Sarcopenic Obesity in Gastroduodenal Ulcer Disease: A Cross-sectional Study of Nutritional and Biochemical Profiles in Lomé, Togo

Abstract

Background: Gastroduodenal ulcer disease (GUD) is a significant health burden in urban West Africa, a region undergoing a rapid nutritional transition. Conventional assessment using Body Mass Index (BMI) may fail to detect complex malnutrition phenotypes like sarcopenic obesity that could impair ulcer healing. This study aimed to characterize the detailed nutritional and metabolic profiles of GUD patients in Lomé, Togo, to unmask these underlying disorders. Methods: This cross-sectional analytical study, conducted from July to October 2024, recruited 127 patients with endoscopically confirmed GUD. Data were collected on sociodemographic, clinical, and dietary characteristics, with dietary quality assessed via a Dietary Diversity Score (SDA). Body composition, including visceral fat and skeletal muscle mass, was evaluated using multi-frequency bioelectrical impedance analysis (BIA). Fasting venous blood was analyzed for key biochemical markers, including albumin, folate, and homocysteine. Results: The cohort (mean age 43.7; 35.4% Helicobacter pylori positive) presented a paradoxical nutritional profile. While BMI classified only 31.5% as overweight or obese, BIA revealed a high prevalence of sarcopenic obesity: 46.5% exhibited a low protein index and 39.4% had visceral obesity. Poor dietary quality (SDA ≤ 4) was significantly associated with lower concentrations of prealbumin and albumin (p<0.05), reduced serum folate (p<0.01), and consequently higher, detrimental levels of homocysteine (p<0.01). Regular fruit consumption was protective against H. pylori infection (OR = 0.42), while a low education level was an independent risk factor (OR = 2.85). Conclusion: Patients with GUD in Lomé are affected by a severe "double burden of malnutrition." The high prevalence of sarcopenic obesity, entirely masked by BMI, fosters a systemic metabolic environment of pro-inflammatory visceral adiposity and depleted protein reserves that is fundamentally antagonistic to mucosal healing. These findings highlight the inadequacy of BMI and underscore the urgent need to integrate body composition analysis and key biochemical markers into clinical assessment to guide effective nutritional interventions.