Combination of sarcopenia and high visceral fat predict poor outcomes in patients with Crohn’s disease

Boparai, Gurasis; Kedia, Saurabh; Kandasamy, Devasenathipathy; Sharma, Raju; Madhusudhan, Kumble Seetharama; Dash, Nihar Ranjan; Sahu, Pabitra; Pal, Sujoy; Sahni, Peush; Panwar, Rajesh; Vuyyuru, Sudheer K.; Kante, Bhaskar; Yadav, Deepika; Mouli, Venigalla Pratap; Makharia, Govind; Ahuja, Vineet

doi:10.1038/s41430-021-00857-x

Cited by 37 publications

(35 citation statements)

References 26 publications

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“…Interestingly, Adams et al ( 47 ) reported that more than 40% of patients affected by sarcopenia presented with a normal BMI, and that up to 20% were overweight or obese, which were not identified as undernourished by traditional measures. Sarcopenia has been considered to be a meaningful marker of an adverse prognosis in patients with CD ( 48 – 50 ). Recent studies reported that moderate endurance and muscle training were beneficial for patients with quiescent or mildly active CD ( 51 , 52 ), which may imply the potential impact of improved muscle status on disease activity to some extent.…”

Section: Discussionmentioning

confidence: 99%

The GLIM Criteria Represent a More Appropriate Tool for Nutritional Assessment in Patients With Crohn's Disease

Peng

et al. 2022

Front. Nutr.

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BackgroundThe early recognition of malnutrition is essential for improving the prognosis of patients with Crohn's disease (CD). The Global Leadership Initiative on Malnutrition (GLIM) criteria represent a new consensus for the diagnosis of malnutrition but need to be validated in CD. The aims were to explore the related factors of malnutrition in CD and explore whether GLIM-positive patients who did not meet the Nutritional Risk Screening 2002 (NRS 2002) would benefit from nutritional treatment.MethodsThis study retrospectively enrolled patients with CD at the Gastroenterology Department of Xiangya Hospital Central South University between March 2020 and March 2021. After bioelectrical impedance analysis, all patients underwent nutritional screening and diagnosis using the NRS 2002 and GLIM criteria, respectively. Multivariable analysis was performed to evaluate risk factors related to malnutrition in patients with CD. A multivariable Cox hazard model was used to assess the association between nutritional therapy and prognostic outcomes.ResultsOf the 118 patients included, fifty were classified as having a high malnutrition risk according to the NRS 2002, while 76 were diagnosed with malnutrition by the GLIM criteria. Multivariate analysis showed that a high malnutrition risk was independently associated with the L4 phenotype [odds ratio (OR) (95% confidence interval (CI)) = 4.718 (1.108, 20.10), p = 0.036] and Crohn's Disease Activity Index (CDAI) [OR (95% CI) = 1.018 (1.007, 1.029), p = 0.002] based on the NRS 2002. The age at onset [OR (95% CI) = 0.828 (0.699, 0.980), p = 0.028] and CDAI [OR (95% CI) = 1.111 (1.034, 1.195), p = 0.004] were regarded as independent risk factors related to malnutrition, as determined by the GLIM criteria. Among 26 GLIM+/NRS− patients, significantly more patients who received nutritional support achieved 6-week remission than patients who did not (100 vs. 71.4%, p < 0.05). The 6-week remission risk in patients treated with nutrition therapy was more than 4-fold higher than those without nutritional therapy.ConclusionThe GLIM criteria could diagnose more malnourished patients with CD who are not positively screened by the NRS 2002, among whom nutritional support therapy would be beneficial for disease remission. The new criteria should be more appropriate for assessing the nutritional status of patients with CD.

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Section: Discussionmentioning

confidence: 99%

The GLIM Criteria Represent a More Appropriate Tool for Nutritional Assessment in Patients With Crohn's Disease

Peng

et al. 2022

Front. Nutr.

