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Sarcopenia (i.e. low skeletal muscle mass), myosteatosis [i.e. low skeletal muscle radiation attenuation (SM\u2010RA)], and impaired objectively measured aerobic fitness (reduced oxygen uptake) have been associated with poor post\u2010operative outcomes and survival in various cancer types. However, the association between CT body composition and physical fitness has not been explored. In this study, we assessed the association of CT body composition with selected CPET variables in patients undergoing hepatobiliary and pancreatic surgery.<\/jats:p><\/jats:sec>Methods<\/jats:title>A pragmatic prospective cohort of 123 patients undergoing hepatobiliary and pancreatic surgery were recruited. All patients underwent preoperative CPET. Preoperative CT scans were analysed using a single\u2010slice CT image at L3 level to assess skeletal muscle mass, adipose tissue mass, and muscle radiation attenuation. Multivariate linear regression was used to test the association between CPET variables and body composition. Main outcomes were oxygen uptake at anaerobic threshold (\nO2<\/jats:sub> at AT), oxygen uptake at peak exercise (\nO2<\/jats:sub> peak), skeletal muscle mass, and SM\u2010RA.<\/jats:p><\/jats:sec>Results<\/jats:title>Of 123 patients recruited [77 men (63%), median age 66.9\u00a0\u00b1\u00a011.7, median body mass index 27.3\u00a0\u00b1\u00a05.2], 113 patients had good\u2010quality abdominal CT scans available and were included. Of the CT body composition variables, SM\u2010RA had the strongest correlation with \nO2<\/jats:sub> peak (r<\/jats:italic>\u00a0=\u00a00.57, P<\/jats:italic>\u00a0<\u00a00.001) and \nO2<\/jats:sub> at AT (r<\/jats:italic>\u00a0=\u00a00.45, P<\/jats:italic>\u00a0<\u00a00.001) while skeletal muscle mass was only weakly associated with \nO2<\/jats:sub> peak (r<\/jats:italic>\u00a0=\u00a00.24, P<\/jats:italic>\u00a0<\u00a00.010). In the multivariate analysis, only SM\u2010RA was associated with \nO2<\/jats:sub> peak (B<\/jats:italic>\u00a0=\u00a00.25, 95% CI 0.15\u20130.34, P<\/jats:italic>\u00a0<\u00a00.001, R<\/jats:italic>2<\/jats:sup>\u00a0=\u00a00.42) and \nO2<\/jats:sub> at AT (B<\/jats:italic>\u00a0=\u00a00.13, 95% CI 0.06\u20130.18, P<\/jats:italic>\u00a0<\u00a00.001, R<\/jats:italic>2<\/jats:sup>\u00a0=\u00a00.26).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>There is a positive association between preoperative CT SM\u2010RA and preoperative physical fitness (\nO2<\/jats:sub> at AT and at peak). This study demonstrates that myosteatosis, and not sarcopenia, is associated with reduced aerobic physical fitness. Combining both myosteatosis and physical fitness variables may provide additive risk stratification accuracy and guide interventions during the perioperative period.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jcsm.12433","type":"journal-article","created":{"date-parts":[[2019,5,22]],"date-time":"2019-05-22T05:39:15Z","timestamp":1558503555000},"page":"860-871","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":71,"title":["Myosteatosis is associated with poor physical fitness in patients undergoing hepatopancreatobiliary surgery"],"prefix":"10.1002","volume":"10","author":[{"given":"Malcolm A.","family":"West","sequence":"first","affiliation":[{"name":"Academic Unit of Cancer Sciences, Faculty of Medicine University of Southampton Southampton UK"},{"name":"Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine University of Southampton Southampton UK"},{"name":"Respiratory and 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