# Sarcopenia With High Subcutaneous Fat Predicts Metabolic Dysfunction Associated Steatotic Liver Disease Development After Pylorus Preserving Pancreaticoduodenectomy

## TL;DR

This study identifies that high subcutaneous fat and low muscle mass predict liver disease after a specific abdominal surgery.

## Contribution

The study introduces preoperative CT-based indicators for predicting metabolic dysfunction-associated steatotic liver disease after pylorus-preserving pancreaticoduodenectomy.

## Key findings

- High subcutaneous fat accumulation is an independent risk factor for MASLD after PPPD.
- Reduced psoas muscle area (sarcopenia) is an independent predictor of postoperative MASLD.
- MASLD after PPPD impacts prognosis and adjuvant chemotherapy availability.

## Abstract

MASLD after PPPD affects not only the long‐term prognosis but also the availability of postoperative adjuvant chemotherapy, its prevention and treatment are important issues. The aim of this study is to analyze whether objective preoperative factors could predict the development of postoperative MASLD in patients after PPPD.

A total of 171 patients who underwent PPPD at our institute between April 2012 and May 2022 were retrospectively enrolled. We evaluated several CT findings, including various body fat areas and psoas muscles. The variables, including the CT findings and histopathological findings, were compared between the patients with and without MASLD after PPPD.

MASLD after PPPD developed 40 patients (23.4%). The clinical factors identified as predictive of postoperative MASLD on univariate analysis were sex (p < 0.001), subcutaneous fat area (p = 0.006), and psoas muscle area at the L3 level (p < 0.001) by univariate analysis. The multivariate analysis revealed subcutaneous fat area (odds ratio [OR] = 3.694, 95% confidence interval [CI]:1.315–10.377, p = 0.013) and psoas muscle area of the L3 level (OR = 0.223, 95%CI: 0.079–0.633, p = 0.005) as independent predictive factors for postoperative NAFLD.

High subcutaneous fat accumulation and reduced psoas muscle area (sarcopenia) were identified as independent risk factors for the development of MASLD after PPPD.

MASLD after PPPD affects not only the long‐term prognosis but also the availability of postoperative adjuvant chemotherapy, its prevention and treatment are important issues. The aim of this study is to analyze whether objective preoperative factors could predict the development of postoperative MASLD in patients after PPPD.