Short-term changes in body composition and the development of sarcopenia following acute pancreatitis: An observational study

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This study aimed to evaluate short-term changes in body composition and the development of sarcopenia in patients with moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP). Methods: This single-center, prospective observational study evaluated patients with MSAP and SAP at admission and after eight weeks. Body composition was measured using bioelectrical impedance analysis (BIA). Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People (EWGSOP2) guidelines, with handgrip strength (HGS) used to identify probable sarcopenia and computed tomography (CT)-derived skeletal muscle index (SMI) used to confirm the diagnosis. Results: Forty patients (22 MSAP, 18 SAP) were included. The mean age was 39.4 ±14.8 years, and 75% were male. Patients with SAP had significantly higher BISAP scores (2.16 vs 1.04) and rates of organ failure compared to the MSAP group. Over eight weeks, both groups experienced significant reductions in body mass index (BMI), body fat, and visceral fat. SMI declined significantly in both MSAP (47.5 to 41.5 cm²/m², p < 0.001) and SAP (48.9 to 41.2 cm²/m², p < 0.001). At follow-up, the prevalence of confirmed sarcopenia was 31.8% in the MSAP group and 22.2% in the SAP group. Handgrip strength did not change significantly in either group. Conclusion: Moderately severe and severe AP lead to rapid, detrimental changes in body composition and a high incidence of sarcopenia within eight weeks. These findings highlight the need for systematic screening and targeted nutritional and physical rehabilitation to mitigate muscle loss in recovering patients. Acute pancreatitis Sarcopenia Body composition Skeletal muscle index Bioelectrical impedance analysis Figures Figure 1 Introduction Acute pancreatitis (AP) is a leading gastrointestinal cause of hospitalization, with a rising global incidence.[ 1 ] In most cases of acute pancreatitis, the cause is identifiable, with gallstones, alcohol use, and idiopathic factors being the most common.[ 1 ] While most cases are mild, approximately 20% of patients develop moderately severe acute pancreatitis (MSAP) or severe acute pancreatitis (SAP) disease, which is characterized by systemic inflammatory response syndrome (SIRS), organ failure, and high mortality.[ 2 ] The intense inflammatory response in acute pancreatitis induces a hypermetabolic, catabolic state that severely impairs nutrition. Malnutrition results from reduced oral intake due to anorexia, abdominal pain, vomiting, ileus, and prolonged fasting, along with pancreatic exocrine dysfunction that causes nutrient maldigestion, which may persist for several months after the acute episode.[ 3 ] This profound catabolic stress leads to significant weight loss and alterations in body composition. One of the most critical consequences of this process is sarcopenia, the progressive loss of skeletal muscle mass and function. In acute or chronic inflammatory states, changes in proinflammatory and anti-inflammatory mediator levels have been shown to play a role in the pathogenesis of sarcopenia.[ 4 ] Myokines, including myostatin and irisin, as well as adipokines like leptin and adiponectin, are involved. Myostatin, predominantly expressed in skeletal muscle, acts as a negative regulator of muscle mass and is often elevated in sarcopenia. In contrast, irisin opposes the effects of myostatin and is typically reduced in this condition.[ 5 ] The 2018 operational definition of sarcopenia developed by the “European Working Group on Sarcopenia in Older People” (EWGSOP2) includes low muscle strength, low muscle quantity or quality, and low physical performance. Probable sarcopenia is defined by reduced muscular strength, while the presence of decreased muscle quality or quantity confirms the diagnosis. Sarcopenia is deemed severe if all three criteria are satisfied.[ 6 ] Recent studies have begun to link body composition to AP outcomes. Yoon et al. studied the relationship between various body composition parameters, including body weight, body mass index (BMI), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and visceral fat-to-muscle ratio (VMR) at the third lumbar vertebral level using computed tomography and their ability to predict the severity of acute pancreatitis. They found that VMR had the highest correlation with moderately severe or severe AP, local complications, and organ failure. [ 7 ] An observational study by Farquhar R et al. found a higher prevalence of sarcopenia and sarcopenic obesity in patients with severe acute pancreatitis and organ failure. Additionally, they identified sarcopenic obesity as a significant predictor of mortality; however, they only used myopenia as a criterion for defining sarcopenia.[ 8 ] Using bioelectrical impedance analysis (BIA) and hand dynamometry to define sarcopenia, Kilic SG et al. recently found that the sarcopenic group had higher rates of SAP and lower body mass index, upper arm circumference, skeletal muscle mass index, and grip strength. However, repeated measurements during clinical follow-up were not conducted, which was a major limitation in predicting long-term outcomes.[ 9 ] Therefore, the present study was designed to fill this critical gap by prospectively tracking changes in both muscle quantity (skeletal muscle index-SMI) and function (handgrip Strength-HGS) over eight weeks, applying the comprehensive EWGSOP2 diagnostic criteria. Crucially, the current scoring systems for AP severity exclude nutritional status, despite growing evidence that sarcopenia and malnutrition are independent predictors of morbidity, mortality, and healthcare costs.[ 10 ] Thus, this study aims to assess short-term changes in body composition and the development of sarcopenia in patients with moderately severe and severe acute pancreatitis. The results may have a significant bearing on the planning of nutritional rehabilitation for these patients during the initial four to eight weeks following acute pancreatitis. Methodology Study Design and Ethics: This prospective observational study was conducted in the Department of Gastroenterology at the Post-Graduate Institute of Medical Education and Research, Chandigarh, India, from July 2022 to December 2023. Ethical approval was obtained from the institutional ethics committee, IEC-INT/2022/DM-240. Informed consent was obtained from all patients. Patient enrollment: We enrolled patients diagnosed with moderately severe (MSAP) and severe acute pancreatitis (SAP) based on the Revised Atlanta Classification :[ 11 ] a) Mild acute pancreatitis- no organ failure and no local or systemic complications b) Moderately severe acute pancreatitis-presence of transient organ failure (lasting 48 hours) and c) Severe acute pancreatitis-persistent organ failure (lasting > 48 hours) Organ failure was assessed using the Modified Marshall Scoring System.[ 12 ] Patients with underlying chronic pancreatitis, known immunodeficient status, preexisting cardiac, chronic liver, or chronic kidney disease, as well as pregnant and lactating women, those with proven malignancy of any organ, and patients with muscular dystrophy or amputation were excluded. All patients underwent a detailed medical history intake and clinical examination within seven days of admission to our center. The history included age, sex, duration of symptoms, prior comorbidities, previous episodes of symptom recurrence, etiological history, medication history, and prior treatments. The examination involved measuring weight, height, BMI, and vital signs (pulse rate, blood pressure, and temperature), along with a general physical examination, abdominal examination, and systemic assessment. Blood tests, including complete blood counts, renal and liver function tests, serum albumin, C-reactive protein (CRP), blood gas analysis, serum calcium, and vitamin D levels, were conducted for all patients. Evaluation of body composition and sarcopenia was performed as follows. A body composition monitor (OMRON HBF-375 Karada Scan) was used to assess body composition via a weak electrical current (50 kHz, 500µA) through both hands and feet using the hand-to-foot bioelectrical impedance (biological resistance) method. The participant was instructed to stand barefoot on foot electrodes and grasp the grip electrodes while raising their arms horizontally and extending their elbows straight to maintain a 90° angle between the arms and torso. The following parameters were calculated: body weight, body mass index (BMI), whole body fat percentage (WBFP), whole body subcutaneous fat percentage (WBSFP), visceral fat level, and whole body skeletal muscle percentage (WBSMP). $$\:Whole\:body\:fat\:percentage\:\left(\%\right)=\frac{Body\:fat\:mass\:\left(Kg\right)}{Body\:weight\:\left(Kg\right)}\times\:100$$ $$\:Whole\:body\:skeletal\:muscle\:percentage\:\left(\%\right)=\frac{Skeletal\:muscle\:mass\:\left(Kg\right)}{Body\:weight\:\left(Kg\right)}\times\:100$$ A digital hand dynamometer was used to assess the handgrip strength of each participant. Participants sat in a standard chair with their shoulders adducted and neutrally rotated, elbows flexed at a right angle, forearms in a neutral position, and wrists positioned between 0º and 30º of dorsiflexion. Before taking measurements, participants received a demonstration of the proper dynamometer usage. Handgrip strength was measured three times for each arm, totaling six measurements. Participants were instructed to apply maximum pressure on the handle for 3 to 5 seconds during each attempt, and the highest value from either arm was recorded as the final measurement. At least one minute of rest was given between consecutive measurements on the same arm. The device was calibrated daily following the manufacturer's instructions. The obtained values were compared to normative data for the local population. The cut-off points for low muscle strength were 27.5 kg for males and 18 kg for females.