Obesity is Associated With Increased Risk of Crohn’s disease, but not Ulcerative Colitis: A Pooled Analysis of Five Prospective Cohort Studies

Abstract

It is unclear whether obesity is associated with the development of inflammatory bowel disease despite compelling data from basic science studies. We therefore examined the association between obesity and risk of Crohn's disease (CD) and ulcerative colitis (UC). METHODS:We conducted pooled analyses of 5 prospective cohorts with validated anthropometric measurements for body mass index (BMI) and waist-hip ratio and other lifestyle factors. Diagnoses of CD and UC were confirmed through medical records or ascertained using validated definitions. We used Cox proportional hazards modeling to calculate pooled multivariable-adjusted HRs (aHRs) and 95% confidence intervals (CIs). RESULTS:Among 601,009 participants (age range, 18-98 years) with 10,110,018 person-years of follow-up, we confirmed 563 incident cases of CD and 1047 incident cases of UC. Obesity (baseline BMI ‡30 kg/m 2 ) was associated with an increased risk of CD (pooled aHR, 1.34; 95% CI, 1.05-1.71, I 2 [ 0%) compared with normal BMI (18.5 to <25 kg/m 2 ). Each 5 kg/ m 2 increment in baseline BMI was associated with a 16% increase in risk of CD (pooled aHR, 1.16; 95% CI, 1.05-1.22; I 2 [ 0%). Similarly, with each 5 kg/m 2 increment in early adulthood BMI (age, 18-20 years), there was a 22% increase in risk of CD (pooled aHR, 1.22; 95% CI, 1.05-1.40; I 2 [ 13.6%). An increase in waist-hip ratio was associated with an increased risk of CD that did not reach statistical significance (pooled aHR across quartiles, 1.08; 95% CI, 0.97-1.19; I 2 [ 0%). No associations were observed between measures of obesity and risk of UC.

Diet fuelling inflammatory bowel diseases: preclinical and clinical concepts

“…[13][14][15] In line with this, prospective epidemiological studies indicated that obesity emerges as an independent risk factor for CD. 16 Preclinical and translational studies indicated that energy metabolism controls gut immune responses and that excessive intake of carbohydrates and long-chain fatty acids deteriorate or instigate gut inflammation in several mouse models. 9 In human IBD, early surgical studies from the 1990s indicated that luminal factors (potentially nutrients, microbes or related metabolites) are sufficient to evoke gut inflammation, 17 18 which led to the nowadays established therapeutic concept of ileostomy.…”

Case report: gastric sleeve surgery leads to new onset Crohn’s disease

“…It could be hypothesized that the weight loss and not the surgery itself, triggers the new onset CD is some patients. However, other studies have shown a relationship between obesity and a higher risk of developing CD [ 2 ].…”

The Role of Intermittent Fasting in the Management of Nonalcoholic Fatty Liver Disease: A Narrative Review

“…IF interventions appeared to confer health benefits independent of energy intake ( Figure 1 ) [ 2 , 3 , 23 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. For example, in two separate trials of overweight women, participants lost the same amount of weight during a 6-month period whether they followed an IF intervention or a 25% energy-restricted diet.…”