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“…Table 1 shows the evaluation methods and frequency of sarcopenia reported in recent years in patients with IBD [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. In more than half of the reports, computed tomography (CT, L3 level) is used to assess sarcopenia, but many reports only use muscle mass assessment to determine sarcopenia, while a few include grip strength and walking speed in the assessment of sarcopenia [ 17 ].…”

Section: Methods and Frequency Of Sarcopenia Assessment In Patients With Ibdmentioning

confidence: 99%

Inflammatory Bowel Disease and Sarcopenia: Its Mechanism and Clinical Importance

Nishikawa

Nakamura

Miyazaki

et al. 2021

JCM

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Malnutrition is a major contributor to muscle loss and muscle dysfunction, known as sarcopenia. Malnutrition is common in patients with inflammatory bowel disease (IBD). IBD includes ulcerative colitis (UC) and Crohn’s disease (CD). The number of patients with IBD has recently been increasing. More severe malnutrition is often seen in CD compared to UC, probably due to CD affecting the main site of nutrient absorption, extensive mucosal lesions, fistulas, short bowel syndrome after resection, or obstruction of the gastrointestinal tract. A recent meta-analysis showed the high prevalence of sarcopenia in patients with IBD, and thus sarcopenia is a very important problem for IBD. Although IBD is more common in younger patients, sarcopenia can develop through a variety of mechanisms, including malnutrition, chronic inflammation, increased inflammatory status in adipose tissue, vitamin deficiency, and imbalance of the muscle–gut axis. In addition, sarcopenia has a negative impact on postoperative complications and hospital stay in patients with IBD. Appropriate intervention for sarcopenia may be important, in addition to clinical remission and endoscopic mucosal healing in patients with IBD. Much more attention will thus be paid to sarcopenia in patients with IBD. In this review, we outline IBD and sarcopenia, based on the current evidence.

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“…More specifically, low muscle attenuation and higher visceral fat index appear to be associated with more severe CD phenotypes 13 , and Bryant et al found that increasing obesity in CD coincided with a decrease in lean muscle mass over time 14 . Boparai et al investigated this inverse relationship further, utilising skeletal muscle indices and differential analysis of visceral and subcutaneous fat to determine that combination of sarcopenia and high visceral fat predicts poor outcomes in patients with CD 15 . In addition, as lean muscle mass has been shown to be of more importance than fat mass in determining bone density, the observed loss of lean muscle mass in CD cohorts could have a significant impact on bone health 16 .…”

Section: Introductionmentioning

confidence: 99%

Adults with Crohn’s disease exhibit elevated gynoid fat and reduced android fat irrespective of disease relapse or remission

Dowling

Jakeman

Norton

et al. 2021

Sci Rep

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Crohn’s disease (CD) is a debilitating inflammatory bowel condition of unknown aetiology that is growing in prevalence globally. Large-scale studies have determined associations between female obesity or low body mass index (BMI) with risk of CD at all ages or 8– < 40 years, respectively. For males, low BMI entering adult life is associated with increased incidence of CD or ulcerative colitis up to 40 years later. Body composition analysis has shown that combinations of lean tissue loss and high visceral fat predict poor CD outcomes. Here, we assessed dietary intake, physical activity and whole or regional body composition of patients with CD relapse or remission. This anthropometric approach found people with CD, irrespective of relapse or remission, differed from a large representative healthy population sample in exhibiting elevated gynoid fat and reduced android fat. CD is associated with mesenteric adipose tissue, or “creeping fat”, that envelops affected intestine exclusive of other tissue; that fat is localised to the android region of the body. In this context, CD mesenteric adiposity represents a stark juxtaposition of organ-specific and regional adiposity. Although our study population was relatively small, we suggest tentatively that there is a rationale to refer to Crohn’s disease as a fatty intestine condition, akin to fatty liver conditions. We suggest that our data provide early insight into a subject that potentially warrants further investigation across a larger patient cohort.

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Combination of sarcopenia and high visceral fat predict poor outcomes in patients with Crohn’s disease

Cited by 37 publications

References 26 publications

The GLIM Criteria Represent a More Appropriate Tool for Nutritional Assessment in Patients With Crohn's Disease

The GLIM Criteria Represent a More Appropriate Tool for Nutritional Assessment in Patients With Crohn's Disease

Inflammatory Bowel Disease and Sarcopenia: Its Mechanism and Clinical Importance

Adults with Crohn’s disease exhibit elevated gynoid fat and reduced android fat irrespective of disease relapse or remission

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