[ 13 ] The skeletal muscle index (muscle quantity) was calculated using non-contrast 128 single-slice axial computed tomography (CT) of the abdomen at the third lumbar vertebra (L3) using a multi-detector row CT scanner (SOMATOM® Definition Flash, Siemens, Germany). The cross-sectional area (cm 2 ) of all skeletal muscles at the L3 level was calculated using Syngo.via software (Siemens Healthineers, Germany). This value was divided by the square of the height (m 2 ) to obtain the skeletal muscle index (SMI). Skeletal muscle was identified based on predefined CT attenuation of -20 to + 120 HU. Based on an Indian study involving healthy participants, the cut-off values for low SMI were 36.54 \(\:{cm}^{2}\) / \(\:{m}^{2}\) for males and 30.21 \(\:{cm}^{2}\) / \(\:{m}^{2}\) for females.[ 14 ] $$\:Skeletal\:muscle\:index\:\left(SMI\right)=\frac{Cross-sectional\:area\:of\:skeletal\:muscle\:at\:L3\left({cm}^{2}\right)}{Height\left({m}^{2}\right)}$$ The definition of probable and confirmed sarcopenia as per EWGSOP2 was used:[ 6 ] Probable Sarcopenia: Low muscle strength (low HGS). Confirmed Sarcopenia: Low muscle strength (low HGS) and low muscle quantity (low SMI). Statistical analysis: Data analysis was performed using SPSS software, version 24 (IBM, Chicago, IL, USA). The normality of all quantitative variables was assessed through histograms, normality Q-Q plots, and the Shapiro-Wilk test. Normal distribution was defined as a \(\:p>0.05\) . Descriptive analysis was performed using mean and standard deviation for normally distributed quantitative data, while categorical variables were presented as frequencies and percentages. The median and interquartile range (IQR) were used to summarize non-normally distributed quantitative variables. The Chi-square test or Fisher's exact test was used to evaluate categorical outcomes between study groups. An independent samples t -test (2 groups) was utilized to compare the mean values of normally distributed quantitative parameters between the two study groups. Changes in variables from baseline to the eight-week follow-up within each group were analyzed using a paired-samples t -test. A p-value ≤ 0.05 was considered statistically significant. Figure 1 Flow chart illustrating the prospective study design, including patient screening, exclusion criteria, enrolment of MSAP and SAP cohorts, and the 8-week follow-up protocol for body composition and sarcopenia assessment Results Baseline characteristics Of the 70 patients screened, 40 (22 MSAP, 18 SAP) were enrolled. The groups were well-matched for age (pooled mean 39.4 ± 14.8 years) and sex (Table 1). The predominant etiologies were alcohol and gallstone disease in both cohorts. As expected, the SAP group demonstrated a significantly higher inflammatory burden, with higher mean CRP (238.1 vs 168.1 mg/L, p <0.05) and BISAP scores (2.16 vs 1.04, p <0.001) compared to the MSAP group. Systemic complications were more common in the SAP group. Persistent organ failure, particularly acute lung injury (88.89%), was the defining feature of the SAP group. Notably, all patients with SAP were vitamin D deficient, a significantly higher proportion than in the MSAP group (100% vs 63.6%, p =0.003). Body composition variables Over the eight-week follow-up period, both groups exhibited significant declines in adiposity measures (Table 2). The mean BMI reduction was −1.6 kg/m² in the MSAP group ( p < 0.001) and −2.8 kg/m² in the SAP group ( p < 0.001), with the decline being significantly more pronounced in the SAP group ( p = 0.05). Both groups also showed significant reductions in whole-body fat percentage, subcutaneous fat percentage, and visceral fat levels. Sarcopenia variables The most critical finding was the significant loss of muscle mass in both cohorts (Table 3). Mean SMI decreased by −5.9 cm²/m² in the MSAP group and by −7.7 cm²/m² in the SAP group (both p < 0.001). In contrast, mean HGS did not change significantly from baseline to follow-up in either the MSAP group (23.5 to 25.4 kg, p = 0.09) or the SAP group (22.5 to 21.9 kg, p = 0.6). Based on the EWGSOP2 criteria, the prevalence of probable sarcopenia (low HGS) was high at baseline and remained high at follow-up (59% in the MSAP group, 61.1% in the SAP group). The prevalence of confirmed sarcopenia (low HGS + low SMI) increased from 4.5% to 31.8% in the MSAP group (p = 0.03) and from 5.6% to 22.2% in the SAP group (p = 0.25). Discussion This prospective observational study provides compelling evidence that MSAP and SAP are associated with significant short-term detrimental changes in body composition and a high incidence of sarcopenia. Our key findings are that over eight weeks, patients with MSAP and SAP experienced a significant reduction in body mass index (BMI), whole-body fat, subcutaneous fat, visceral fat, and, most importantly, the skeletal muscle index (SMI). Utilizing the EWGSOP2 criteria, we found a strikingly high prevalence of probable sarcopenia (59% in the MSAP group, 61.1% in the SAP group) and confirmed sarcopenia (31.8% in the MSAP group, 22.2% in the SAP group) at the eight week follow-up, underscoring the profound impact of the disease on musculoskeletal health. The pathophysiology of AP involves a hypercatabolic state, where the release of inflammatory cytokines (e.g., TNF-α, IL-1, and IL-6) and stress hormones creates a metabolic disturbance similar to that seen in sepsis.[ 3 , 15 ] This systemic inflammation drives accelerated lipolysis, which explains the significant decline in all adiposity parameters (BMI, body fat, and visceral fat) observed in our cohort. The more pronounced reduction in BMI in the SAP group compared to the MSAP group suggests a dose-response relationship between disease severity and the overall catabolic burden. Critically, this inflammatory state also promotes aggressive muscle protein breakdown. Severe inflammation in acute pancreatitis promotes protein breakdown, with released amino acids used for acute-phase protein synthesis, leading to a rapid decline in muscle mass and function within just five days without nutritional support.[ 3 ] As mentioned in the introduction, mediators such as myostatin, a negative regulator of muscle mass, are often elevated in catabolic states, while anabolic myokines such as irisin are suppressed.[ 5 ]The consequence, as demonstrated in our study, is a rapid and significant decline in SMI. This loss of muscle is a grave concern, as it is a key determinant of physical function, metabolic health, and long-term survival. Our results are in concordance with the study by Farquhar et al., which also identified a high prevalence of sarcopenia in severe AP.[ 8 ] However, our study extends this knowledge by demonstrating that this muscle loss is a progressive phenomenon occurring during the short-term recovery period, a finding that addresses a limitation in the work of Kilic et al.[ 9 ] The current study provides robust evidence of rapid muscle breakdown in acute pancreatitis, demonstrated by a significant reduction in the skeletal muscle index (SMI) across both groups over eight weeks. Unexpectedly, the prevalence of confirmed sarcopenia did not differ significantly between MSAP and SAP cohorts at follow-up (31.8% vs. 22.2%, p = 0.25). These findings suggest that the catabolic "trigger" in acute pancreatitis is potent enough to induce uniform muscle wasting once the moderately severe threshold is reached, irrespective of the initial inflammatory insult. While the SAP group exhibited a greater overall catabolic burden—evidenced by more pronounced losses in BMI and fat stores, alongside higher BISAP scores and CRP levels—this did not translate into higher rates of confirmed sarcopenia. This lack of divergence may stem from the SAP group receiving more intensive nutritional support, such as total parenteral nutrition (TPN), and frequent percutaneous interventions that likely mitigated the extreme proteolysis expected with greater disease severity. Furthermore, our small sample size may have limited the statistical power to detect subtle differences in muscle mass trajectories between these two high-acuity cohorts. Interestingly, despite the significant loss of muscle mass, we did not observe a corresponding significant decline in handgrip strength (HGS). This apparent dissociation between muscle quantity and function is an important finding. The baseline HGS likely reflected the profound functional impairment of the acute illness—driven by pain, inflammation, and systemic weakness—rather than a true pre-illness state. The failure of HGS to decline after eight weeks, while muscle mass was actively diminishing, indicates that muscle strength and function were not as severely compromised as muscle mass. This finding suggests that in the early recovery period following critical illness, CT-measured SMI may be a more sensitive marker of deteriorating musculoskeletal health than HGS, as functional strength can be confounded by systemic factors such as pain, fatigue, and incomplete neurological recovery. Other factors likely contribute to this muscle wasting. The significantly higher CRP levels in the SAP group are consistent with meta-analyses linking elevated systemic inflammation to sarcopenia.[ 16 ] Additionally, the near-universal vitamin D deficiency in our SAP cohort is particularly notable, as vitamin D is crucial for musculoskeletal health, and its supplementation helps preserve or enhance muscle mass, strength, and overall physical performance.[ 17 ] The study by Huh et al. found that the prevalence of vitamin D deficiency increased with the severity of AP.