Degree of Creeping Fat Assessed by Computed Tomography Enterography is Associated with Intestinal Fibrotic Stricture in Patients with Crohn’s Disease: A Potentially Novel Mesenteric Creeping Fat Index

Abstract

Background and Aims Emerging evidence points to a link between creeping fat and pathogenesis of Crohn’s disease (CD). Non-invasive assessment of the severity of creeping fat on cross-sectional imaging modality has seldom been investigated. This study aimed to develop and characterize a novel mesenteric creeping fat index (MCFI) based on CT in CD patients. Methods MCFI was developed based on vascular findings on CT in retrospective cohort (n=91) and validated in prospective cohort (n=30). The severity of creeping fat was graded based on the extent to which mesenteric fat extended around the intestinal circumference using the vessels in the fat as a marker. The accuracy of MCFI was assessed by comparing it with the degree of creeping fat observed in surgical specimens. The relationship between MCFI and fibrostenosis was characterized by determining if these correlated. The accuracy of MCFI was compared with other radiographic indices (i.e. visceral to subcutaneous fat area ratio and fibrofatty proliferation score). Results In retrospective cohort, MCFI had moderate accuracy in differentiating moderate-severe from mild fibrostenosis (AUC=0.799; P=0.000). ROC analysis in retrospective cohort identified a threshold MCFI of >3 which accurately differentiated fibrostenosis severity in prospective cohort (AUC=0.756; P=0.018). Excellent correlation was shown between MCFI and the extent of fat wrapping in specimens in prospective cohort (r=0.840, P=0.000). Neither visceral to subcutaneous fat area ratio nor fibrofatty proliferation score correlated well with intestinal fibrosis degree. Conclusions MCFI can accurately characterize the extent of mesenteric fat wrapping in surgical specimens. It may become another non-invasive measure of CD fibrostenosis.

Impact of Sarcopenia on Clinical Outcomes in a Cohort of Caucasian Active Crohn’s Disease Patients Undergoing Multidetector CT-Enterography

“…These results indicate that human fat tissue should be not only considered a reservoir for excess nutrients but a dynamic tissue involved in the regulation of immunity, inflammation, and angiogenesis [ 41 ]. Indeed, the VFA/SFA ratio and fibrofatty proliferation score play key roles in developing fibrostenosis in CD [ 42 , 43 , 44 , 45 ].…”

Hydrogen Sulfide Prevents Mesenteric Adipose Tissue Damage, Endothelial Dysfunction, and Redox Imbalance From High Fructose Diet-Induced Injury in Aged Rats

“…Consumption of a high amount of dietary fructose or other types of sugars in sweetened foods and aging could cause adipocyte tissue damage which might be related to metabolic and obesityrelated disorders (Crescenzo et al, 2014;Pinnick et al, 2019). Human studies reveal the tendency of mesenteric fat wrapping or visceral adiposities and may act as a "red flag" in patients much earlier than symptom-onset (Li et al, 2021).…”

Hydrogen Sulfide-Releasing Anti-Inflammatory Drug Atb-340 Treatment Potentially Reduces Mesenteric Metaflammation in the Experimental Age- And High Fructose Dietary-Induced Injury

“…5 obesity is still not fully elucidated, but it involves a complex interaction between environmental, host genetic, metabolic and uncontrolled immune-derived factors that are responsible for metafl ammation. Mesenteric white adipocyte remodeling has the potential to produce infl ammatory mediators such as adipokines, cytokines TNF-α, IL-6, and IL-1β, hereby increasing tissue destruction and inducing infl ammation even more in local tissues, but the whole understanding of the link of its remodeling and metafl ammation is still incomplete [25,26]. Studies in vivo rodent models based on high fructose diet have contributed signifi cantly to our understanding of the molecular events involved in remodeling of white adipocytes and metafl ammation and their outcomes [27].…”