga Z. Neal K.R. Rowlands B.J. Allison S.P. Lobo D.N. A practical posture for hand grip dynamometry in the clinical setting Clin. Nutr. 2005 24 224 228 10.1016/j.clnu.2004.09.013 15784482 · DOI
  41. [43]Bibby N. Rajai A. O’Reilly D.A. From prehab to rehab: Nutritional support for people undergoing pancreatic cancer surgery J. Hum. Nutr. Diet. Off. J. Br. Diet. Assoc. 2023 36 493 503 10.1111/jhn.13040 35607759 · DOI
  42. [44]Goonetilleke K.S. Hathurusinghe H.R. Burden S. Siriwardena A.K. Nutritional and anthropometric assessment of the scope for dietary optimization during staging prior to pancreaticoduodenectomy JOP J. Pancreas 2008 9 415 421 18648132
  43. [45]Werba G. Sparks A.D. Lin P.P. Johnson L.B. Vaziri K. The PrEDICT-DGE score as a simple preoperative screening tool identifies patients at increased risk for delayed gastric emptying after pancreaticoduodenectomy HPB Off. J. Int. Hepato Pancreato Biliary Assoc. 2022 24 30 39 10.1016/j.hpb.2021.06.417 34274231 · DOI
  44. [46]Besselink M.G. van Rijssen L.B. Bassi C. Dervenis C. Montorsi M. Adham M. Asbun H.J. Bockhorn M. Strobel O. Buchler M.W. Definition and classification of chyle leak after pancreatic operation: A consensus statement by the International Study Group on Pancreatic Surgery Surgery 2017 161 365 372 10.1016/j.surg.2016.06.058 27692778 · DOI
  45. [47]Belyaev O. Munding J. Herzog T. Suelberg D. Tannapfel A. Schmidt W.E. Mueller C.A. Uhl W. Histomorphological features of the pancreatic remnant as independent risk factors for postoperative pancreatic fistula: A matched-pairs analysis Pancreatol. Off. J. Int. Assoc. Pancreatol. 2011 11 516 524 10.1159/000332587 22056514 · DOI
  46. [48]Buehring B. Siglinsky E. Krueger D. Evans W. Hellerstein M. Yamada Y. Binkley N. Comparison of muscle/lean mass measurement methods: Correlation with functional and biochemical testing Osteoporos. Int. 2018 29 675 683 10.1007/s00198-017-4315-6 29198074 · DOI
  47. [49]Neidlein S. Wirth R. Pourhassan M. Iron deficiency, fatigue and muscle strength and function in older hospitalized patients Eur. J. Clin. Nutr. 2021 75 456 463 10.1038/s41430-020-00742-z 32901103 PMC7943415 · DOI
  48. [50]Deprato A. Verhoeff K. Purich K. Kung J.Y. Bigam D.L. Dajani K.Z. Surgical outcomes and quality of life following exercise-based prehabilitation for hepato-pancreatico-biliary surgery: A systematic review and meta-analysis Hepatobiliary Pancreat. Dis. Int. 2022 21 207 217 10.1016/j.hbpd.2022.02.004 35232658 · DOI

Cited by

Sorted by citations

Authors
Phillips, M. E., Robertson, M. D., Bennett-Eastley, K., Rowe, L., Frampton, A. E., & Hart, K. H.
Affiliations
  • University of Surrey (GB)
  • Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
  • Royal Surrey NHS Foundation Trust (GB)
Corresponding author
Phillips, Mary E.
ORCID
Venue
Nutrients
Publisher
MDPI AG
Published
2024-04-25
Volume
16
Issue
9
Pages
1269
ISSN
2072-6643 (ISSN-L)
DOI
10.3390/nu16091269
PMC
PMC11085118
OpenAlex
W4395454026
Cited by
11
References
0
Citations by year
2026: 6 · 2025: 5
FWCI
3.13
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrients (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • University of Surrey “Bid for better”
  • Royal Surrey County Hospital NHS Foundation Trust
  • Pancreatic Cancer Action
Topics
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
Keywords
sarcopenia, sarcopenic obesity, nutritional assessment, malnutrition, grip strength, GLIM criteria, prehabilitation, obesity, length of hospital stay, surgical risk
MeSH terms
Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Nutritional Status, Obesity, Retrospective Studies, Risk Factors, Nutrition Assessment, Pancreaticoduodenectomy, Muscle, Skeletal, Hand Strength, Malnutrition, Sarcopenia

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review