The Impact of Obesity on Inflammatory Bowel Disease

Abstract

Obesity is prevalent in the inflammatory bowel disease (IBD) population, particularly in newly developed countries where both IBD and obesity in the general population are on the rise. The role of obesity in the pathogenesis of IBD was entertained but results from available studies are conflicting. It does, however, appear to negatively influence disease course whilst impacting on our medical and surgical therapies. The pro-inflammatory profile of the visceral adipose tissue might play a role in the pathogenesis and course of Crohn’s Disease (CD). Interestingly, isolating the mesentery from the surgical anastomosis using a KONO-S technique significantly decreases anastomotic recurrence rate. Anti-obesity therapy is not widely used in IBD but was suggested as an adjunctive therapy in those patients. In this review, we aimed to highlight the epidemiology of obesity in IBD and to describe its influence on disease course and outcomes.

Crohn’s Disease and Ulcerative Colitis: From Pathophysiology to Novel Therapeutic Approaches

“…The accumulation of excess macronutrients in adipose tissue triggers the release of inflammatory mediators, such as tumor necrosis factor and IL-6, leading to a pro-inflammatory state and oxidative stress [ 30 ]. Kaazan et al [ 31 ] (Contribution 8) reviewed the impact of obesity on IBD, uncovering a correlation between obesity, the incidence and severity of IBD, and an increased risk of surgical complications. The review highlights the intricate relationship between obesity and IBD, marked by chronic inflammation, gut flora dysbiosis, and impaired immune function, which, in turn, influences IBD prognosis.…”

Cellular and Molecular Determinants of Biologic Drugs Resistance and Therapeutic Failure in Inflammatory Bowel Disease

“…IBDs are increasingly considered Western diseases; therefore, besides the impact of nutritional deficiencies on biologic treatment, recent evidence has shed light on the role of obesity and hyper nutrition in determining reduced response to biologic drugs. The negative impact of obesity on treatment outcomes has been convincingly demonstrated for anti-TNFα agents (especially when administered subcutaneously), whilst conflicting evidence is available for vedolizumab [ 94 , 95 ]. The explanation between obesity and reduced response to therapies can be considered in relation to several mechanisms.…”

Extracellular Vesicles: Novel Potential Therapeutic Agents in Inflammatory Bowel Diseases

“…However, genetics alone does not represent the only cause of IBD. Environmental factors, notably smoking, a high-fat diet, and obesity, strongly enhance gut inflammation [ 6 ]. More recently, the influence of gut microbiota has emerged due to its crucial role in maintaining intestinal homeostasis and gut barrier function and its heterogeneous interconnections with dietary elements, epithelial cells, and the immune system [ 7 , 8 ].…”