Visceral adiposity predicts post‐operative Crohn's disease recurrence

Holt, Darcy; Moore, Gregory Thomas Charles; Strauss, Boyd Josef Gimnicher; Hamilton, Amy L.; Kamm, Michael A.

doi:10.1111/apt.14018

Cited by 93 publications

(86 citation statements)

References 64 publications

(117 reference statements)

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“…In one such study, authors looked at the patients from POCER study and concluded that visceral adiposity was an independent risk factor for recurrence of CD after a surgery. Patients with visceral adiposity had RR of 2.1% (95% CI 1.5‐3.0, P = 0.012) for endoscopic recurrence at 18 months compared with control population 25 . Authors concluded increased visceral adipose tissue was associated with alterations in gut biome which was similar to the ones seen in patients with IBD 25 .…”

Section: Discussionmentioning

confidence: 75%

Risk of de‐novo inflammatory bowel disease among obese patients treated with bariatric surgery or weight loss medications

Kochhar

Desai

Syed

et al. 2020

Aliment Pharmacol Ther

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Background: An association between bariatric surgery and development of de-novo inflammatory bowel disease (IBD) has been observed.Aim: To evaluate further the association among bariatric surgery, weight loss medications, obesity and new-onset IBD. Methods: Using Explorys, a population-based Health Insurance Portability andAccountability Act compliant database, we estimated the prevalence of de-novo IBD among patients treated with bariatric surgery (Roux-en-Y gastrojejunostomy, laparoscopic sleeve gastrectomy or gastric banding) (n = 60 870) or weight loss medications (orlistat, phentermine/topiramate, lorcaserin, bupropion/naltrexone and liraglutide) (n = 193 790) compared with obese controls (n = 5 021 210), between 1999 and 2018.Results: The prevalence of de-novo IBD was lower among obese patients exposed to bariatric surgery (7.72 per 1000 patients) or weight loss medications (7.22 per 1000 patients) compared with patients with persistent obesity not exposed to these interventions (11.66 per 1000 patients, P < 0.0001). The risk reduction for de-novo IBD was consistent across bariatric surgeries and weight loss medications with the exception of orlistat which was not associated with a reduction in risk for de-novo IBD compared with the persistent obese control cohort. Conclusion:Obese patients undergoing treatment with bariatric surgery or weight loss medications are at a lower risk for developing de-novo IBD compared with persistently obese controls not exposed to these interventions. These data suggest that obesity and ineffective management of obesity are risk factors for de-novo IBD.Further research is needed to confirm these observations and understand potential mechanisms.

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Section: Discussionmentioning

confidence: 75%

Risk of de‐novo inflammatory bowel disease among obese patients treated with bariatric surgery or weight loss medications

Kochhar

Desai

Syed

et al. 2020

Aliment Pharmacol Ther

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“…Empirical studies have evaluated, and confirmed, the association between adiposity and CD as biologically plausible . Firstly, adipocyte‐derived mediators such as leptin, TNF‐α, and IL‐6 are known to be prominent proinflammatory mediators .…”

Section: Discussionmentioning

confidence: 99%

“…28,29 Empirical studies have evaluated, and confirmed, the association between adiposity and CD as biologically plausible. 25,30,31 Firstly, adipocyte-derived mediators such as leptin, TNF-α, and IL-6 are known to be prominent proinflammatory mediators. 32 Secondly, serosal creeping fat or fat wrapping is a well-established marker of CD activity and is strongly associated with muscular hypertrophy, fibrosis, and stricturing disease.…”

