Sarcopenia is associated with poor clinical outcomes in patients with inflammatory bowel disease: a prospective cohort study

Abstract

Background: Patients with inflammatory bowel disease (IBD) often have low weight, malnutrition and sarcopenia. The criteria of sarcopenia used were European and American standards previously. The aim of the study was to evaluate the impact of sarcopenia on clinical outcomes in patients with IBD using the Asian Working Group for Sarcopenia 2019 (AWGS2019) criteria. Methods:The inclusion of the subjects was IBD patients between 18 to 60 years. Sarcopenia, presarcopenia and sarcopenic obesity were defined. Participants were followed up for 90 days. Information as to whether the symptoms improved, treatment plans changed, underwent surgery, were readmitted to the hospital, or died was recorded. Analyses of chi-square test, t-test, cumulative survival analysis and receiver operating characteristic (ROC) curves were done through SPSS25.0 software. Odds ratio (OR) and 95% confidence interval (CI) were calculated.Results: A total of 110 patients with IBD were included. The prevalence of pre-sarcopenia was 44.6% and of sarcopenia 50.8%. Body mass index (BMI) (P=0.018; OR =0.449) and albumin (Alb) levels were lower (P=0.004; OR =0.608) in the sarcopenia group than the control and pre-sarcopenia groups, and they were risk factors for sarcopenia. Meanwhile, a history of more frequent alcohol consumption, parenteral manifestations, IBD-related complications, higher C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were significant statistic different for sarcopenia group compared with others. Rates of surgery (P<0.001; OR =6.651), re-hospitalization (P<0.001; OR =6.344) or death (P=0.003) were higher in the sarcopenia group than in the control group. The sarcopenia group had higher rates of surgery (P=0.022; OR =3.608) and re-hospitalization (P=0.048; OR =5.500) than the pre-sarcopenia group after adjustment analysis.Patients in the sarcopenic obesity group with body fat percentages ≥24.8% (P=0.039; 95% CI: 0.590-1.000) in men and ≥32.0% (P=0.006; 95% CI: 0.692-1.000) in women were more likely to receive surgery, female patients with that ≥24.5% (P=0.025; 95% CI: 0.556-1.000) were more likely to experience re-hospitalization.Conclusions: Patients with IBD diagnosed with sarcopenia or sarcopenic obesity based on AWGS2019 criteria had poorer outcomes. The AWGS2019 criteria are comprehensive and more suitable for predicting outcomes in IBD patients, which helps doctors making precise treatment.

CT-based body composition parameters predict the loss of response to infliximab in patients with Crohn’s disease

“…In addition, study found that the sarcopenia group had higher surgery, re-hospitalization and death rate than the control group in patients with in ammatory bowel disease [24]. And, intensifying the dose of in iximab with LOR on standard dosing patterns can improve the mucosal healing rate [25].…”

Managing the older adult with inflammatory bowel disease: is age just a number?

“…In a recent retrospective study, sarcopenia was independently associated with increased risk of anastomotic leak in IBD patients undergoing colorectal surgery [32 ▪ ]. In a separate prospective study, sarcopenia, measured by grip strength and muscle mass in patients with IBD who were 18–60 years-old, was associated with worse clinical outcomes as compared to controls and individuals defined as presarcopenic [35 ▪ ]. Future research should expand upon this using uniform diagnostic criteria, and include measures of muscle strength and function to comprehensively evaluate the impact of sarcopenia on operative and clinical outcomes in IBD.…”

Review article: Putting some muscle into sarcopenia—the pathogenesis, assessment and clinical impact of muscle loss in patients with inflammatory bowel disease

“…Of interest, in the multivariate analysis, pre-operative nutritional optimization was protective (OR 0.13, p = 0.004) against surgical complications. 45 Most recently, Liu et al 46 utilised a prospective cohort study to better understand the impact of sarcopenia on clinical outcomes and similarly identified that those with sarcopenia (as defined by BIA and handgrip) and a normal BMI as well as those with sarcopenic obesity had higher rates of readmission and re-operation as well as post-operative mortality. Finally, a recent meta-analysis identified 4 studies that evaluated the impact of sarcopenia on post-operative complications in patients with IBD.…”