Jonah Moyal, Benjamin Rehany

Radiological assessment of body composition changes and complications in an era of incretin-based therapies: A narrative review

Introduction

Radiological assessment of body composition changes and complications in an era of incretin-based therapies: a narrative review. Radiological assessment (CT, MRI, ultrasound) tracks body composition changes & complications from incretin therapies in obesity & diabetes. Focus on precision, composition-centric management.

Abstract

Introduction Obesity and type 2 diabetes mellitus management have been transformed by the emergence of incretin-based therapies, such as dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists. While these agents facilitate significant weight loss, traditional metrics like body mass index fail to distinguish between the loss of metabolically active visceral fat and the potentially detrimental depletion of lean body mass. This review examines the role of radiology in monitoring the physiological transformations induced by these medications. Methods This narrative review involved a comprehensive search across University of Toronto Library, PubMed, and Google Scholar to investigate the radiological manifestations and complications of incretin therapy. From an initial 210 records, 34 research studies were included after screening for key themes in body composition, gastrointestinal safety, and imaging modalities, including computed tomography, magnetic resonance imaging, and ultrasound. Results The analysis focuses on imaging-based evidence regarding changes in subcutaneous and visceral adipose tissue, alongside the preservation of skeletal muscle integrity. Radiological measurements can fill an unmet need to monitor metabolic health and body composition changes in individuals who require pharmacological intervention. Furthermore, this review identifies imaging markers for treatment-related complications and perioperative applicability. Conclusion Ultimately, this review advocates for a shift from weight-centric to composition-centric management. By integrating computed tomography, magnetic resonance imaging, and ultrasound into clinical workflows, clinicians can objectively quantify tissue quality and distribution. This holistic approach, combining pharmacological intervention with precision imaging and structured nutritional support, ensures that pharmacologically induced weight loss optimizes long-term functional health and patient safety.

Review

This narrative review, titled "Radiological assessment of body composition changes and complications in an era of incretin-based therapies," addresses a timely and critical gap in the management of obesity and type 2 diabetes. With the transformative impact of incretin-based therapies on weight loss, the authors rightly highlight the inadequacy of traditional metrics like Body Mass Index (BMI) in distinguishing between beneficial visceral fat reduction and potentially detrimental lean body mass loss. The core premise—that radiology offers a precise means to monitor these complex physiological transformations—is highly relevant, advocating for a more sophisticated and objective approach to patient assessment in this rapidly evolving therapeutic landscape. The review's methodology involved a comprehensive search across major academic databases, ultimately synthesizing findings from 34 studies to investigate the radiological manifestations and complications of incretin therapy. A key strength lies in its focus on imaging-based evidence concerning changes in subcutaneous and visceral adipose tissue, alongside the preservation of skeletal muscle integrity. By detailing the utility of computed tomography, magnetic resonance imaging, and ultrasound, the paper effectively demonstrates how these modalities can fulfill an unmet need in monitoring metabolic health and body composition. Furthermore, the identification of imaging markers for treatment-related complications and perioperative applicability adds significant clinical value. Ultimately, this review makes a compelling case for a paradigm shift from a "weight-centric" to a "composition-centric" management strategy. Its strong advocacy for integrating precision imaging into clinical workflows promises to enable clinicians to objectively quantify tissue quality and distribution, thereby optimizing long-term functional health and patient safety in individuals undergoing incretin-based therapies. While a narrative review offers a broad synthesis, the clear articulation of radiology's indispensable role provides a robust framework for future research, including systematic reviews and potentially prospective studies correlating specific imaging findings with clinical outcomes in this patient population.

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