Applied nutritional investigation Association between specific presurgical anthropometric indexes and morbidity in patients undergoing rectal cancer resection Alessandro Giani M.D. a,b , Simone Famularo M.D. a,b , Luca Riva M.D. a,c , Nicol  o Tamini M.D. b , Davide Ippolito M.D. c , Luca Nespoli M.D. a,b , Paola Conconi M.D. a , Sandro Sironi M.D. a , Marco Braga M.D. a,b , Luca Gianotti M.D., Sc.D. a,b, * a School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy b Department of Surgery, San Gerardo Hospital, Monza, Italy c Department of Radiology, San Gerardo Hospital, Monza, Italy ARTICLE INFO Article History: Received 27 October 2019 Received in revised form 27 January 2020 Accepted 28 January 2020 ABSTRACT Objectives: Baseline body composition has been associated with dismal outcomes in patients undergoing a variety of major abdominal operations. Whether specific anthropometric indexes can predict morbidity after rectal resection has been poorly investigated. The aims of this study were to assess whether there is a rela- tionship between body mass index and the different computed tomographyÀassessed body composition indexes, and whether the analysis of different body compartments could be predictive of short-term out- comes in patients undergoing curative surgery for rectal cancer. Methods: Computed tomographyÀderived measures of skeletal muscle and adipose tissue areas of patients undergoing surgery for rectal cancer between January 2009 and December 2016 were used to calculate pop- ulation-specific thresholds of sarcopenia, subcutaneous adiposity, visceral adiposity, visceral obesity, sarco- penic obesity, and myosteatosis. Association between the aforementioned body composition features were related with overall complication, infection, and anastomotic leak. Results: During the study period, 311 patients received surgery and 173 were eligible for an accessible preop- erative computed tomography imaging. After surgery, 59 (34.1%) patients experienced a complication, 29 an infection, and 10 an anastomotic failure. The overall morbidity rate was observed more frequently in patients with sarcopenia than in those without sarcopenia (39% versus 17.5%; P = 0.002) and infections (41.4% versus 21.5% respectively; P = 0.024). The presence of myosteatosis also was associated with a higher incidence of overall morbidity (33.9% versus 20.2% in patients without myoteatosis; P = 0.048). Anastomotic failure occurred in 6 of 10 patients with visceral obesity and in 24 of 112 (21.4%) patients without this condition (P = 0.007). Conclusions: Some anthropometric indexes are accurate predictors of specific types of morbidity. These find- ings may allow a more accurate preoperative risk stratification. © 2020 Elsevier Inc. All rights reserved. Keywords: Sarcopenia Sarcopenic obesity Myosteatosis Rectal surgery Cancer Outcome Introduction Colorectal cancer (CRC) is the third most common malignancy among men and the second among women worldwide and rectal cancer accounts for 30% of all CRC [1]. Despite progress in perioperative care, rectal cancer surgery is still burdened by a con- siderable risk for morbidity and functional sequelae [2]. To poten- tially optimize clinical pathways and lower the risk for perioperative complications, the preoperative identification of modifiable risk factors remains a cornerstone [3]. The association of host body composition and surgical outcome is gaining awareness. Body mass index (BMI) is a comprehensive measurement of body architecture based on the weight-to-height ratio that does not account for quality and quantity of different body compartments and their interaction [4], and studies evaluat- ing outcomes based on it have been inconclusive [5]. Notwith- standing, BMI remains the most frequently used anthropometric measure owing to its immediacy and practicality, despite the AG, SF, NT, and LG were responsible for the conceptualization of the study. AG, SF, LR, NT, DI, LN, PC, SS, MB, and LG were responsible for the study methodology and validation. AG, SF, LR, PC, DI, SS, and LG were responsible for formal analysis of the study. AG, SF, LR, NT, DI, LN, PC, SS, MB, LG were responsible for writing the manu- script; SS, MB, LG were responsible for supervision of the study. All authors gave final approval of the manuscript. *Corresponding author: Tel.: +39 392 33 2391; Fax: +39 392 33 3652. E-mail address: luca.gianotto@unimib.it (L. Gianotti). https://doi.org/10.1016/j.nut.2020.110779 0899-9007/© 2020 Elsevier Inc. All rights reserved. Nutrition 75À76 (2020) 110779 Contents lists available at ScienceDirect Nutrition journal homepage: www.nutritionjrnl.com