Feasibility of implementing ESPEN/EASO consensus criteria for sarcopenic obesity assessment in bariatric surgery: A dual-modality imaging pilot study.

BACKGROUND

The heterogeneous diagnostic methods for sarcopenic obesity lack standardization across clinical practice. The 2022 ESPEN/EASO consensus established standardized diagnostic criteria emphasizing weight-adjusted muscle mass indices, yet implementation feasibility in bariatric surgery populations remains unexplored. The absence of validated cutoff values for Class III obesity and limited evidence on dual-modality assessment protocols represent critical barriers to clinical implementation.

OBJECTIVE

This pilot study objectively assessed the implementation of ESPEN/EASO consensus criteria using dual-modality DXA and MRI assessment in women undergoing sleeve gastrectomy, with primary focus on protocol completion rates, technical precision, and preliminary evaluation of weight-adjusted diagnostic indices.

METHODS

Following CONSORT 2010 pilot trial extension guidelines, this feasibility study analyzed eleven women (age 41.3 ± 7.9 years (95 % CI: 36.6-46.0 years), 41.0 ± 5.0 kg/m2 (95 % CI: 38.0-44.0 kg/m2) undergoing laparoscopic sleeve gastrectomy. Primary feasibility outcomes included dual-modality assessment completion rates, MRI segmentation algorithm performance, and protocol adherence. Secondary outcomes encompassed preliminary body composition changes and ASM/weight diagnostic utility evaluation using ESPEN/EASO recommended cutoffs.

RESULTS

Dual-modality assessment achieved 100 % completion rates with excellent technical precision (MRI segmentation Dice coefficient: 0.95 ± 0.01 for muscle, 0.95 ± 0.03 for adipose tissue). Protocol adherence was optimal with all participants completing scheduled assessments. Preliminary body composition analysis demonstrated substantial weight reduction of 29.4 ± 25.3 kg (95 % CI: 14.4-44.4 kg) at six months. ASM/weight ratios showed potential diagnostic utility, though wide confidence intervals reflect substantial uncertainty inherent in small sample analysis.

CONCLUSIONS

Implementation of ESPEN/EASO consensus criteria demonstrates 100 % protocol completion rates and MRI segmentation precision with Dice coefficients of 0.95 ± 0.01 for muscle and 0.95 ± 0.03 for adipose tissue in bariatric surgery populations. This pilot study establishes the methodological foundation and demonstrates feasibility for larger-scale validation studies to develop obesity-specific diagnostic thresholds and optimize sarcopenic obesity assessment protocols in bariatric medicine.