P635 Assessment of sarcopenia and nutritional status in a cohort of patients with Crohn’s disease

Abstract Background Altered body composition may negatively impact on the clinical outcome and quality of life of patients with IBD. Sarcopenia, defined as a progressive loss of skeletal muscle mass and function, is commonly observed in patients with IBD and can be reliably assessed by computed tomography (CT) which allows accurate and reproducibile quantification of both abdominal adipose tissues (subcutaneous and visceral), as well as skeletal muscles. We aimed to assess the prevalence of sarcopenia in Crohn’s disease (CD) patients undergoing contrast-enhanced CT(CECT). We further investigated the associations of sarcopenia with visceral fat parameters, disease severity and surgery Methods 40 CD patients (22F, aged 44±16 yrs; BMI 20.8±3.7) who underwent CECT for clinical assessment were retrospectively enrolled. CECT was performed using a 64-rows multi-detector equipment after i.v. injection of non ionic iodinated contrast media with a tailored scan delay. Demographic and clinical data were collected at the date of abdominal CT. Clinical outcome included the rate of surgery within one year. The skeletal muscle index (SMI) at the level of third lumbar vertebra was used to assess sarcopenia defined as a SMI<38.5cm2/m2 in women and <42cm2/m2 in men (Fig1).Clinical malnutrition was defined by a BMI<18.5 kg/m2, while visceral obesity as a visceral fat area ≥130cm2 Results Mean duration of disease was 117 months ± 84. Most patients 60% had a moderate-severe clinical activity based on Harvey Bradshaw index (HBI) >8, whereas 35% had a mild activity (HBI 5–7) and 5% were in remission (HBI<5). Overall, 17(42.5%) patients were sarcopenic. In detail, 14 out of 22 (63.6%) females and only 3 out of 18 (16.6%) males (p=0.04). The majority (65%) had moderate activity of inflammation with a mean of HBI 9.2 ± 1.6. Malnutrition occurred in 41,2% sarcopenic patients with a mean BMI of 16.5±3.75. A significant correlation was observed between BMI and sarcopenia (r=0.4,p<0.001). A total of 25 (62.5%) patients underwent surgery within one year. Among them, 40% patients were sarcopenic, while 60% non sarcopenic (p=0.7). In the total population the mean of visceral fat was 48,03±58.04 and only 4 patients had a visceral fat area ≥104 cm2. The ratio between visceral fat and subcutaneous fat area (VFA/SFA) was 0,57±0.5. The correlation between SMI and visceral fat was significant (r=0.4,p=0.02),while it was not significant with VFA/SFA (p=0.7). For all IBD patients, univariate analysis revealed that female sex (p=0.002) and low BMI (p=0.003) were significantly associated with sarcopenia Conclusion Approximately 42.5%CD patients were sarcopenic. Female sex and low BMI were significantly associated with sarcopenia but this latter did not correlate with the clinical outcome

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Tu1632 High Visceral Fat Area Is Association With Postoperative Complications in Patients With Crohn's Disease Following Primary Surgery

Gastroenterology ◽

10.1016/s0016-5085(14)63985-8 ◽

2014 ◽

Vol 146 (5) ◽

pp. S-1093

Author(s):

Zhao Ding ◽

Lei Lian ◽

Luca Stocchi ◽

Erick M. Remer ◽

Arthur J. McCullough ◽

...

Keyword(s):

Crohn’S Disease ◽

Postoperative Complications ◽

Crohn's Disease ◽

Visceral Fat ◽

Visceral Fat Area ◽

Primary Surgery

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Association between high visceral fat area and postoperative complications in patients with Crohn's disease following primary surgery

Colorectal Disease ◽

10.1111/codi.13128 ◽

2016 ◽

Vol 18 (2) ◽

pp. 163-172 ◽

Cited By ~ 33

Author(s):

Z. Ding ◽

X.-R. Wu ◽

E. M. Remer ◽

L. Lian ◽

L. Stocchi ◽

...

Keyword(s):

Crohn’S Disease ◽

Postoperative Complications ◽

Crohn's Disease ◽

Visceral Fat ◽

Visceral Fat Area ◽

Primary Surgery

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Visceral fat area is associated with a high risk for early postoperative recurrence in Crohn's disease

Colorectal Disease ◽

10.1111/codi.12798 ◽

2015 ◽

Vol 17 (3) ◽

pp. 225-234 ◽

Cited By ~ 46

Author(s):

Y. Li ◽

W. Zhu ◽

J. Gong ◽

W. Zhang ◽

L. Gu ◽

...

Keyword(s):

Crohn’S Disease ◽

High Risk ◽

Crohn's Disease ◽

Visceral Fat ◽

Postoperative Recurrence ◽

Visceral Fat Area

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Lower skeletal muscle attenuation and high visceral fat index are associated with complicated disease in patients with Crohn's disease: An exploratory study

Clinical Nutrition ESPEN ◽

10.1016/j.clnesp.2017.04.005 ◽

2017 ◽

Vol 21 ◽

pp. 79-85 ◽

Cited By ~ 3

Author(s):

Marília L. Cravo ◽

Sónia Velho ◽

Joana Torres ◽

Maria Pia Costa Santos ◽

Carolina Palmela ◽

...