Section: Discussionmentioning

confidence: 99%

Body mass index and risk of inflammatory bowel disease: A systematic review and dose‐response meta‐analysis of cohort studies of over a million participants

et al. 2019

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Summary The relationship between body mass index (BMI) and risk of inflammatory bowel disease (IBD) is controversial. We performed a dose‐response meta‐analysis to investigate the association between BMI and risk of incident ulcerative colitis (UC) and Crohn's disease (CD) using prospective cohort studies. A systematic search was conducted in MEDLINE/PubMed, SCOPUS, Cochrane, and Web of Science databases from inception to January 2019. DerSimonian and Laird random‐effects model was used to estimate combined hazard ratios (HRs). Overall, 882 articles were screened, and 42 full‐text articles were reviewed for inclusion using the study eligibility criteria. Five studies evaluated the association between BMI and IBD with 1 044 517 participants. Pooled results showed a significant association between participants affected by obesity and risk of CD (HR: 1.42, 95% CI: 1.18‐1.71, I2: 0.00). There was a significant nonlinear association between BMI and risk of CD (P = .01, coeff = 0.5024). Pooled results did not show any significant association between being underweight and risk of UC (HR: 1.07, 95% CI: 0.96‐1.19, I2: 0.00) or CD (HR: 1.11, 95% CI: 0.93‐1.31, I2: 12.8). There was no difference in the risk for UC among participants affected by obesity compared with participants categorized as having normal BMI (HR: 0.96, 95% CI: 0.80‐1.14, I2: 8.0). This systematic review and meta‐analysis identified significant dose‐response relationship between being affected by obesity, as a risk factor, and incidence of CD.

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“…Zhang et al reported the relationships between decreased skeletal muscle volume and postoperative complications [11]. Furthermore, Holt et al reported that visceral adiposity but not low skeletal muscle predicted endoscopic recurrence after surgery in CD [12]. However, the relationship between reductions in skeletal muscle volume and prognoses of IBD patients has yet to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

Sarcopenia is a predictive factor for intestinal resection in admitted patients with Crohn’s disease

et al. 2017

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The relationship between skeletal muscle volume and the prognosis of patients with inflammatory bowel disease (IBD) remains undetermined. We conducted a retrospective study of 72 IBD patients who were admitted to the hospital due to disease exacerbation. We enrolled IBD patients who had undergone abdominal computed tomography and assessed the nutritional indices, such as the Onodera’s prognostic nutritional index (O-PNI) and the controlling nutritional status (CONUT) index. The L3 skeletal muscle index (SMI), which is the ratio of the cross-sectional area of skeletal muscles at the level of the third lumbar (L3) vertebra to the height squared, was used to identify sarcopenia. Sarcopenia, defined as a low SMI, was observed in 42% of all IBD patients (37% with Crohn’s disease (CD) and 48% with ulcerative colitis (UC)). In UC patients, the O-PNI and CONUT values, height, and albumin levels were significantly lower than in CD patients. The SMI strongly correlated with sex, body weight, albumin level, and O-PNI in IBD patients. Multivariate analysis using the Cox regression model demonstrated that the presence of sarcopenia (P = 0.015) and disease type (CD or UC) (P = 0.007) were significant factors predicting intestinal resection. The cumulative operation-free survival rate was significantly lower for sarcopenic patients than in all IBD patients (P = 0.003) and a stratified analysis of CD patients (P = 0.001) using the Kaplan–Meier method and log-rank test. The L3 skeletal muscle area is a prognostic factor for intestinal resection in patients with CD.

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Visceral adiposity predicts post‐operative Crohn's disease recurrence

Abstract: Visceral adiposity is an independent risk factor for endoscopic recurrence of Crohn's disease after surgery. Sarcopenia correlates with inflammatory biomarkers. Measures of visceral adipose tissue may help to stratify risk in post-operative management strategies.

Cited by 93 publications

References 64 publications

Risk of de‐novo inflammatory bowel disease among obese patients treated with bariatric surgery or weight loss medications

Risk of de‐novo inflammatory bowel disease among obese patients treated with bariatric surgery or weight loss medications

Body mass index and risk of inflammatory bowel disease: A systematic review and dose‐response meta‐analysis of cohort studies of over a million participants

Sarcopenia is a predictive factor for intestinal resection in admitted patients with Crohn’s disease

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