Body mass index–adjusted calf circumference is associated with mortality in hospitalized older patients with excess weight

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2024-09, Vol.125, p.112505, Article 112505
• Main Authors: Costa Pereira, Jarson Pedro da, Gonzalez, Maria Cristina, Prado, Carla M., Cabral, Poliana Coelho, Nascimento, Tais Galdencio do, Nascimento, Maria Karolainy do, Diniz, Alcides da Silva, Ramiro, Claudia Porto Sabino Pinho, Fayh, Ana Paula Trussardi
• Format: Article
• Language: English
• Subjects: Body composition; Body mass index; Body size; Body weight; Calf circumference; Clinical outcomes; Data collection; Edema; Electronic health records; Hospitalization; Hospitals; Malnutrition; Medical records; Mortality; Muscle mass; muscle tissues; Muscles; nutrition; Nutritional status; Obesity; Patients; Prognosis; Sarcopenia; Software
• ISSN: 0899-9007; 1873-1244; 1873-1244
• DOI: 10.1016/j.nut.2024.112505

[Display omitted] •Calf circumference (CC) without body mass index (BMI) adjustment may mask low muscle mass in excess weight.•BMI-adjusted CC can be not only an anthropometric but also a prognostic marker.•BMI-adjusted CC may predict mortality among older patients.•Each centimeter decrease in BMI-adjusted CC increased mortality hazard by 19%. Given the innovative nature of the method, our study aimed to assess the prognostic significance of body mass index (BMI)-adjusted calf circumference (CC) in older patients who are hospitalized. This was a unique analysis as part of other cohorts comprising general hospitalized patients aged 60 years or older of both sexes. Only patients with excess weight (BMI ≥ 25 kg/m2) were included. CC was adjusted by reducing 3, 7, or 12 cm for BMI (in kg/m2) within 25-29.9, 30–39.9, and ≥40 kg/m2, respectively. CC was considered low if ≤ 34 cm for males and ≤ 33 cm for females. Clinical outcomes included prolonged length of hospital stay (LOS) and mortality. A total of 222 patients were included. After BMI adjustments, 72.1% of the patients were reclassified from a normal CC category to a low CC category. The frequency of low CC increased from 33.8% to 81.9% following BMI adjustments. Among those reclassified to the low CC, 11 died, compared to only 2 patients in the group that maintained a normal CC classification. BMI-adjusted CC was inversely associated with mortality (HR adjusted 0.84, 95% CI 0.73 to 0.95), but not with prolonged LOS. Our novel study highlights the prognostic value of BMI-adjusted CC. As an anthropometric marker of muscle mass, it proved to be a predictor of mortality in older patients with high BMI. This adjustment is further important because it may help to better detect low muscle mass in these patients where such conditions might be masked.