Inflammatory bowel diseasesJun 12, 2023

Abdominal Fat Predicts Flare-Up Timing in Inflammatory Bowel Disease Better Than Body Mass Index

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Apr 1, 2026

Abstract

Higher visceral adiposity is associated with a 4.8 times greater risk of shorter time to inflammatory bowel disease flare.

Visceral adipose tissue to subcutaneous adipose tissue ratio (VAT:SAT) was the primary measure of adiposity in the study.
Among 200 patients with Crohn's disease and ulcerative colitis, 23% experienced a flare within a median time of 90 days.
A VAT:SAT ratio of 1.0 or higher was linked to significantly shorter time to flare compared to a lower ratio.
Body mass index (BMI) was not associated with time to flare, indicating that traditional obesity measures may not be as predictive.
The association between higher VAT:SAT and shorter time to flare was notably stronger for Crohn's disease patients.

Simplified

BACKGROUND: Obesity is associated with progression of inflammatory bowel disease (IBD). Visceral adiposity may be a more meaningful measure of obesity compared with traditional measures such as body mass index (BMI). This study compared visceral adiposity vs BMI as predictors of time to IBD flare among patients with Crohn's disease and ulcerative colitis.

METHODS: This was a retrospective cohort study. IBD patients were included if they had a colonoscopy and computed tomography (CT) scan within a 30-day window of an IBD flare. They were followed for 6 months or until their next flare. The primary exposure was the ratio of visceral adipose tissue to subcutaneous adipose tissue (VAT:SAT) obtained from CT imaging. BMI was calculated at the time of index CT scan.

RESULTS: A total of 100 Crohn's disease and 100 ulcerative colitis patients were included. The median age was 43 (interquartile range, 31-58) years, 39% had disease duration of 10 years or more, and 14% had severe disease activity on endoscopic examination. Overall, 23% of the cohort flared with median time to flare 90 (interquartile range, 67-117) days. Higher VAT:SAT was associated with shorter time to IBD flare (hazard ratio of 4.8 for VAT:SAT ≥1.0 vs VAT:SAT ratio <1.0), whereas higher BMI was not associated with shorter time to flare (hazard ratio of 0.73 for BMI ≥25 kg/m2 vs BMI <25 kg/m2). The relationship between increased VAT:SAT and shorter time to flare appeared stronger for Crohn's than for ulcerative colitis.

CONCLUSIONS: Visceral adiposity was associated with decreased time to IBD flare, but BMI was not. Future studies could test whether interventions that decrease visceral adiposity will improve IBD disease activity.

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Abdominal Fat Predicts Flare-Up Timing in Inflammatory Bowel Disease Better Than Body Mass Index

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