Obesity in IBD: epidemiology, pathogenesis, disease course and treatment outcomes

Abstract

Incidence of IBD is rising in parallel with overweight and obesity. Contrary to conventional belief, about 15–40% of patients with IBD are obese, which might contribute to the development of IBD. Findings from cross-sectional and retrospective cohort studies are conflicting on the effect of obesity on natural history and course of IBD. Most studies are limited by small sample size, low event rates, non-validated assessment of disease activity and lack robust longitudinal follow-up and have incomplete adjustment for confounding factors. The effect of obesity on the efficacy of IBD-related therapy remains to be studied, though data from other autoimmune diseases suggests that obesity results in suboptimal response to therapy, potentially by promoting rapid clearance of biologic agents leading to low trough concentrations. These data provide a rationale for using weight loss interventions as adjunctive therapy in patients with IBD who are obese. Obesity also makes colorectal surgery technically challenging and might increase the risk of perioperative complications. In this Review, we highlight the existing literature on the epidemiology of obesity in IBD, discuss its plausible role in disease pathogenesis and effect on disease course and treatment response, and identify high-priority areas of future research.

A multicentre Study of Nutrition Risk Assessment in Adult Patients with Inflammatory Bowel Disease Attending Outpatient Clinics

“…Thus, between 15 and 40% of IBD patients are now reported as overweight or obese [3,4]. Nutrition screening of all inpatients is mandatory and routinely carried out in the health services of certain countries.…”

Depressive and anxiety symptoms among patients with inflammatory bowel diseases

“…In recent epidemiological studies, the incidence of obesity or overweight among IBD patients is estimated at 15-40%, and their occurrence significantly complicates treatment, particularly the effectiveness of surgical intervention [29]. It is believed that IBD and obesity have many common elements, including intestinal microbiota, diet, and proinflammatory features of intra-abdominal adipose tissue [30].…”

The Differential Impact Of High-Intensity Swimming Exercise and Inflammatory Bowel Disease On IL-1b, TNF-a, and COX-2 Gene Expression in the Small Intestine and Colon in Mice

“…Animal studies that examine the impact of IBD on the large intestine are necessary, as limitations exist in measuring bowel movement function or conducting epidemiologic and factual studies in patients with IBD. 16 Moreover, animal studies are critical for examining differences in the impact of high-intensity exercise and the induction of IBD on immune system activity in the intestine.…”