Keyword(s):

Skeletal Muscle ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Visceral Fat ◽

Exploratory Study ◽

Muscle Attenuation

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DOP88 Visceral fat area correlates well with anti-TNFα drug levels and secondary loss of response in Crohn’s disease patients

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.127 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S126-S127

Author(s):

Z Lim ◽

C Welman ◽

W Raymond ◽

L Thin

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Body Mass ◽

Visceral Fat ◽

Trough Level ◽

Secondary Outcome ◽

Visceral Fat Area ◽

Secondary Loss ◽

Loss Of Response ◽

Trough Levels

Abstract Background A high body mass index (BMI) is known to adversely affect anti-TNFα trough levels and secondary loss of response (SLOR); however, the literature is scarce in defining what aspect of body mass determine these outcomes. We hypothesise that a large visceral fat area is associated with a lower anti-TNFα level and a higher rate of SLOR. Our aim was to determine the impact of fat and muscle compartment areas on these outcomes. Methods Crohn’s disease (CD) patients who were prescribed standard doses of an anti-TNFα agent [5 mg/kg, 8 weekly infliximab (IFX) or 40 mg EOW of adalimumab (ADA)] from 1 February 2015 to 30 June 2018 were examined retrospectively. Primary responders with a minimum therapy duration of 12 weeks, at least 12 months of follow-up and a trough level within 6 months of a CT or MRI, were eligible for inclusion. The primary outcome was the trough level and the secondary outcome was time to SLOR, defined as a need to dose escalate, change out of class, requiring ≥3 courses of corticosteroids in a 12-month period, or surgery. Patients were followed until they met a SLOR or the census date of 30 June 2019. Visceral fat area (VFA), subcutaneous fat area (SFA) and skeletal muscle area (SMA) were measured on the CT/MRI at the L3 vertebral level in cm2 by a radiologist blinded to the clinical outcome and corrected for patient height (cm2/m2). Results Of 813 patients prescribed an anti-TNFα agent in the study period, data from 69 eligible CD patients were included for analysis. The median age was 43.5 ± 16.2 years, and 42 (60.9%) were males. Forty-four (63.8%) and 25 (36.2%) patients were treated with IFX and ADA respectively. The mean BMI was 26.9 ± 5.2. Univariate analysis of infliximab trough levels found that total fat area, VFA, visceral fat index [VFI (VFA/height in m2)] and VFA/SMA ratio were inversely correlated with anti-TNFα trough level (p < 0.05). No association was found between ADA trough level and muscle/fat areas. After multivariate adjustment for CRP, albumin, presence of antibodies, concurrent immunomodulator use and gender, IFX levels were inversely associated with VFA [-0.021 (−0.038, −0.003) p = 0.025], VFI [−0.066 (−0.119, −0.013) p = 0.016] and VFA/SMA [−3.805 (−7.132, −0.477) p = 0.026] but not BMI [−0.232 (−0.520, 0.055) p = 0.11). No association was found for ADA trough levels. Kaplan–Meir analyses showed a trend towards a shorter time to SLOR with an increasing tertile of VFI in both IFX and ADA treated patients. Conclusion Visceral fat area corrected for height (VFI) is a better determinant of anti-TNFα trough levels and SLOR than BMI.

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High serum concentrations of growth differentiation factor-15 in male Crohn’s disease patients with low skeletal muscle index

10.21203/rs.3.rs-904046/v1 ◽

2021 ◽

Author(s):

Hiroyuki Yamamoto ◽

Fuminao Takeshima ◽

Masafumi Haraguchi ◽

Kayoko Matsushima ◽

Moto Kitayama ◽

...

Keyword(s):

Skeletal Muscle ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Handgrip Strength ◽

Intestinal Resection ◽

Bioelectrical Impedance ◽

Japanese Patients ◽

High Serum ◽

Skeletal Muscle Index ◽

Significant Difference

Abstract Sarcopenia is defined as low skeletal muscle index (SMI) in addition to low muscle strength (MS) or low physical function, and many biomarkers have been reported. In Crohn's disease (CD), low SMI is associated with predictors and complications of intestinal resection. Therefore, in many reports of CD, sarcopenia was defined only by SMI. However, there have been no reports of MS in Japan. Our study aimed to investigate the frequency of sarcopenia by assessing both SMI and MS in Japanese patients with CD and biomarkers predicting low SMI. We evaluated SMI using bioelectrical impedance analysis, handgrip strength, and blood tests, including CRP, ALB, IL-6, TNFα, GDF-8, and GDF-15 as biomarker candidates for 78 CD patients in our hospital. Sarcopenia and low SMI were 8% and 42.3%, respectively. Each candidate biomarker and SMI were negatively correlated with GDF-15 (Pearson's r=-0.414, P = 0.0031) in males and positively correlated with ALB (r = 0.377, P = 0.048), and negatively correlated with IL-6 (r=-0.484, P = 0.012) in females. Multivariate analysis adjusted for these items, age, and BMI showed a significant difference in male GDF-15 (P = 0.011, OR: 7.86, 95% CI: 1.09–56.58). Therefore, GDF-15 in male patients is considered a biomarker of low SMI.

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