Body composition and Crohn's disease behavior: Is adiposity the main game changer?

Sónia Velho; Bárbara Morão; Catarina Gouveia; Lisa Agostinho; Joana Torres; Rui Maio; Vickie E Baracos; Marília Cravo

doi:10.1016/j.nut.2022.111959

Body composition and Crohn's disease behavior: Is adiposity the main game changer?

Nutrition. 2023 Apr:108:111959. doi: 10.1016/j.nut.2022.111959. Epub 2022 Dec 31.

Authors

Sónia Velho¹, Bárbara Morão², Catarina Gouveia², Lisa Agostinho³, Joana Torres², Rui Maio⁴, Vickie E Baracos⁵, Marília Cravo⁶

Affiliations

¹ Dietetics and Nutrition Department, Hospital Beatriz Ângelo, Loures, Portugal. Electronic address: soniavelho0@gmail.com.
² Gastroenterology Department, Hospital Beatriz Ângelo, Loures, Portugal.
³ Radiology Department, Hospital Beatriz Ângelo, Loures, Portugal.
⁴ Surgery Department, Hospital da Luz Lisboa, Lisbon, Portugal.
⁵ Oncology Department, University of Alberta, Edmonton, Alberta, Canada.
⁶ Gastroenterology Department, Hospital da Luz Lisboa, Lisbon, Portugal.

PMID: 36709640
DOI: 10.1016/j.nut.2022.111959

Abstract

Objective: We investigated the association between body composition upon diagnosis and complicated phenotypes and time until surgery in patients with Crohn's disease (CD).

Methods: We conducted a retrospective cohort study including patients with CD who had a computed tomography enterography or a magnetic resonance enterography performed ≤6 mo of diagnosis. Skeletal muscle and visceral and subcutaneous adipose tissue cross-sectional areas were determined with computed tomography or magnetic resonance images at the third lumbar vertebral level, processed with the sliceOmatic (TomoVison, Magog, QC, Canada) and ABACS plugin.

Results: We included 63 patients: 33 (52%) men, median age 35 y. Disease location (L) and behavior (B) according to the Montreal classification were L1 (ileal disease) = 28 (44%), L2 (colonic disease) = 13 (21%), L3(ileocolonic disease) = 18 (28%), L1 + L4 (ileal and isolated upper disease) = 1 (2%), L3 + L4 (ileocolonic and isolated upper disease) = 3 (5%), B1 (non-stricturing) = 39 (62%), B2 (stricturing) = 11 (17%), and B3 (penetrating)= 13 (21%); 20 (32%) patients had perianal disease. Visceral obesity was present in 12 (19%) patients and was associated with higher age of CD onset (median 60 versus 34 y; P = 0.002) and complicated disease behavior (B2 and B3) (66.7% versus 31.7%; P = 0.021). After adjusting for age and perianal disease, total adipose tissue was associated with a 4% increase in the odds of complicated behavior per 10 cm² of total adipose tissue (odds ratio [OR] = 1.004; 95% confidence interval [CI], 1.00-1.008; P = 0.043). Median follow-up time was 3.35 y, during which 15 (24%) of patients underwent abdominal surgery. Visceral obesity was associated with 5.10-times higher risk of abdominal surgery (95% CI, 1.52-17.09; P = 0.008); after adjusting for disease behavior, visceral obesity maintained a near-significant association with a 2.90-times higher risk of surgery (95% CI, 0.83-10.08; P = 0.09).

Conclusion: Total fat was associated with complicated disease phenotype and visceral obesity, with higher risk of abdominal surgery and shorter time until surgery.

Keywords: Abdominal surgery; Body composition; Crohn disease behavior; Total fat; Visceral obesity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adiposity
Crohn Disease* / complications
Humans
Obesity, Abdominal / complications
Retrospective Studies
Tomography, X-Ray Computed