[ 18 ] Our study has several strengths, including its prospective design, the use of validated methods for body composition (BIA) and muscle mass quantification (CT-based SMI), and the application of the comprehensive EWGSOP2 criteria for sarcopenia. The repeated measurements at a standardized eight-week interval provide a clear picture of the trajectory of change. However, certain limitations must be acknowledged. The single-center design and relatively small sample size may limit the generalizability of our findings. The lack of a control group comprising mild AP patients or healthy individuals prevents direct comparison, though the use of established, regionally appropriate cut-off values for sarcopenia mitigates this. Additionally, while BIA provides valuable data on overall body composition, readings can be influenced by fluid shifts common in the acute phase of pancreatitis; however, our primary muscle quantity endpoint was based on the gold-standard CT analysis. Finally, the eight-week follow-up, while informative for short-term changes, does not capture the long-term trajectory of recovery or the potential for rehabilitation. In conclusion, this study demonstrates that patients recovering from MSAP and SAP experience profound and rapid detrimental changes in body composition, culminating in a high risk of developing sarcopenia within just eight weeks. The significant loss of skeletal muscle mass— a silent epidemic in this population— demands immediate clinical attention. These findings argue for a paradigm shift in the follow-up care of pancreatitis survivors, moving beyond the resolution of local complications to incorporate a dedicated focus on musculoskeletal health. Future research should focus on randomized controlled trials of targeted interventions, such as pharmaconutrition and structured exercise programs, to prevent and treat pancreatitis-associated sarcopenia and improve long-term survival and quality of life. Statements and Declarations Acknowledgements: The authors would like to thank the staff of the Department of Gastroenterology at the Post-Graduate Institute of Medical Education and Research, Chandigarh, for their support in data collection. Author Contributions: Saroj Kant Sinha conceptualized and designed the study. Sushmita Bhattarai performed data acquisition, while radiological analysis was conducted by Pankaj Gupta. Sushmita Bhattarai, Sagun Baral, and Mithu Bhowmick performed the statistical analysis and data interpretation. The manuscript was drafted by Sushmita Bhattarai and Sagun Baral and critically revised by Jayanta Samanta, Saroj Kant Sinha, and Harshal S. Mandavdhare. All authors approved the final version and agree to be accountable for the work's integrity. Funding: The authors did not receive support from any organization for the submitted work. Competing Interests: The authors have no relevant financial or non-financial interests to disclose. Ethics Approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Ethics Committee of the Post-Graduate Institute of Medical Education and Research, Chandigarh (IEC-INT/2022/DM-240). Informed Consent: Informed consent was obtained from all individual participants included in the study. Data Availability: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. References Chatila AT, Bilal M, Guturu P. Evaluation and management of acute pancreatitis World J Clin Cases . 2019;7:1006-1020. Al Mofleh IA. Severe acute pancreatitis: pathogenetic aspects and prognostic factors World J Gastroenterol . 2008;14:675-684. Lakananurak N, Gramlich L. Nutrition management in acute pancreatitis: clinical practice consideration World J Clin Cases . 2020;8:1561-1573. Rong Y, Bian AL, Hu HY, Ma Y, Zhou XZ. Study on relationship between elderly sarcopenia and inflammatory cytokine IL-6, anti-inflammatory cytokine IL-10 BMC Geriatr . 2018;18:223. Larsson L, Degens H, Li M. Sarcopenia: aging-related loss of muscle mass and function Physiol Rev . 2019;99:427-511. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis Age Ageing . 2019;48:16-31. Yoon SB, Choi MH, Lee IS, et al. Impact of body fat and muscle distribution on severity of acute pancreatitis Pancreatology . 2017;17:188-193. Farquhar R, Matthews S, Baxter N. Sarcopenia and sarcopenic obesity on body composition analysis is a significant predictor of mortality in severe acute pancreatitis: a longitudinal observational study World J Surg . 2023;47:2825-2833. Kilic GS, Tahtaci M, Yagmur F, et al. Influence of sarcopenia as determined by bioelectrical impedance analysis in acute pancreatitis Medicine (Baltimore) . 2024;103:e40868. Zahariev OJ, Vámossy KL, Budai BC, et al. Nutritional status of acute pancreatitis patients Clin Nutr ESPEN . 2024;63:1166-1167. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus Gut . 2013;62:102-111. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple Organ Dysfunction Score: A reliable descriptor of a complex clinical outcome Crit Care Med . 1995;23:1638-1652. Pal R, Aggarwal A, Singh T, et al. Diagnostic cut-offs, prevalence, and biochemical predictors of sarcopenia in healthy Indian adults: the Sarcopenia-Chandigarh Urban Bone Epidemiological Study (Sarco-CUBES) Eur Geriatr Med . 2020;11:725-735. Benjamin J, Shasthry V, Kaal CR, et al. Characterization of body composition and definition of sarcopenia in patients with alcoholic cirrhosis: a computed tomography based study Liver Int . 2017;37:1668-1674. Arutla M, Raghunath M, Deepika G. Efficacy of enteral glutamine supplementation in patients with severe and predicted severe acute pancreatitis—a randomized controlled trial Indian J Gastroenterol . 2019;38:338-347. Bano G, Trevisan C, Carraro S, et al. Inflammation and sarcopenia: a systematic review and meta-analysis Maturitas . 2017;96:10-15. Widajanti N, Hadi U, Soelistijo SA, et al. The effect of vitamin D supplementation on parameters of sarcopenia in elderly people: a systematic review and meta-analysis Can Geriatr J . 2024;27:63-75. Huh JH, Kim JW, Lee KJ, et al. Vitamin D deficiency predicts severe acute pancreatitis United Eur Gastroenterol J . 2019;7:90-95. Tables Table 1 Baseline characteristics of patients with acute pancreatitis (N=40) Parameters MSAP(n=22) SAP(n=18) p -value Age, years 39.59±16.27 39.05±12.87 0.91 Sex, n (%) Male Female 18(81.8%) 4(18.18%) 12(66.67%) 6(33.33%) 0.46 Aetiology, n (%) Alcohol Gallstone Hypercalcemia Idiopathic Post ERCP Infection 11(50%) 7(31.8%) 1(4.5%) 2(9.1%) 0 1(4.5%) 7(38.89%) 7(38.89%) 0 2(11.1%) 2(11.1%) 0 0.73 Albumin, (g/dl) 3.065±0.57 3±0.69 0.71 Vitamin D status, n (%) 0.003 · Deficient 14(63.6%) 18(100%) · Insufficient 7(31.8%) 0 · Sufficient 1(4.5%) 0 CRP, (mg/L) 168.1 ±91.18 238.1±100.44 <0.05 Local complication, n (%) · Peripancreatic necrotic collection 17(77.2%) 13(83.3%) 1 · Ascites 4(18.18%) 3(16.6 %) 1 · Pleural effusion 7(31.8%) 12(66.67%) 0.04 Splanchnic vein thrombosis, n (%) · Splenic vein thrombosis 4(18.1%) 3(16.67%) · Superior mesenteric thrombosis 0 1(5.5%) · Portal vein thrombosis 0 2(11.1%) Organ failure, n (%) · AKI 2(9%) 7(38.89 %) 0.03 · ALI 3(13.6%) 16 (88.89%) <0.001 BISAP Score 1.04 ±0.7 2.16 ±0.7 <0.001 Interventions, n (%) · Pigtail Catheter Drainage 10(45.4%) 8(44.4%) 1 · Cystogastrostomy 2(9%) 4(22.2%) 0.38 · Direct endoscopic necrosectomy 1(4.5%) 2(11.1%) 0.59 · Pleural fluid drainage 2(9%) 6(33.3%) 0.08 Data are presented as mean ± standard deviation or n (%). Percentages may not sum to 100 due to rounding. ERCP, Endoscopic Retrograde Cholangiopancreatography; CRP, C-Reactive Protein; AKI, Acute Kidney Injury; ALI, Acute Lung Injury; BISAP, Bedside Index of Severity in Acute Pancreatitis Table 2 Body composition parameters in patients with moderately severe and severe acute pancreatitis assessed by bioelectrical impedance analysis Body composition parameters MSAP(n=22) SAP (n=18) P value* Body Mass Index, kg/m 2 Baseline Follow-up Mean Change p -Value (Within Group) 22.1 ±4.3 20.5 ±3.8 -1.6±1.6 <0.001 25.3 ±5.2 22.4±5.2 -2.8±2.3 <0.001 0.05 WBFP, % Baseline Follow-up Mean change p -value (Within group) 23.5±8.1 21.0±8.0 -2.5 ±4.5 0.01 27.2±9.7 24.4±6.4 -2.7±5.24 0.03 0.89 WBSFP, % Baseline Follow-up Mean change p -value (Within group) 16.8±5.7 14.9±5.9 -1.9±2.7 0.003 20.7±8.6 18.6±7.1 -2.6±3.4 0.01 0.47 WBSMP, % Baseline Follow-up Mean change p -value (Within group) 30.9±3.9 30.7±4.7 -0.2±4.3 0.81 29.2±4.7 30.2±4.7 1.04±2.49 0.09 0.2 Visceral fat level Baseline Follow-up Mean change p -value (Within group) 6.1±5.2 4.5±4.3 -1.5±1.8 <0.001 9.6±6.9 6.5±5.4 -3±2.8 <0.001 0.4 Data are presented as mean ± standard deviation. WBFP, Whole-Body Fat Percentage; WBSFP, Whole-Body Subcutaneous Fat Percentage; WBSMP, Whole-Body Skeletal Muscle Percentage *p-value for the difference in mean change between groups (independent samples t-test). Within-group p -values are from paired samples t -tests comparing baseline to eight-week follow-up. Table 3 Sarcopenia variables in patients with moderately severe and severe acute pancreatitis Parameters MSAP (n=22) SAP (n=18) P value* Handgrip Strength, Kg Baseline Follow-up Mean change p -value (Within group) 23.5±8.2 25.4±8.4 1.9±5.2 0.09 22.5±10 21.9±8.5 -0.6±5.4 0.59 0.71 0.19 0.14 Skeletal Muscle Index, cm²/m² Baseline Follow-up Mean change p -value (Within group) 47.5±10.5 41.5±7.3 -5.9±7.2 <0.001 48.9±10.2 41.2±8.5 -7.7±5.7 <0.001 0.64 0.9 0.3 Probable sarcopenia, n (%) Baseline Follow-up 15 (68.1%) 13 (59%) 12 (66.67%) 11 (61.1%) 1.0 0.74 Confirmed Sarcopenia, n (%) Baseline Follow-up p -value (Change in prevalence) 1 (4.54%) 7 (31.8%) 0.03 1 (5.6%) 4 (22.2%) 0.25 1.0 1.0 Data are presented as mean ± standard deviation or n (%). AP, acute pancreatitis. p-values for between-group comparisons of baseline, follow-up, or mean change values, as appropriate. Probable sarcopenia was defined by low handgrip strength. Confirmed sarcopenia was defined by low handgrip strength plus low skeletal muscle index per EWGSOP2 criteria. Additional Declarations No competing interests reported. 