Impact of biological therapy on body composition of patients with Chron's disease

Santos, Julianne Campos dos; Malaguti, Carla; Lucca, Fernando de Azevedo; Cabalzar, Andrea Lemos; Ribeiro, Tarsila Campanha da Rocha; Gaburri, Pedro Duarte; Chebli, Liliana Andrade

doi:10.1590/1806-9282.63.05.407

Cited by 23 publications

(32 citation statements)

References 42 publications

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“…From the studies included in the meta-analyses, 9 studies reported a significant overall increase in body weight (Franchimont et al, 2005;De Oliveira et al, 2008;Saraceno et al, 2008;Esposito et al, 2009;Di Renzo et al, 2011;Toussirot et al, 2014;Csontos et al, 2016;Dos Santos et al, 2017) and 11 reported a significant increase in BMI (Gisondi et al, 2008;Esposito et al, 2009;Di Renzo et al, 2011;Tan et al, 2013;Mahe et al, 2014;Toussirot et al, 2014;Csontos et al, 2016;Ehsani et al, 2016;Dos Santos et al, 2017). Seven studies reported no significant change in body weight (Marcora et al, 2006;Metsios et al, 2007;Wiedenmann et al, 2008;Popa et al, 2009;Derdemezis et al, 2010;Younis et al, 2013;Ersozlu Bozkirli et al, 2014) and nine reported no significant change in BMI.…”

Section: Summary Of the Main Resultsmentioning

confidence: 99%

“…Reid and Li propose that TNF-a stimulates differentiated muscle cell protein loss through its activation of nuclear factor (NF)-kB and subsequent upregulation of ubiquitin/proteasome pathway (Reid and Li, 2001;Patel and Patel, 2017). In line with this, five studies using TNF-a inhibitors reported an increase in lean mass (Briot et al, 2005;Briot et al, 2008;Di Renzo et al, 2011;Csontos et al, 2016;Dos Santos et al, 2017).…”

Section: Mechanisms How Tnf-a Inhibitors Might Lead To Weight Painmentioning

confidence: 88%

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Impact of TNF-α Inhibitors on Body Weight and BMI: A Systematic Review and Meta-Analysis

et al. 2020

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The aim of this systematic review and meta-analysis of longitudinal studies was to ascertain to effects of TNF-a inhibitor therapy on body weight and BMI. Methods: Three databases (PubMed, OVID, and EMBASE) were systematically searched from inception to August 2018. We identified prospective, retrospective, and randomized controlled studies in adults with immune-mediated inflammatory diseases treated with TNF-a inhibitors based on pre-specified inclusion criteria. A random-effects model was used to estimate standardised mean change (SMCC). Results: Twenty-six longitudinal studies with a total of 1,245 participants were included in the meta-analysis. We found evidence for a small increase in body weight (SMCC = 0.24, p = .0006, 95% CI [0.10, 0.37]) and in BMI (SMCC = 0.26, p < .0001, 95% CI [0.13, 0.39]). On average, patients gained 0.90kg (SD = 5.13) under infliximab, 2.34kg (D = 5.65) under etanercept and 2.27kg (SD = 4.69) during treatment with adalimumab within the duration of the respective studies (4-104 weeks). Conclusion: Our results yield further support the for the view that TNF-a inhibitors increase body weight and BMI as a potential side effect. Modulating cytokine signaling could be a future therapeutic mechanism to treat disorders associated with weight changes such as anorexia nervosa.

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Section: Summary Of the Main Resultsmentioning

confidence: 99%

Section: Mechanisms How Tnf-a Inhibitors Might Lead To Weight Painmentioning

confidence: 88%

Impact of TNF-α Inhibitors on Body Weight and BMI: A Systematic Review and Meta-Analysis

et al. 2020

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“…In addition, they also showed that in 12 active CD patients, following the induction protocol with infliximab, FFM increased, albeit not significantly, and PhA normalized. However, Santos et al [20] showed that PhA did not improve after 24 weeks of infliximab therapy in 23 CD patients (p ¼ 0.53), and some differences were observed in BC, with a substantial increase in FM compared to FFM. Our findings did not show any significant differences between CD patients, although both total and segmental PhA were slightly higher, albeit not significantly, in those on biologic therapy compared to the values of patients on conventional therapy or no therapy.…”

Section: Discussionmentioning

confidence: 97%

“…As such, many studies used PhA as a tool for predicting nutritional status as well as for assessing clinical results and/or disease progression in different clinical conditions [15e18]. To date, however, only a few studies [19,20] have assessed impedance parameters to identify and monitor nutritional risk in adults with CD, showing contrasting results.…”

