Visceral adiposity predicts post‐operative Crohn's disease recurrence

Mar 1, 2017Alimentary pharmacology & therapeutics

Abdominal fat predicts Crohn's disease returning after surgery

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Abstract

Visceral adipose tissue/height greater than 1.5 times the gender-specific mean is associated with 100% endoscopic recurrence at 18 months in post-operative Crohn's disease patients.

Subjects with excessive visceral fat experienced a significantly higher rate of endoscopic recurrence compared to those without this level of fat.
Waist circumference showed a strong correlation with visceral adipose tissue area, indicating a potential measure for assessing visceral fat.
Low skeletal muscle mass was found in 41% of patients but did not predict endoscopic recurrence.
Inversely, lower appendicular skeletal muscle indices correlated with higher levels of faecal calprotectin, suggesting an association with inflammation.

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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/height>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). 2

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.

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Visceral adiposity predicts post‐operative Crohn's disease recurrence

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