{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T16:05:24Z","timestamp":1783958724835,"version":"3.55.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"\n Introduction<\/jats:title>\n Low psoas muscle radiodensity (PMD) on computed tomography (CT) indicates impaired muscle quality and is widely used as an operational marker of myosteatosis in individuals with obesity. In this study, we aimed to develop and internally validate a clinically accessible prediction model for low PMD in adults with severe obesity.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This retrospective study included 150 adults with severe obesity, defined as body mass index (BMI) \u2265\u202f35\u202fkg\/m\n 2<\/jats:sup>\n , who underwent CT evaluation as candidates for metabolic and bariatric surgery at our university hospital between January 2019 and May 2025. PMD was quantified on CT, and low PMD was defined as the lowest quartile [cutoff: \u226440.8 Hounsfield units (HU)]. A prediction model incorporating age, BMI, serum albumin, and bioelectrical impedance analysis-derived phase angle (PhA) was developed. Model performance was assessed using discrimination and accuracy metrics, with internal validation by bootstrapping.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The mean age, BMI, and PMD were 37.0\u202f\u00b1\u202f10.6\u202fyears, 40.30\u202f\u00b1\u202f8.05\u202fkg\/m\n 2<\/jats:sup>\n , and 45.90\u202f\u00b1\u202f8.76 HU, respectively. PhA provided incremental explanatory value for PMD (\u0394\n R<\/jats:italic>\n 2<\/jats:sup>\n \u202f=\u202f0.048,\n p<\/jats:italic>\n \u202f=\u202f0.001). In multivariable logistic regression analysis, age and BMI were independently associated with low PMD, whereas albumin and PhA were not significantly associated with low PMD; however, their incremental contribution was assessed based on predictive performance. The integrated model demonstrated improved discrimination compared with the age\u2013BMI model [area under the curve (AUC)\u202f=\u202f0.841 vs. 0.829]. At an optimal cutoff of 0.38, the sensitivity was 67.5%, specificity was 85.5%, and optimism-corrected AUC was 0.821.\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n This clinically accessible model demonstrated good discrimination and high specificity, supporting clinical risk stratification in settings where CT is limited.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fnut.2026.1864098","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T15:15:37Z","timestamp":1783955737000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A clinical prediction model for low psoas muscle radiodensity in adults with severe obesity: development and internal validation"],"prefix":"10.3389","volume":"13","author":[{"given":"Eunhye","family":"Seo","sequence":"first","affiliation":[{"name":"Department of Nursing, College of Nursing, Keimyung University","place":["Daegu, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi Kyung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Keimyung University School of Medicine","place":["Daegu, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suh","family":"Youngsung","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Keimyung University Dongsan Medical Centre","place":["Daegu, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Shan","family":"Hsieh","sequence":"additional","affiliation":[{"name":"School of Nursing, National Taipei University of Nursing and Health Sciences","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Wan","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Keimyung University Dongsan Medical Centre","place":["Daegu, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.soard.2022.08.013","article-title":"2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of obesity and metabolic disorders (IFSO) indications for metabolic and bariatric surgery","volume":"33","author":"Eisenberg","year":"2023","journal-title":"Obes Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1016\/j.soard.2022.02.022","article-title":"Preservation of fat-free mass in the first year after bariatric surgery: a systematic review and meta-analysis of 122 studies and 10,758 participants","volume":"18","author":"Haghighat","year":"2022","journal-title":"Surg Obes Relat Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.3803\/EnM.2021.1348","article-title":"Quality matters as much as quantity of skeletal muscle: clinical implications of myosteatosis in cardiometabolic health","volume":"36","author":"Kim","year":"2021","journal-title":"Endocrinol Metab"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.2337\/dbi25-0003","article-title":"High-quality weight loss in obesity: importance of skeletal muscle","volume":"74","author":"Harper","year":"2025","journal-title":"Diabetes"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1007\/s11154-023-09864-8","article-title":"A multifaceted and inclusive methodology for the detection of sarcopenia in patients undergoing bariatric surgery: an in-depth analysis of current evidence","volume":"25","author":"Seo","year":"2024","journal-title":"Rev Endocr Metab Disord"},{"key":"ref6","first-page":"104","article-title":"Skeletal muscle attenuation determined by computed tomography is associated with skeletal muscle lipid content","volume-title":"J Appl Physiol","author":"Goodpaster","year":"2000"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1750","DOI":"10.1002\/jcsm.13527","article-title":"Association between myosteatosis and impaired glucose metabolism: a deep learning whole-body magnetic resonance imaging population phenotyping approach","volume":"15","author":"Jung","year":"2024","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e1385","DOI":"10.1210\/clinem\/dgae567","article-title":"Myosteatosis predicts bariatric surgery response: a longitudinal study in patients with morbid obesity","volume":"110","author":"Han","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.3803\/EnM.2021.1206","article-title":"Computed tomography-derived skeletal muscle radiodensity is an