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Bhattarai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIiWNgGAWjYHACNgYGAwk5fgbGBx8SGCQY+NgbgIIGFgS1GEs2MBvOAGlh4zkA0iJBQAsDQ+KGA0AtYK5EAojCrUV+RvqzRzcKLIwl25sZGx7UWMizST6/uuFHgQQDf3t3AjYtBjdyzI1zQH7hOczYkHBMwrBNOqfsZg/QYRJnzm7AqkUih006B+SXGfnHHyQ2SDACtaTd4AFqMZDIxaoF5DCQlsQNN5IZG4Ba7Nskz6Td/INHC8ONBDMULYltEuzHbuOzxeDMGzOIw3ogfklu48lhuy1jIMGDyy/y7SCH/amT42dvZmz8UVNn289+/NnNN39s5Pjbe7E7DAvgMQCTxCoHAfYHpKgeBaNgFIyC4Q8AqaheI1j48f8AAAAASUVORK5CYII=","orcid":"","institution":"Postgraduate Institute of Medical Education and Research","correspondingAuthor":true,"prefix":"","firstName":"Sushmita","middleName":"","lastName":"Bhattarai","suffix":""},{"id":591151097,"identity":"d96480ed-4c16-4dca-b6d9-1454a5461c7c","order_by":1,"name":"Sagun Baral","email":"","orcid":"","institution":"Postgraduate Institute of Medical Education and Research","correspondingAuthor":false,"prefix":"","firstName":"Sagun","middleName":"","lastName":"Baral","suffix":""},{"id":591151098,"identity":"8dbd7e1e-0a51-4a45-a86a-ef3a1baeabe4","order_by":2,"name":"Mithu Bhowmick","email":"","orcid":"","institution":"Postgraduate Institute of Medical Education and Research","correspondingAuthor":false,"prefix":"","firstName":"Mithu","middleName":"","lastName":"Bhowmick","suffix":""},{"id":591151099,"identity":"ad9f4e2f-cee6-4e45-a37a-1f676d7e2f16","order_by":3,"name":"Jayanta Samanta","email":"","orcid":"","institution":"Postgraduate Institute of Medical Education and Research","correspondingAuthor":false,"prefix":"","firstName":"Jayanta","middleName":"","lastName":"Samanta","suffix":""},{"id":591151100,"identity":"8bc588c1-b0d5-45fc-ab2b-a3170b7665a9","order_by":4,"name":"Pankaj Gupta","email":"","orcid":"","institution":"Postgraduate Institute of Medical Education and Research","correspondingAuthor":false,"prefix":"","firstName":"Pankaj","middleName":"","lastName":"Gupta","suffix":""},{"id":591151101,"identity":"8b31d4c4-d22d-45df-9a7f-b3a54eed9bb2","order_by":5,"name":"Harshal S Mandavdhare","email":"","orcid":"","institution":"Postgraduate Institute of Medical Education and Research","correspondingAuthor":false,"prefix":"","firstName":"Harshal","middleName":"S","lastName":"Mandavdhare","suffix":""},{"id":591151102,"identity":"f1983b15-8778-4f9a-977a-27d7bac11cbe","order_by":6,"name":"Saroj Kant Sinha","email":"","orcid":"","institution":"Postgraduate Institute of Medical Education and Research","correspondingAuthor":false,"prefix":"","firstName":"Saroj","middleName":"Kant","lastName":"Sinha","suffix":""}],"badges":[],"createdAt":"2026-02-10 15:53:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8842854/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8842854/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102851966,"identity":"13130b55-ceba-4aa3-8144-cd7dc9139d80","added_by":"auto","created_at":"2026-02-17 14:34:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":136200,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart illustrating the prospective study design, including patient screening, exclusion criteria, enrolment of MSAP and SAP cohorts, and the 8-week follow-up protocol for body composition and sarcopenia assessment\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-8842854/v1/a173271da5de544354d13a20.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"Short-term changes in body composition and the development of sarcopenia following acute pancreatitis: An observational study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcute pancreatitis (AP) is a leading gastrointestinal cause of hospitalization, with a rising global incidence.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] In most cases of acute pancreatitis, the cause is identifiable, with gallstones, alcohol use, and idiopathic factors being the most common.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] While most cases are mild, approximately 20% of patients develop moderately severe acute pancreatitis (MSAP) or severe acute pancreatitis (SAP) disease, which is characterized by systemic inflammatory response syndrome (SIRS), organ failure, and high mortality.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe intense inflammatory response in acute pancreatitis induces a hypermetabolic, catabolic state that severely impairs nutrition. Malnutrition results from reduced oral intake due to anorexia, abdominal pain, vomiting, ileus, and prolonged fasting, along with pancreatic exocrine dysfunction that causes nutrient maldigestion, which may persist for several months after the acute episode.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThis profound catabolic stress leads to significant weight loss and alterations in body composition. One of the most critical consequences of this process is sarcopenia, the progressive loss of skeletal muscle mass and function. In acute or chronic inflammatory states, changes in proinflammatory and anti-inflammatory mediator levels have been shown to play a role in the pathogenesis of sarcopenia.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Myokines, including myostatin and irisin, as well as adipokines like leptin and adiponectin, are involved. Myostatin, predominantly expressed in skeletal muscle, acts as a negative regulator of muscle mass and is often elevated in sarcopenia. In contrast, irisin opposes the effects of myostatin and is typically reduced in this condition.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe 2018 operational definition of sarcopenia developed by the \u0026ldquo;European Working Group on Sarcopenia in Older People\u0026rdquo; (EWGSOP2) includes low muscle strength, low muscle quantity or quality, and low physical performance. Probable sarcopenia is defined by reduced muscular strength, while the presence of decreased muscle quality or quantity confirms the diagnosis. Sarcopenia is deemed severe if all three criteria are satisfied.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eRecent studies have begun to link body composition to AP outcomes. Yoon et al. studied the relationship between various body composition parameters, including body weight, body mass index (BMI), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and visceral fat-to-muscle ratio (VMR) at the third lumbar vertebral level using computed tomography and their ability to predict the severity of acute pancreatitis. They found that VMR had the highest correlation with moderately severe or severe AP, local complications, and organ failure. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] An observational study by Farquhar R et al. found a higher prevalence of sarcopenia and sarcopenic obesity in patients with severe acute pancreatitis and organ failure. Additionally, they identified sarcopenic obesity as a significant predictor of mortality; however, they only used myopenia as a criterion for defining sarcopenia.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Using bioelectrical impedance analysis (BIA) and hand dynamometry to define sarcopenia, Kilic SG et al. recently found that the sarcopenic group had higher rates of SAP and lower body mass index, upper arm circumference, skeletal muscle mass index, and grip strength. However, repeated measurements during clinical follow-up were not conducted, which was a major limitation in predicting long-term outcomes.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Therefore, the present study was designed to fill this critical gap by prospectively tracking changes in both muscle quantity (skeletal muscle index-SMI) and function (handgrip Strength-HGS) over eight weeks, applying the comprehensive EWGSOP2 diagnostic criteria.\u003c/p\u003e \u003cp\u003eCrucially, the current scoring systems for AP severity exclude nutritional status, despite growing evidence that sarcopenia and malnutrition are independent predictors of morbidity, mortality, and healthcare costs.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Thus, this study aims to assess short-term changes in body composition and the development of sarcopenia in patients with moderately severe and severe acute pancreatitis. The results may have a significant bearing on the planning of nutritional rehabilitation for these patients during the initial four to eight weeks following acute pancreatitis.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy Design and Ethics:\u003c/h2\u003e\n \u003cp\u003eThis prospective observational study was conducted in the Department of Gastroenterology at the Post-Graduate Institute of Medical Education and Research, Chandigarh, India, from July 2022 to December 2023. Ethical approval was obtained from the institutional ethics committee, IEC-INT/2022/DM-240. Informed consent was obtained from all patients.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003ePatient enrollment:\u003c/h3\u003e\n\u003cp\u003eWe enrolled patients diagnosed with moderately severe (MSAP) and severe acute pancreatitis (SAP) based on the Revised Atlanta Classification :[\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003ea) Mild acute pancreatitis- no organ failure and no local or systemic complications\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003eb) Moderately severe acute pancreatitis-presence of transient organ failure (lasting\u0026thinsp;\u0026lt;\u0026thinsp;48 hours) or presence of local or systemic complications in the absence of persistent organ failure (lasting\u0026thinsp;\u0026gt;\u0026thinsp;48 hours) and\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003ec) Severe acute pancreatitis-persistent organ failure (lasting\u0026thinsp;\u0026gt;\u0026thinsp;48 hours)\u003c/p\u003e\n\u003c/span\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eOrgan failure was assessed using the Modified Marshall Scoring System.[\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003ePatients with underlying chronic pancreatitis, known immunodeficient status, preexisting cardiac, chronic liver, or chronic kidney disease, as well as pregnant and lactating women, those with proven malignancy of any organ, and patients with muscular dystrophy or amputation were excluded.