Visceral adiposity predicts post‐operative Crohn's disease recurrence

• Published in: Alimentary pharmacology & therapeutics Vol. 45; no. 9; pp. 1255 - 1264
• Main Authors: Holt, D. Q., Moore, G. T., Strauss, B. J. G., Hamilton, A. L., De Cruz, P., Kamm, M. A.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.05.2017
• Subjects: Adipose tissue; Adiposity; Adult; Biomarkers - metabolism; Body composition; Colonoscopy; Crohn Disease - metabolism; Crohn Disease - surgery; Crohn's disease; Endoscopy; Feces - chemistry; Female; Humans; Inflammatory bowel diseases; Intestine; Intra-Abdominal Fat - metabolism; Leukocyte L1 Antigen Complex - metabolism; Male; Middle Aged; Musculoskeletal system; Postoperative Period; Recurrence; Risk Factors; Sarcopenia; Skeletal muscle; Surgery; Young Adult
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.14018

Summary Background Excessive visceral adipose tissue has been associated with poorer outcomes in patients with inflammatory bowel disease. Aim To determine whether body composition is associated with outcome in a prospective study of post‐operative Crohn's disease patients. Methods The POCER study evaluated management strategies for prevention of post‐operative Crohn's disease recurrence; subjects were enrolled after resection of all macroscopic Crohn's disease and were randomised to early endoscopy and possible treatment escalation, or standard care. The primary endpoint was endoscopic recurrence at 18 months. 44 subjects with cross‐sectional abdominal imaging were studied, and body composition analysis performed using established techniques to measure visceral adipose tissue area, subcutaneous adipose tissue area, and skeletal muscle area. Results The body composition parameter with the greatest variance was visceral adipose tissue. Regardless of treatment, all subjects with visceral adipose tissue/height2 >1.5 times the gender‐specific mean experienced endoscopic recurrence at 18 months (compared to 47%) [relative risk 2.1, 95% CI 1.5–3.0, P = 0.012]. Waist circumference correlated strongly with visceral adipose tissue area (ρ = 0.840, P < 0.001). Low skeletal muscle was prevalent (41% of patients), but did not predict endoscopic recurrence; however, appendicular skeletal muscle indices correlated inversely with faecal calprotectin (ρ = 0.560, P = 0.046). Conclusions 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. Linked ContentThis article is linked to Holt et al, and Stidham and Waljee papers. To view these articles visit https://doi.org/10.1111/apt.14102 and https://doi.org/10.1111/apt.14069.