early, sensitive marker of age-related musculoskeletal changes in healthy adults","volume":"36","author":"Jung","year":"2021","journal-title":"Endocrinol Metab"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1097\/MCO.0b013e328337d826","article-title":"Epidemiology of myosteatosis","volume":"13","author":"Miljkovic","year":"2010","journal-title":"Curr Opin Clin Nutr Metab Care"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1111\/j.0894-0959.2004.17603.x","article-title":"Serum albumin: relationship to inflammation and nutrition","volume":"17","author":"Don","year":"2004","journal-title":"Semin Dial"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1016\/j.clnu.2024.11.008","article-title":"Phase angle as a marker of muscle quality: a systematic review and meta-analysis","volume":"43","author":"Costa Pereira","year":"2024","journal-title":"Clin Nutr"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"4799","DOI":"10.1016\/j.clnu.2021.06.013","article-title":"Phase angle as a marker for muscle abnormalities and function in patients with colorectal cancer","volume":"40","author":"Souza","year":"2021","journal-title":"Clin Nutr"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1093\/ajcn\/nqaa305","article-title":"Development and validation of nomograms for the prediction of low muscle mass and radiodensity in gastric cancer patients","volume":"113","author":"Zhang","year":"2021","journal-title":"Am J Clin Nutr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"112256","DOI":"10.1016\/j.nut.2023.112256","article-title":"Establishment and validation of novel nomograms to predict muscle quality in colorectal cancer patients","volume":"117","author":"Ren","year":"2024","journal-title":"Nutrition"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/S1470-2045(08)70153-0","article-title":"Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study","volume":"9","author":"Prado","year":"2008","journal-title":"Lancet Oncol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2783","DOI":"10.2337\/dc20-2907","article-title":"The nonlinear relationship between psoas cross-sectional area and BMI: a new observation and its insights into diabetes remission after roux-en-Y gastric bypass","volume":"44","author":"Li","year":"2021","journal-title":"Diabetes Care"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e094252","DOI":"10.1136\/bmjopen-2024-094252","article-title":"Study protocol to redefine muscle attenuation cut-offs for better prediction of mortality in patients with cirrhosis: a comprehensive post hoc validation study \u2013 a study protocol","volume":"15","author":"Di Cola","year":"2025","journal-title":"BMJ Open"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"7937","DOI":"10.21037\/qims-24-365","article-title":"Myosteatosis: diagnostic significance and assessment by imaging approaches","volume":"14","author":"Garcia-Diez","year":"2024","journal-title":"Quant Imaging Med Surg"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"382","DOI":"10.3945\/an.116.014258","article-title":"Nutritional recommendations for adult bariatric surgery patients: clinical practice","volume":"8","author":"Sherf-Dagan","year":"2017","journal-title":"Adv Nutr"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"87","DOI":"10.3389\/fphys.2017.00087","article-title":"The need for standardized assessment of muscle quality in skeletal muscle function deficit and other aging-related muscle dysfunctions: a symposium report","volume":"8","author":"Correa-de-Araujo","year":"2017","journal-title":"Front Physiol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"4022","DOI":"10.1016\/j.clnu.2021.04.017","article-title":"Age-related changes in muscle quality and development of diagnostic cutoff points for myosteatosis in lumbar skeletal muscles measured by CT scan","volume":"40","author":"Kim","year":"2021","journal-title":"Clin Nutr"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"111306","DOI":"10.1016\/j.exger.2021.111306","article-title":"Computed tomography\u2013based skeletal muscle and adipose tissue attenuation: variations by age, sex, and muscle","volume":"149","author":"Figueiredo","year":"2021","journal-title":"Exp Gerontol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1093\/ajcn.82.1.49","article-title":"Bioelectrical impedance analysis: population reference values for phase angle by age and sex","volume":"82","author":"Barbosa-Silva","year":"2005","journal-title":"Am J Clin Nutr"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"590","DOI":"10.7705\/biomedica.5765","article-title":"Sarcopenia and blood albumin: a systematic review with meta-analysis","volume":"41","author":"Silva-Fhon","year":"2021","journal-title":"Biomedica"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"482","DOI":"10.4093\/dmj.2020.0277","article-title":"Computed tomography-derived myosteatosis and metabolic disorders","volume":"45","author":"Miljkovic","year":"2021","journal-title":"Diabetes Metab J"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2227","DOI":"10.1016\/j.clnu.2019.10.003","article-title":"Computed tomography-based psoas skeletal muscle area and radiodensity are poor sentinels for whole L3 skeletal muscle values","volume":"39","author":"Rollins","year":"2020","journal-title":"Clin Nutr"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2370","DOI":"10.1161\/ATVBAHA.117.309633","article-title":"Intermuscular adipose tissue and subclinical coronary artery calcification in midlife","volume":"37","author":"Terry","year":"2017","journal-title":"Arterioscler Thromb Vasc Biol"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1864098\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T15:15:38Z","timestamp":1783955738000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1864098\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,13]]},"references-count":28,"alternative-id":["10.3389\/fnut.2026.1864098"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1864098","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,13]]},"article-number":"1864098"}}