Section: Introductionmentioning

confidence: 99%

Assessment of bioelectrical phase angle as a predictor of nutritional status in patients with Crohn's disease: A cross sectional study

et al. 2020

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Background & aims: The assessment of body composition (BC) can be used to identify malnutrition in patients with Crohn's disease (CD). The aim of this study was to evaluate the nutritional status of CD patients by assessing BC, phase angle (PhA) and muscle strength. Differences in disease duration and medications were also considered. Methods: Consecutive adult CD patients aged 18e65 years were enrolled in this cross-sectional study. Disease activity was clinically defined by the Crohn's Disease Activity Index (CDAI) in the active and quiescent phases. All participants underwent anthropometry, BC and handgrip-strength (HGS) measurements; additionally, blood samples were taken. Data from CD patients were also compared with age-, sex-and BMI-matched healthy people. Results: A total of 140 CD patients with a mean age of 38.8 ± 13.9 years and a mean body weight of 64.9 ± 12 kg were recruited and compared to controls. The findings showed that all nutritional parameters, especially PhA and HGS, were lower in CD patients than in controls, and these parameters were substantially impaired as disease activity increased. Active CD patients had a lower body weight and fat mass than both the quiescent and control groups. PhA was negatively correlated with age (r ¼ À0.362; p ¼ 0.000) and CDAI (r ¼ À0.135; p ¼ 0.001) but was positively associated with fat free mass (FFM) (r ¼ 0.443; p ¼ 0.000) and HGS (r ¼ 0.539; p ¼ 0.000). Similarly, serum protein markers were lower in the active CD group than in the quiescent group (p < 0.05). Disease duration and medications did not significantly affect nutritional status. Conclusions: BIA-derived PhA is a valid indicator of nutritional status in CD patients, and its values decreased with increasing disease activity. Additionally, small alterations in BC, such as low FFM, and reduced HGS values can be considered markers of nutritional deficiency. Therefore, the assessment of BC should be recommended in clinical practice for screening and monitoring the nutritional status of CD patients.

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“…Of the 23 studies, 11 reported information on body weight changes. Of these, six involved paediatric patients (164 participants) [8,25,33,35,36,40] and five involved adults [21,22,24,39,42]. For paediatrics, SMD calculation was possible for four of the six studies; these four studies were included in the meta-analysis [8,25,33,40].…”

Section: The Effect Of Tumour Necrosis Factor (Tnf)-α Inhibitors On Bmentioning

confidence: 99%

Changes in Anthropometric Parameters After Anti-TNFα Therapy in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

et al. 2020

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Background Tumour necrosis factor (TNF)-α inhibitors have been widely used for the treatment of moderate-to-severe inflammatory bowel disease (IBD). TNFα also plays an important role in the regulation of weight homeostasis and metabolism and has been linked to variations in anthropometric responses. This relationship in patients with IBD has yet to be determined. Objectives Our objective was to evaluate the effects of TNFα inhibitors on changes in anthropometric measures in both adults and children with IBD through a systematic review and meta-analysis. Methods Multiple database searches identified studies involving children and adults with IBD and treated with TNFα inhibitors and reporting at least one primary outcome measure. Where possible, data were combined for meta-analysis. The primary outcomes included weight, body mass index (BMI), waist circumference, height, height/velocity, and fat and lean mass. Secondary outcomes included surrogate markers of disease activity. A random-effects model was used to estimate the standardised mean difference (SMD). Results In total, 23 cohort studies (total 1167 participants) met the inclusion criteria. Meta-analysis was performed on 13 of these studies. In children, 6-29.3 months of anti-TNFα therapy had a small but statistically significant effect on weight (SMD 0.31; 95% confidence interval [CI] 0.12-0.49; P = 0.001) with a mean gain in z score of 0.30 (standard error [SE] 0.12). In adults, 2-22.4 months of treatment had a moderate effect on BMI (SMD 0.72; 95% CI 0.17-1.26; P = 0.010; mean gain 1.23 kg/m 2 ; SE 0.21). A small but statistically significant increase in BMI z score was found in children (SMD 0.28; 95% CI 0.03-0.53; P = 0.026; mean change 0.31 ± standard deviation [SD] 0.14) after 12-29.3 months of therapy. A meta-analysis of four studies found a negligible but statistically significant increase in height (SMD 0.16; 95% CI 0.06-0.26; P = 0.002; mean change 0.17 z score [SE 0.05]). A negligible effect on fat mass (SMD 0.24; 95% CI −0.19-0.66; P = 0.272) was found in a meta-analysis of five studies. Of note, despite the high heterogeneity among the studies that addressed the issue, these results were also consistently supported by findings from studies not included in the meta-analysis and reviewed in the systematic review. Unfortunately, a lack of data meant we were unable to perform moderator analysis on observed heterogeneity. Conclusion Anti-TNFα treatment appears to be associated with an increase in body weight, BMI, and other anthropometric parameters. Given the differing courses of IBD between children and adults, this association should be considered before initiating biologics for undernourished, overweight, and obese patients. Registration: PROSPERO registration number CRD42020163079.

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Impact of biological therapy on body composition of patients with Chron's disease

Abstract: suMMary Study conducted at the Inflammatory

Cited by 23 publications

References 42 publications

Impact of TNF-α Inhibitors on Body Weight and BMI: A Systematic Review and Meta-Analysis

Impact of TNF-α Inhibitors on Body Weight and BMI: A Systematic Review and Meta-Analysis

Assessment of bioelectrical phase angle as a predictor of nutritional status in patients with Crohn's disease: A cross sectional study

Changes in Anthropometric Parameters After Anti-TNFα Therapy in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

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