\u003c/p\u003e\n\u003cp\u003eAll patients underwent a detailed medical history intake and clinical examination within seven days of admission to our center. The history included age, sex, duration of symptoms, prior comorbidities, previous episodes of symptom recurrence, etiological history, medication history, and prior treatments. The examination involved measuring weight, height, BMI, and vital signs (pulse rate, blood pressure, and temperature), along with a general physical examination, abdominal examination, and systemic assessment. Blood tests, including complete blood counts, renal and liver function tests, serum albumin, C-reactive protein (CRP), blood gas analysis, serum calcium, and vitamin D levels, were conducted for all patients. Evaluation of body composition and sarcopenia was performed as follows.\u003c/p\u003e\n\u003cp\u003eA body composition monitor (OMRON HBF-375 Karada Scan) was used to assess body composition via a weak electrical current (50 kHz, 500\u0026micro;A) through both hands and feet using the hand-to-foot bioelectrical impedance (biological resistance) method. The participant was instructed to stand barefoot on foot electrodes and grasp the grip electrodes while raising their arms horizontally and extending their elbows straight to maintain a 90\u0026deg; angle between the arms and torso. The following parameters were calculated: body weight, body mass index (BMI), whole body fat percentage (WBFP), whole body subcutaneous fat percentage (WBSFP), visceral fat level, and whole body skeletal muscle percentage (WBSMP).\u003c/p\u003e\n\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\n \u003cdiv class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e$$\\:Whole\\:body\\:fat\\:percentage\\:\\left(\\%\\right)=\\frac{Body\\:fat\\:mass\\:\\left(Kg\\right)}{Body\\:weight\\:\\left(Kg\\right)}\\times\\:100$$\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Equb\" class=\"Equation\"\u003e\n \u003cdiv class=\"mathdisplay\" id=\"FileID_Equb\" name=\"EquationSource\"\u003e$$\\:Whole\\:body\\:skeletal\\:muscle\\:percentage\\:\\left(\\%\\right)=\\frac{Skeletal\\:muscle\\:mass\\:\\left(Kg\\right)}{Body\\:weight\\:\\left(Kg\\right)}\\times\\:100$$\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003eA digital hand dynamometer was used to assess the handgrip strength of each participant. Participants sat in a standard chair with their shoulders adducted and neutrally rotated, elbows flexed at a right angle, forearms in a neutral position, and wrists positioned between 0\u0026ordm; and 30\u0026ordm; of dorsiflexion. Before taking measurements, participants received a demonstration of the proper dynamometer usage. Handgrip strength was measured three times for each arm, totaling six measurements. Participants were instructed to apply maximum pressure on the handle for 3 to 5 seconds during each attempt, and the highest value from either arm was recorded as the final measurement. At least one minute of rest was given between consecutive measurements on the same arm. The device was calibrated daily following the manufacturer\u0026apos;s instructions. The obtained values were compared to normative data for the local population. The cut-off points for low muscle strength were 27.5 kg for males and 18 kg for females.[\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003eThe skeletal muscle index (muscle quantity) was calculated using non-contrast 128 single-slice axial computed tomography (CT) of the abdomen at the third lumbar vertebra (L3) using a multi-detector row CT scanner (SOMATOM\u0026reg; Definition Flash, Siemens, Germany). The cross-sectional area (cm\u003csup\u003e2\u003c/sup\u003e) of all skeletal muscles at the L3 level was calculated using Syngo.via software (Siemens Healthineers, Germany). This value was divided by the square of the height (m\u003csup\u003e2\u003c/sup\u003e) to obtain the skeletal muscle index (SMI). Skeletal muscle was identified based on predefined CT attenuation of -20 to +\u0026thinsp;120 HU. Based on an Indian study involving healthy participants, the cut-off values for low SMI were 36.54 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{cm}^{2}\\)\u003c/span\u003e\u003c/span\u003e/\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{m}^{2}\\)\u003c/span\u003e\u003c/span\u003e for males and 30.21\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{cm}^{2}\\)\u003c/span\u003e\u003c/span\u003e/\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{m}^{2}\\)\u003c/span\u003e\u003c/span\u003e for females.[\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e\n\u003cdiv id=\"Equc\" class=\"Equation\"\u003e\n \u003cdiv class=\"mathdisplay\" id=\"FileID_Equc\" name=\"EquationSource\"\u003e$$\\:Skeletal\\:muscle\\:index\\:\\left(SMI\\right)=\\frac{Cross-sectional\\:area\\:of\\:skeletal\\:muscle\\:at\\:L3\\left({cm}^{2}\\right)}{Height\\left({m}^{2}\\right)}$$\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003eThe definition of probable and confirmed sarcopenia as per EWGSOP2 was used:[\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eProbable Sarcopenia: Low muscle strength (low HGS).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eConfirmed Sarcopenia: Low muscle strength (low HGS) and low muscle quantity (low SMI).\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis:\u003c/h2\u003e\n \u003cp\u003eData analysis was performed using SPSS software, version 24 (IBM, Chicago, IL, USA). The normality of all quantitative variables was assessed through histograms, normality Q-Q plots, and the Shapiro-Wilk test. Normal distribution was defined as a \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:p\u0026gt;0.05\\)\u003c/span\u003e\u003c/span\u003e. Descriptive analysis was performed using mean and standard deviation for normally distributed quantitative data, while categorical variables were presented as frequencies and percentages. The median and interquartile range (IQR) were used to summarize non-normally distributed quantitative variables. The Chi-square test or Fisher\u0026apos;s exact test was used to evaluate categorical outcomes between study groups. An independent samples \u003cem\u003et\u003c/em\u003e-test (2 groups) was utilized to compare the mean values of normally distributed quantitative parameters between the two study groups. Changes in variables from baseline to the eight-week follow-up within each group were analyzed using a paired-samples \u003cem\u003et\u003c/em\u003e-test. A p-value\u0026thinsp;\u0026le;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFigure\u0026nbsp;1\u003c/strong\u003e Flow chart illustrating the prospective study design, including patient screening, exclusion criteria, enrolment of MSAP and SAP cohorts, and the 8-week follow-up protocol for body composition and sarcopenia assessment\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 70 patients screened, 40 (22 MSAP, 18 SAP) were enrolled. The groups were well-matched for age (pooled mean 39.4 \u0026plusmn; 14.8 years) and sex (Table 1). The predominant etiologies were alcohol and gallstone disease in both cohorts. As expected, the SAP group demonstrated a significantly higher inflammatory burden, with higher mean CRP (238.1 vs 168.1 mg/L, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05) and BISAP scores (2.16 vs 1.04, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001) compared to the MSAP group. Systemic complications were more common in the SAP group. Persistent organ failure, particularly acute lung injury (88.89%), was the defining feature of the SAP group. Notably, all patients with SAP were vitamin D deficient, a significantly higher proportion than in the MSAP group (100% vs 63.6%, \u003cem\u003ep\u0026nbsp;\u003c/em\u003e=0.003).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBody composition variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOver the eight-week follow-up period, both groups exhibited significant declines in adiposity measures (Table 2). The mean BMI reduction was \u0026minus;1.6 kg/m\u0026sup2; in the MSAP group (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) and \u0026minus;2.8 kg/m\u0026sup2; in the SAP group (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001), with the decline being significantly more pronounced in the SAP group (\u003cem\u003ep\u003c/em\u003e = 0.05). Both groups also showed significant reductions in whole-body fat percentage, subcutaneous fat percentage, and visceral fat levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSarcopenia variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most critical finding was the significant loss of muscle mass in both cohorts (Table 3). Mean SMI decreased by \u0026minus;5.9 cm\u0026sup2;/m\u0026sup2; in the MSAP group and by \u0026minus;7.7 cm\u0026sup2;/m\u0026sup2; in the SAP group (both \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eIn contrast, mean HGS did not change significantly from baseline to follow-up in either the MSAP group (23.5 to 25.4 kg, \u003cem\u003ep\u003c/em\u003e = 0.09) or the SAP group (22.5 to 21.9 kg, \u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.6).\u003c/p\u003e\n\u003cp\u003eBased on the EWGSOP2 criteria, the prevalence of probable sarcopenia (low HGS) was high at baseline and remained high at follow-up (59% in the MSAP group, 61.1% in the SAP group). The prevalence of confirmed sarcopenia (low HGS + low SMI) increased from 4.5% to 31.8% in the MSAP group (p = 0.03) and from 5.6% to 22.2% in the SAP group (p = 0.25).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis prospective observational study provides compelling evidence that MSAP and SAP are associated with significant short-term detrimental changes in body composition and a high incidence of sarcopenia. Our key findings are that over eight weeks, patients with MSAP and SAP experienced a significant reduction in body mass index (BMI), whole-body fat, subcutaneous fat, visceral fat, and, most importantly, the skeletal muscle index (SMI). Utilizing the EWGSOP2 criteria, we found a strikingly high prevalence of probable sarcopenia (59% in the MSAP group, 61.1% in the SAP group) and confirmed sarcopenia (31.8% in the MSAP group, 22.2% in the SAP group) at the eight week follow-up, underscoring the profound impact of the disease on musculoskeletal health.