(P24-002-25) Enhancing Muscle Mass in Pancreatic Adenocarcinoma Through Nutrition Support: A Prehabilitation Case Report Utilizing Computed Tomography

Objectives: Pancreatic adenocarcinoma leads to significant nutritional challenges due to altered digestion and appetite, making nutrition support crucial to avoid severe malnutrition.  As the disease progresses, individuals often experience muscle wasting and decreased physical performance, necessitating nutrition assessment and intervention. The use of CT by registered dietitians has provided quantitative evaluation of body tissues to monitor outcomes.

Methods: Here we present a case of a 70 yr old female with stage IIA pancreatic adenocarcinoma complicated by small bowel perforation with Whipple and end ileostomy with subsequent weight loss leading to parenteral nutritional (PN) support. She had limited oral intake due to high ostomy output and abdominal pain. Multiple CT scans were completed, which were used to assess body composition. The CT scans revealed significant muscle loss and worsening body composition (29.6% decrease) from her baseline to when PN was initiated. PN as her main source of nutrition at the time led to improvement of her skeletal muscle mass (44.3% increase) as measured by an artificial intelligence program, Voronoi Data Analysis Facilitation Suite, Version 3.9.1. Of note she did not develop any infectious complications from PN. Upon withdrawal of nutrition support, she experienced a decrease in her muscle mass, but not as severe (11.4% decrease). 

Results: This case highlights the dynamic nature of skeletal muscle mass changes in response to targeted nutritional and physical interventions. The initial decline in muscle mass followed by a significant increase during the nutrition intervention period, and subsequent decrease post-intervention, provide valuable insights into the effectiveness and limitations of such approaches in managing muscle mass. Finally, the worsening of muscle mass post withdrawal of nutritional support suggests the need for ongoing monitoring and nutritional assessment. 

Conclusions: Assessing body composition accurately through the course of disease can provide a more comprehensive assessment of nutritional status. Understanding the changes in body composition can aid in the development of personalized nutrition strategies for maintaining and improving muscle mass in similar clinical scenarios.

Funding Sources: Morrison Cleveland Clinic Research Collaborative