Bioelectrical Impedance Analysis as a Contemporary Biomarker of Obesity in Adults with Marfan- or Loeys-Dietz-Syndrome

Background: It is clinically widely overlooked that many patients with Marfan- (MFS) or Loeys-Dietz-Syndrome (LDS) are obese. While anthropometric routine parameters are not very suitable, the modern Bioelectrical Impedance Analysis (BIA) seems superior for the acquisition of reliable noninvasive assessment of body composition of patients. The aim of the study was to assess the body composition of patients with MFS/LDS by BIA in order to detect occult obesity, which may be a risk marker for aortic or vascular complications. Methods: In this exploratory cross-sectional study, 50 patients (66% female; mean age: 37.7 +/- 11.7 [range: 17-64] years) with a molecular genetic (n= 45; 90%) or clinical (n= 5; 10%) proven diagnosis of MFS or LDS were enrolled between June 2020 and February 2022. All BIA-measurements were performed with the Multifrequence-Impedance-Analyzer Nutriguard-MS (Data Input, Poecking, Germany). Results: The MFS/LDS collective was significantly different from an age-, sex-, and BMI-adjusted control in terms of body fat, percent cell ularity, body cell mass, extra cellular mass/body cell mass index, and phase angle (all p < 0.05). The mean I31A-measured bodyfat was 31.7 +/- 8.7% [range: 9.5.-53.5%], while the mean calculated 13MI of the included patients was 23.0 +/- 4.8 kg/m(2) [range: 15.2-41.9 kg/m(2)]. Therefore, using the obesity cut-off values for the body fat percentage of 25% in men and 35% in women, the BIA classifies as many as 28 patients (56.0%) as obese. In contrast only 12 patients (24.0%) were pre-obese, respectively 3 (6.0%) obese by BMI. The significant difference (p < 0.001) had an accordance of 42.7%. Overall, 15 patients (13 MFS; 2 LDS) had previous aortic surgery (n=14) and/or interventional treatment (n=2) for aortic complications (aneurysm, aortic dissection). 11 out of these 15 (73.3%) were currently classified as obese by BIA. Conclusions: The fact that many patients with MFS or LDS are obese is widely unknown, although obesity may be associated with impaired vascular endothelial function and an increased risk of cardiovascular complications. Also, in patients with MFS/I.DS, INA allows a reliable assessment of the body composition beyond the normal anthropometric parameters, such as BMI. In the future, BIA-data possibly may be of particular i mportance for the assessment of the vascular risk of MFS/LDS patients, besides the aortic diameters.

Automated summary

In this study, the body composition of patients with MFS/LDS was assessed using bioelectrical impedance analysis. It was found that many patients with MFS/LDS are obese, which is often overlooked. BIA was shown to be a superior method for evaluating body composition compared to routine anthropometric parameters. These findings highlight the importance of assessing obesity in MFS/LDS patients for vascular risk evaluation.