\u003c/p\u003e \u003cp\u003eThe pathophysiology of AP involves a hypercatabolic state, where the release of inflammatory cytokines (e.g., TNF-α, IL-1, and IL-6) and stress hormones creates a metabolic disturbance similar to that seen in sepsis.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] This systemic inflammation drives accelerated lipolysis, which explains the significant decline in all adiposity parameters (BMI, body fat, and visceral fat) observed in our cohort. The more pronounced reduction in BMI in the SAP group compared to the MSAP group suggests a dose-response relationship between disease severity and the overall catabolic burden.\u003c/p\u003e \u003cp\u003eCritically, this inflammatory state also promotes aggressive muscle protein breakdown. Severe inflammation in acute pancreatitis promotes protein breakdown, with released amino acids used for acute-phase protein synthesis, leading to a rapid decline in muscle mass and function within just five days without nutritional support.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] As mentioned in the introduction, mediators such as myostatin, a negative regulator of muscle mass, are often elevated in catabolic states, while anabolic myokines such as irisin are suppressed.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]The consequence, as demonstrated in our study, is a rapid and significant decline in SMI. This loss of muscle is a grave concern, as it is a key determinant of physical function, metabolic health, and long-term survival. Our results are in concordance with the study by Farquhar et al., which also identified a high prevalence of sarcopenia in severe AP.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] However, our study extends this knowledge by demonstrating that this muscle loss is a progressive phenomenon occurring during the short-term recovery period, a finding that addresses a limitation in the work of Kilic et al.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe current study provides robust evidence of rapid muscle breakdown in acute pancreatitis, demonstrated by a significant reduction in the skeletal muscle index (SMI) across both groups over eight weeks. Unexpectedly, the prevalence of confirmed sarcopenia did not differ significantly between MSAP and SAP cohorts at follow-up (31.8% vs. 22.2%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.25). These findings suggest that the catabolic \"trigger\" in acute pancreatitis is potent enough to induce uniform muscle wasting once the moderately severe threshold is reached, irrespective of the initial inflammatory insult. While the SAP group exhibited a greater overall catabolic burden\u0026mdash;evidenced by more pronounced losses in BMI and fat stores, alongside higher BISAP scores and CRP levels\u0026mdash;this did not translate into higher rates of confirmed sarcopenia. This lack of divergence may stem from the SAP group receiving more intensive nutritional support, such as total parenteral nutrition (TPN), and frequent percutaneous interventions that likely mitigated the extreme proteolysis expected with greater disease severity. Furthermore, our small sample size may have limited the statistical power to detect subtle differences in muscle mass trajectories between these two high-acuity cohorts.\u003c/p\u003e \u003cp\u003eInterestingly, despite the significant loss of muscle mass, we did not observe a corresponding significant decline in handgrip strength (HGS). This apparent dissociation between muscle quantity and function is an important finding. The baseline HGS likely reflected the profound functional impairment of the acute illness\u0026mdash;driven by pain, inflammation, and systemic weakness\u0026mdash;rather than a true pre-illness state. The failure of HGS to decline after eight weeks, while muscle mass was actively diminishing, indicates that muscle strength and function were not as severely compromised as muscle mass. This finding suggests that in the early recovery period following critical illness, CT-measured SMI may be a more sensitive marker of deteriorating musculoskeletal health than HGS, as functional strength can be confounded by systemic factors such as pain, fatigue, and incomplete neurological recovery.\u003c/p\u003e \u003cp\u003eOther factors likely contribute to this muscle wasting. The significantly higher CRP levels in the SAP group are consistent with meta-analyses linking elevated systemic inflammation to sarcopenia.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Additionally, the near-universal vitamin D deficiency in our SAP cohort is particularly notable, as vitamin D is crucial for musculoskeletal health, and its supplementation helps preserve or enhance muscle mass, strength, and overall physical performance.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] The study by Huh et al. found that the prevalence of vitamin D deficiency increased with the severity of AP.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eOur study has several strengths, including its prospective design, the use of validated methods for body composition (BIA) and muscle mass quantification (CT-based SMI), and the application of the comprehensive EWGSOP2 criteria for sarcopenia. The repeated measurements at a standardized eight-week interval provide a clear picture of the trajectory of change. However, certain limitations must be acknowledged. The single-center design and relatively small sample size may limit the generalizability of our findings. The lack of a control group comprising mild AP patients or healthy individuals prevents direct comparison, though the use of established, regionally appropriate cut-off values for sarcopenia mitigates this. Additionally, while BIA provides valuable data on overall body composition, readings can be influenced by fluid shifts common in the acute phase of pancreatitis; however, our primary muscle quantity endpoint was based on the gold-standard CT analysis. Finally, the eight-week follow-up, while informative for short-term changes, does not capture the long-term trajectory of recovery or the potential for rehabilitation.\u003c/p\u003e \u003cp\u003eIn conclusion, this study demonstrates that patients recovering from MSAP and SAP experience profound and rapid detrimental changes in body composition, culminating in a high risk of developing sarcopenia within just eight weeks. The significant loss of skeletal muscle mass\u0026mdash; a silent epidemic in this population\u0026mdash; demands immediate clinical attention.\u003c/p\u003e \u003cp\u003eThese findings argue for a paradigm shift in the follow-up care of pancreatitis survivors, moving beyond the resolution of local complications to incorporate a dedicated focus on musculoskeletal health. Future research should focus on randomized controlled trials of targeted interventions, such as pharmaconutrition and structured exercise programs, to prevent and treat pancreatitis-associated sarcopenia and improve long-term survival and quality of life.\u003c/p\u003e"},{"header":"Statements and Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e The authors would like to thank the staff of the Department of Gastroenterology at the Post-Graduate Institute of Medical Education and Research, Chandigarh, for their support in data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Saroj Kant Sinha conceptualized and designed the study. Sushmita Bhattarai performed data acquisition, while radiological analysis was conducted by Pankaj Gupta. Sushmita Bhattarai, Sagun Baral, and Mithu Bhowmick performed the statistical analysis and data interpretation. The manuscript was drafted by Sushmita Bhattarai and Sagun Baral and critically revised by Jayanta Samanta, Saroj Kant Sinha, and Harshal S. Mandavdhare. All authors approved the final version and agree to be accountable for the work's integrity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors did not receive support from any organization for the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval:\u003c/strong\u003e This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Ethics Committee of the Post-Graduate Institute of Medical Education and Research, Chandigarh (IEC-INT/2022/DM-240).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent:\u003c/strong\u003e Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eChatila AT, Bilal M, Guturu P. Evaluation and management of acute pancreatitis \u003cem\u003eWorld J Clin Cases\u003c/em\u003e. 2019;7:1006-1020.\u003c/li\u003e\n \u003cli\u003eAl Mofleh IA. Severe acute pancreatitis: pathogenetic aspects and prognostic factors \u003cem\u003eWorld J Gastroenterol\u003c/em\u003e. 2008;14:675-684.\u003c/li\u003e\n \u003cli\u003eLakananurak N, Gramlich L. Nutrition management in acute pancreatitis: clinical practice consideration \u003cem\u003eWorld J Clin Cases\u003c/em\u003e. 2020;8:1561-1573.\u003c/li\u003e\n \u003cli\u003eRong Y, Bian AL, Hu HY, Ma Y, Zhou XZ. Study on relationship between elderly sarcopenia and inflammatory cytokine IL-6, anti-inflammatory cytokine IL-10 \u003cem\u003eBMC Geriatr\u003c/em\u003e. 2018;18:223.\u003c/li\u003e\n \u003cli\u003eLarsson L, Degens H, Li M. Sarcopenia: aging-related loss of muscle mass and function \u003cem\u003ePhysiol Rev\u003c/em\u003e. 2019;99:427-511.\u003c/li\u003e\n \u003cli\u003eCruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis \u003cem\u003eAge Ageing\u003c/em\u003e. 2019;48:16-31.\u003c/li\u003e\n \u003cli\u003eYoon SB, Choi MH, Lee IS, et al. Impact of body fat and muscle distribution on severity of acute pancreatitis \u003cem\u003ePancreatology\u003c/em\u003e. 2017;17:188-193.\u003c/li\u003e\n \u003cli\u003eFarquhar R, Matthews S, Baxter N. Sarcopenia and sarcopenic obesity on body composition analysis is a significant predictor of mortality in severe acute pancreatitis: a longitudinal observational study \u003cem\u003eWorld J Surg\u003c/em\u003e. 2023;47:2825-2833.