- Fecal Incontinence
|Visceral Adipose Tissue Is Associated With Stricturing Crohn's Disease Behavior, Fecal Calprotectin, and Quality of Life
Bryant RV1,2, Schultz CG3, Ooi S4, Goess C4, Costello SP1,2, Vincent AD5, Schoeman S1, Lim A1, Bartholomeusz FD3, Travis SPL6, Andrews JM2,4. Inflamm Bowel Dis. 2018 Sep 12. doi: 10.1093/ibd/izy278. [Epub ahead of print]
1 IBD Service, Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Woodville South, South Australia.
2 School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia.
3 Department of Nuclear Medicine, PET and Bone Densitometry, Royal Adelaide Hospital, Adelaide, South Australia.
4 IBD Service, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia.
5 Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, Adelaide, South Australia.
6 Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, Oxfordshire, UK.
BACKGROUND: Visceral adipose tissue (VAT) has been proposed to play a pathogenic role in Crohn's disease (CD); however, prospective clinical data are lacking. The aim was to evaluate whether VAT, beyond body mass index (BMI), is associated with CD behavior, disease activity, quality of life (QoL), or outcomes.
METHODS: Body composition data and clinical, anthropometric, disease activity (fecal calprotectin [FC]), and QoL scores were gathered prospectively on adults with CD at 0, 12, and 24 months. BMI and, VAT metrics (visceral adipose tissue volume [cm3]/height [m2] index and VAT:subcutaneous adipose tissue [SAT] ratio) were calculated. Inflammatory bowel disease-related surgery and hospitalization were recorded over extended follow-up (median, 51 months). Multivariable linear mixed effects and logistic regression analyses were performed.
RESULTS: Ninety-seven participants were assessed at baseline (55% male; median age, 31 years), 84 at 12 months, and 72 at 24 months. VAT:SAT was positively associated with stricturing disease behavior (log odds ratio [OR], 1.7; 95% confidence interval [CI], 0.32 to 3; P = 0.01) and elevated FC in patients with ileocolonic disease (β, 1.3; 95% CI, 0.32 to 2.3; P = 0.01). VAT:SAT was associated with lower QoL, particularly in those with ileal disease (β, -12; 95% CI, -19 to -4.5; P = 0.05). However, no prospective associations were observed between serial VAT measurements and time to surgery or hospitalization. No correlations were found between BMI and disease behavior, activity, or QoL.
CONCLUSIONS: VAT:SAT, rather than BMI, is associated with stricturing CD behavior, elevated FC, and reduced QoL in a diseasedistribution-dependent manner. Further studies are required to substantiate the role of VAT as a useful biomarker in CD.