ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1604230
Visceral Fat-to-Muscle Ratio Guides Spontaneous Closure in Post-Sepsis Duodenal Fistula: A Body Composition Divergence Beyond Visceral-Subcutaneous Fat Ratio
Provisionally accepted
- 1Nanjing Jiangning Hospital, Nanjing, China
- 2Anhui Provincial Hospital, Hefei, Anhui Province, China
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Background: This study aimed to investigate whether body composition parameters (visceral fat area/total abdominal muscle area index, VFA/TAMAI; visceral-to-subcutaneous fat ratio, VFA/SFA) predict spontaneous closure in duodenal fistula patients after sepsis resolution.Methods: A multicenter retrospective study enrolled 104 duodenal fistula patients with controlled sepsis treated between2019-2025. Standardized management included infection control and nutritional support. Restricted cubic spline regression identified optimal cutoffs for VFA/TAMAI and VFA/SFA. Cox proportional hazards models evaluated associations with 90-day spontaneous closure, with inverse probability treatment weighting (IPTW) and propensity score matching (PSM) addressing confounding.Results: 52.9% (55/104) achieved spontaneous closure within 90 days (median time: 31 days). Elevated VFA/TAMAI (≥3.20, 31.7% patients) independently predicted reduced closure likelihood (adjusted HR=0.59, 95%CI:0.42-0.85, P=0.004), while VFA/SFA showed no prognostic value (P>0.05). Incorporation of VFA/TAMAI significantly improved predictive accuracy (C-index increased from 0.67 to 0.72, P=0.013). Sensitivity analyses confirmed VFA/TAMAI≥3.20 remained predictive after IPTW adjustment (HR=0.38, 95%CI:0.17-0.84) and PSM (HR=0.39, 95%CI:0.19-0.83).Conclusion: VFA/TAMAI serves as a robust predictor of spontaneous closure in post-sepsis duodenal fistula, with the threshold of 3.20 identifying high-risk patients requiring intensified nutritional-metabolic interventions. These findings highlight body composition monitoring as a critical adjunct to conventional nutritional management.
Keywords: Duodenal fistula, Body Composition, Sepsis, visceral fat area, Spontaneous closure
Received: 01 Apr 2025; Accepted: 07 May 2025.
Copyright: © 2025 Tang, Li, Xu, Zhao, Zhao and Yao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Risheng Zhao, Nanjing Jiangning Hospital, Nanjing, China
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