\u003c/li\u003e\n \u003cli\u003eKilic GS, Tahtaci M, Yagmur F, et al. Influence of sarcopenia as determined by bioelectrical impedance analysis in acute pancreatitis \u003cem\u003eMedicine (Baltimore)\u003c/em\u003e. 2024;103:e40868.\u003c/li\u003e\n \u003cli\u003eZahariev OJ, V\u0026aacute;mossy KL, Budai BC, et al. Nutritional status of acute pancreatitis patients \u003cem\u003eClin Nutr ESPEN\u003c/em\u003e. 2024;63:1166-1167.\u003c/li\u003e\n \u003cli\u003eBanks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis\u0026mdash;2012: revision of the Atlanta classification and definitions by international consensus \u003cem\u003eGut\u003c/em\u003e. 2013;62:102-111.\u003c/li\u003e\n \u003cli\u003eMarshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple Organ Dysfunction Score: A reliable descriptor of a complex clinical outcome \u003cem\u003eCrit Care Med\u003c/em\u003e. 1995;23:1638-1652.\u003c/li\u003e\n \u003cli\u003ePal R, Aggarwal A, Singh T, et al. Diagnostic cut-offs, prevalence, and biochemical predictors of sarcopenia in healthy Indian adults: the Sarcopenia-Chandigarh Urban Bone Epidemiological Study (Sarco-CUBES) \u003cem\u003eEur Geriatr Med\u003c/em\u003e. 2020;11:725-735.\u003c/li\u003e\n \u003cli\u003eBenjamin J, Shasthry V, Kaal CR, et al. Characterization of body composition and definition of sarcopenia in patients with alcoholic cirrhosis: a computed tomography based study \u003cem\u003eLiver Int\u003c/em\u003e. 2017;37:1668-1674.\u003c/li\u003e\n \u003cli\u003eArutla M, Raghunath M, Deepika G. Efficacy of enteral glutamine supplementation in patients with severe and predicted severe acute pancreatitis\u0026mdash;a randomized controlled trial \u003cem\u003eIndian J Gastroenterol\u003c/em\u003e. 2019;38:338-347.\u003c/li\u003e\n \u003cli\u003eBano G, Trevisan C, Carraro S, et al. Inflammation and sarcopenia: a systematic review and meta-analysis \u003cem\u003eMaturitas\u003c/em\u003e. 2017;96:10-15.\u003c/li\u003e\n \u003cli\u003eWidajanti N, Hadi U, Soelistijo SA, et al. The effect of vitamin D supplementation on parameters of sarcopenia in elderly people: a systematic review and meta-analysis \u003cem\u003eCan Geriatr J\u003c/em\u003e. 2024;27:63-75.\u003c/li\u003e\n \u003cli\u003eHuh JH, Kim JW, Lee KJ, et al. Vitamin D deficiency predicts severe acute pancreatitis \u003cem\u003eUnited Eur Gastroenterol J\u003c/em\u003e. 2019;7:90-95.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eBaseline characteristics of patients with acute pancreatitis (N=40)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"652\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eParameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eMSAP(n=22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003eSAP(n=18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e39.59\u0026plusmn;16.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e39.05\u0026plusmn;12.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eSex, n (%)\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18(81.8%)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4(18.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12(66.67%)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6(33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAetiology, n (%)\u003c/p\u003e\n \u003cp\u003eAlcohol\u003c/p\u003e\n \u003cp\u003eGallstone\u003c/p\u003e\n \u003cp\u003eHypercalcemia\u003c/p\u003e\n \u003cp\u003eIdiopathic\u003c/p\u003e\n \u003cp\u003ePost ERCP\u003c/p\u003e\n \u003cp\u003eInfection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11(50%)\u003c/p\u003e\n \u003cp\u003e7(31.8%)\u003c/p\u003e\n \u003cp\u003e1(4.5%)\u003c/p\u003e\n \u003cp\u003e2(9.1%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e1(4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7(38.89%)\u003c/p\u003e\n \u003cp\u003e7(38.89%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e2(11.1%)\u003c/p\u003e\n \u003cp\u003e2(11.1%)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAlbumin, (g/dl)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e3.065\u0026plusmn;0.57\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e3\u0026plusmn;0.69\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eVitamin D status, n (%)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026middot; Deficient\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e14(63.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e18(100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026middot; Insufficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e7(31.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026middot; Sufficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e1(4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eCRP, (mg/L)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e168.1 \u0026plusmn;91.18\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e238.1\u0026plusmn;100.44\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eLocal complication, n (%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026middot; Peripancreatic necrotic collection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e17(77.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e13(83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026middot; Ascites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e4(18.18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e3(16.6 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026middot; Pleural effusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e7(31.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e12(66.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eSplanchnic vein thrombosis, n (%)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026middot; Splenic vein thrombosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e4(18.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e3(16.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026middot; Superior mesenteric thrombosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e1(5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026middot; Portal vein thrombosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e2(11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eOrgan failure, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026middot; AKI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e2(9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e7(38.89 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026middot; ALI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e3(13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e16 (88.89%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eBISAP Score\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e1.04 \u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e2.16 \u0026plusmn;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eInterventions, n (%)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026middot; Pigtail Catheter Drainage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e10(45.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e8(44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026middot; Cystogastrostomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e2(9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e4(22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026middot; Direct endoscopic necrosectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e1(4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e2(11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u0026middot; Pleural fluid drainage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003e2(9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 179px;\"\u003e\n \u003cp\u003e6(33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eData are presented as mean \u0026plusmn; standard deviation or n (%). Percentages may not sum to 100 due to rounding.\u003c/em\u003e\u003cbr\u003e\u003cem\u003eERCP, Endoscopic Retrograde Cholangiopancreatography; CRP, C-Reactive Protein; AKI, Acute Kidney Injury; ALI, Acute Lung Injury; BISAP, Bedside Index of Severity in Acute Pancreatitis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 Body composition parameters in patients with moderately severe and severe acute pancreatitis assessed by bioelectrical impedance analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eBody composition parameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMSAP(n=22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eSAP (n=18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eP value*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody Mass Index, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eBaseline\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFollow-up\u003c/p\u003e\n \u003cp\u003eMean Change\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-Value (Within Group)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22.1 \u0026plusmn;4.3\u003c/p\u003e\n \u003cp\u003e20.5 \u0026plusmn;3.8\u003c/p\u003e\n \u003cp\u003e-1.6\u0026plusmn;1.6\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25.3 \u0026plusmn;5.2\u003c/p\u003e\n \u003cp\u003e22.4\u0026plusmn;5.2\u003c/p\u003e\n \u003cp\u003e-2.8\u0026plusmn;2.3\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWBFP, %\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;Baseline\u003c/p\u003e\n \u003cp\u003eFollow-up\u003c/p\u003e\n \u003cp\u003eMean change\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value (Within group)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23.5\u0026plusmn;8.1\u003c/p\u003e\n \u003cp\u003e21.0\u0026plusmn;8.0\u003c/p\u003e\n \u003cp\u003e-2.5 \u0026plusmn;4.5\u003c/p\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27.2\u0026plusmn;9.7\u003c/p\u003e\n \u003cp\u003e24.4\u0026plusmn;6.4\u003c/p\u003e\n \u003cp\u003e-2.7\u0026plusmn;5.24\u003c/p\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWBSFP, %\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003cp\u003eFollow-up\u003c/p\u003e\n \u003cp\u003eMean change\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value (Within group)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16.8\u0026plusmn;5.7\u003c/p\u003e\n \u003cp\u003e14.9\u0026plusmn;5.9\u003c/p\u003e\n \u003cp\u003e-1.9\u0026plusmn;2.7\u003c/p\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20.7\u0026plusmn;8.6\u003c/p\u003e\n \u003cp\u003e18.6\u0026plusmn;7.1\u003c/p\u003e\n \u003cp\u003e-2.6\u0026plusmn;3.4\u003c/p\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWBSMP, %\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003cp\u003eFollow-up\u003c/p\u003e\n \u003cp\u003eMean change\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value (Within group)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30.9\u0026plusmn;3.9\u003c/p\u003e\n \u003cp\u003e30.7\u0026plusmn;4.7\u003c/p\u003e\n \u003cp\u003e-0.2\u0026plusmn;4.3\u003c/p\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29.2\u0026plusmn;4.7\u003c/p\u003e\n \u003cp\u003e30.2\u0026plusmn;4.7\u003c/p\u003e\n \u003cp\u003e1.04\u0026plusmn;2.49\u003c/p\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVisceral fat level\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003cp\u003eFollow-up\u003c/p\u003e\n \u003cp\u003eMean change\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value (Within group)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6.1\u0026plusmn;5.2\u003c/p\u003e\n \u003cp\u003e4.5\u0026plusmn;4.3\u003c/p\u003e\n \u003cp\u003e-1.5\u0026plusmn;1.8\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9.6\u0026plusmn;6.9\u003c/p\u003e\n \u003cp\u003e6.5\u0026plusmn;5.4\u003c/p\u003e\n \u003cp\u003e-3\u0026plusmn;2.8\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eData are presented as mean \u0026plusmn; standard deviation. WBFP, Whole-Body Fat Percentage; WBSFP, Whole-Body Subcutaneous Fat Percentage; WBSMP, Whole-Body Skeletal Muscle Percentage\u003c/em\u003e\u003cbr\u003e\u003cem\u003e*p-value for the difference in mean change between groups (independent samples t-test).\u003c/em\u003e\u003cbr\u003eWithin-group \u003cem\u003ep\u003c/em\u003e-values are from paired samples\u003cem\u003e\u0026nbsp;t\u003c/em\u003e-tests comparing baseline to eight-week follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e Sarcopenia variables in patients with moderately severe and severe acute pancreatitis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003eParameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMSAP (n=22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eSAP (n=18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eP value*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHandgrip Strength, Kg\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003cp\u003eFollow-up\u003c/p\u003e\n \u003cp\u003eMean change\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value (Within group)\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23.5\u0026plusmn;8.2\u003c/p\u003e\n \u003cp\u003e25.4\u0026plusmn;8.4\u003c/p\u003e\n \u003cp\u003e1.9\u0026plusmn;5.2\u003c/p\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22.5\u0026plusmn;10\u003c/p\u003e\n \u003cp\u003e21.9\u0026plusmn;8.5\u003c/p\u003e\n \u003cp\u003e-0.6\u0026plusmn;5.4\u003c/p\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkeletal Muscle Index, cm\u0026sup2;/m\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003cp\u003eFollow-up\u003c/p\u003e\n \u003cp\u003eMean change\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value (Within group)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e47.5\u0026plusmn;10.5\u003c/p\u003e\n \u003cp\u003e41.5\u0026plusmn;7.3\u003c/p\u003e\n \u003cp\u003e-5.9\u0026plusmn;7.2\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48.9\u0026plusmn;10.2\u003c/p\u003e\n \u003cp\u003e41.2\u0026plusmn;8.5\u003c/p\u003e\n \u003cp\u003e-7.7\u0026plusmn;5.7\u003c/p\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProbable sarcopenia, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003cp\u003eFollow-up\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (68.1%)\u003c/p\u003e\n \u003cp\u003e13 (59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (66.67%)\u003c/p\u003e\n \u003cp\u003e11 (61.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConfirmed Sarcopenia, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eBaseline\u003c/p\u003e\n \u003cp\u003eFollow-up\u003c/p\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value (Change in prevalence)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (4.54%)\u003c/p\u003e\n \u003cp\u003e7 (31.8%)\u003c/p\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (5.6%)\u003c/p\u003e\n \u003cp\u003e4 (22.2%)\u003c/p\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eData are presented as mean \u0026plusmn; standard deviation or n (%). AP, acute pancreatitis.\u003c/em\u003e\u003cbr\u003e\u003cem\u003ep-values for between-group comparisons of baseline, follow-up, or mean change values, as appropriate.\u003c/em\u003e\u003cbr\u003e\u003cem\u003eProbable sarcopenia was defined by low handgrip strength. Confirmed sarcopenia was defined by low handgrip strength plus low skeletal muscle index per EWGSOP2 criteria.\u003c/em\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"digestive-diseases-and-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ddsj","sideBox":"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)","snPcode":"10620","submissionUrl":"https://submission.nature.com/new-submission/10620/3","title":"Digestive Diseases and Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Acute pancreatitis, Sarcopenia, Body composition, Skeletal muscle index, Bioelectrical impedance analysis","lastPublishedDoi":"10.21203/rs.3.rs-8842854/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8842854/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e Malnutrition is a common complication of acute pancreatitis (AP), and it may\u003c/p\u003e\n\u003cp\u003eadversely affect outcomes. This study aimed to evaluate short-term changes in body composition and the development of sarcopenia in patients with moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis single-center, prospective observational study evaluated patients with MSAP and SAP at admission and after eight weeks. Body composition was measured using bioelectrical impedance analysis (BIA). Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People (EWGSOP2) guidelines, with handgrip strength (HGS) used to identify probable sarcopenia and computed tomography (CT)-derived skeletal muscle index (SMI) used to confirm the diagnosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eForty patients (22 MSAP, 18 SAP) were included. The mean age was 39.4 ±14.8 years, and 75% were male. Patients with SAP had significantly higher BISAP scores (2.16 vs 1.04) and rates of organ failure compared to the MSAP group. Over eight weeks, both groups experienced significant reductions in body mass index (BMI), body fat, and visceral fat. SMI declined significantly in both MSAP (47.5 to 41.5 cm²/m², \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) and SAP (48.9 to 41.2 cm²/m², \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). At follow-up, the prevalence of confirmed sarcopenia was 31.8% in the MSAP group and 22.2% in the SAP group. Handgrip strength did not change significantly in either group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eModerately severe and severe AP lead to rapid, detrimental changes in body composition and a high incidence of sarcopenia within eight weeks. These findings highlight the need for systematic screening and targeted nutritional and physical rehabilitation to mitigate muscle loss in recovering patients.\u003c/p\u003e","manuscriptTitle":"Short-term changes in body composition and the development of sarcopenia following acute pancreatitis: An observational study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-17 14:34:24","doi":"10.21203/rs.3.rs-8842854/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-18T16:17:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-17T17:29:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-11T09:11:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-10T14:49:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-09T21:27:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"266714755391596433406689514633910322316","date":"2026-03-06T19:22:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4633842941681395039542276226697299834","date":"2026-03-06T16:14:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"77244086205106679832222862119663003067","date":"2026-03-05T03:27:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"11689383697110845514082543209909517177","date":"2026-03-05T01:43:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220520958884512908725994567729738046290","date":"2026-03-04T19:16:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-11T23:45:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-11T20:59:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-11T13:59:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"Digestive Diseases and Sciences","date":"2026-02-10T14:38:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"digestive-diseases-and-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ddsj","sideBox":"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)","snPcode":"10620","submissionUrl":"https://submission.nature.com/new-submission/10620/3","title":"Digestive Diseases and Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"964e8ab8-5bba-4776-89b1-206c52d3126c","owner":[],"postedDate":"February 17th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T18:54:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-17 14:34:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8842854","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8842854","identity":"rs-8842854","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}